Triple therapy comprising an inhaled corticosteroid (ICS), a long-acting β₂-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) has become an important treatment option for chronic obstructive pulmonary disease (COPD). Major randomized controlled trials have demonstrated reductions in exacerbations, improvements in lung function, and better health-related quality of life in selected patients. However, uncertainty remains regarding whether triple therapy should be prescribed universally as first-line treatment for symptomatic COPD or reserved for patients most likely to benefit from ICS. This narrative review evaluates contemporary GOLD recommendations, major clinical trials, blood eosinophils as a treatment-response biomarker, mortality outcomes, and ICS-associated pneumonia risk. Evidence from IMPACT, ETHOS, TRIBUTE, FULFIL, TRILOGY, and other studies supports triple therapy in appropriately selected patients with established COPD, particularly those with previous exacerbations. However, most pivotal trials enrolled patients receiving maintenance inhalers, limiting direct extrapolation to treatment-naïve patients. Blood eosinophil counts, exacerbation history, concomitant asthma, and infection susceptibility should guide treatment selection. Indian publications additionally highlight challenges involving COPD awareness, diagnostic practices, inhaler access, and rational prescribing. LABA/LAMA remains the preferred initial treatment for most symptomatic patients without a compelling indication for ICS, whereas initial triple therapy may be considered in selected high-risk patients, particularly those with blood eosinophils ≥300 cells/µL. A phenotype-directed approach offers the most rational balance between exacerbation prevention, symptom control, and treatment-related harm.

Post-COVID-19 condition, commonly called Long COVID, has shifted the clinical question from whether a patient survived the acute infection to whether normal health and function have returned. For some, recovery is straightforward; for others, symptoms persist, fluctuate or appear after an interval, affecting several organ systems at once. This narrative review examines rheumatological, hematological and vascular, immunological and infectious, neuropsychiatric, and cardiovascular sequelae, including sudden cardiac death (SCD). Proposed mechanisms include immune dysregulation, persistent antigenic stimulation in subsets of patients, endothelial injury, altered coagulation, autonomic dysfunction, neuroinflammation, residual tissue damage and the consequences of critical illness. These mechanisms are neither mutually exclusive nor universal. The practical challenge is to recognize meaningful patterns without assuming that every symptom is caused by COVID-19. Joint pain does not automatically indicate autoimmune disease; an elevated D-dimer does not diagnose thrombosis; urticaria does not establish generalized immune deficiency; and “brain fog” should prompt a thoughtful assessment rather than dismissal or premature attribution. Observational evidence suggests increased risks of selected cardiovascular outcomes after infection, but SCD is a separate endpoint and must be evaluated with specific evidence. A phenotype-led approach—targeted investigation, attention to alternative diagnoses, clear communication and individualized rehabilitation—offers the most defensible current strategy. Indian clinical publications add useful regional context, particularly for inflammatory markers, radiological outcomes, tuberculosis and post-COVID symptoms, but should be interpreted according to study design and limitations.

Inguinal hernia repair is among the most frequently performed general surgical procedures worldwide. The introduction of laparoscopic techniques has significantly transformed the management of adult inguinal hernias, with transabdominal preperitoneal (TAPP) repair emerging as a widely accepted minimally invasive approach. TAPP repair provides excellent visualization of the myopectineal orifice, facilitates identification of occult hernias, and allows bilateral repairs through the same access ports. TAPP repair has demonstrated outcomes comparable to open mesh repair regarding recurrence while offering advantages in postoperative pain, return to normal activities, and cosmetic results. However, the procedure requires advanced laparoscopic expertise and carries a small risk of visceral and vascular complications associated with entry into the peritoneal cavity. This review summarizes the TAPP procedure and compares it with the TEP repair and open inguinal hernia repairs like the Lichtenstein and Shouldice repairs.

Objectives: 1. This study aims to understand whether dexamethasone is an effective drug for the prevention of postoperative shivering in patients undergoing general anesthesia. 2. The research will aid in minimizing the occurrence of shivering by providing appropriate treatment. Settings: The study was carried out in the operating theater and post-anesthesia care units (PACU) of SIUT, specifically EDHI OT and old OT and their respective PACUs. Method: This study has a randomized controlled trial design; participants were randomly assigned to either the control group or the experimental group. A total of 60 patients were assigned in this study, with 30 in each group. • Group dexamethasone (D): Receiving the drug (0.15mg/kg). • Group placebo (P): Receiving placebo. Result: The result reveals that the incidence and severity of postoperative shivering differ significantly between the dexamethasone and the placebo (p-value<0.05). Conclusion: The administration of dexamethasone could be a practical intervention to reduce postoperative shivering in patients undergoing general anesthesia.

Inguinal hernia repair remains one of the most frequently performed operations worldwide. Although mesh-based techniques currently represent the standard of care in most adult patients, tissue-based repairs continue to play an important role in selected clinical situations, including contaminated surgical fields, resource-limited settings, and patient preference. Among the classical tissue repairs, Bassini repair and darning repair have maintained clinical relevance. Edoardo Bassini revolutionized hernia surgery in the late nineteenth century by introducing anatomical reconstruction of the posterior wall of the inguinal canal, significantly reducing recurrence rates compared with previous techniques. Darning repair, particularly the Moloney darn, was later developed as a tension-reducing tissue repair that employs nonabsorbable sutures to create a mesh-like support between the conjoint tendon and inguinal ligament. This review examines the indications, outcomes, advantages, disadvantages, and contemporary role of Bassini and darning repairs in adults with inguinal hernia. Current evidence suggests that while both techniques are effective in selected patients, darning repair generally demonstrates lower postoperative pain and tension, whereas Bassini repair provides a solid anatomical reconstruction but may be associated with higher recurrence rates when excessive tension is present. Despite the predominance of mesh repairs, both methods remain valuable components of the hernia surgeon's armamentarium.

Background: Asthma is a common chronic respiratory disease characterized by variable respiratory symptoms and airflow limitation. Despite the availability of effective therapies, a substantial proportion of patients continue to have uncontrolled asthma. Identification of clinical and treatment-related factors associated with poor control is important for improving patient outcomes. Objective: To study the clinical profile and factors associated with uncontrolled asthma among adult patients attending the Medicine Clinic of a tertiary care hospital. Methods: A hospital-based observational study was conducted among 30 adult patients with clinically diagnosed asthma attending the Medicine Clinic. Sociodemographic and clinical details, including age, sex, duration of asthma, smoking or passive smoke exposure, previous exacerbations, comorbidities, medication adherence and inhaler technique, were recorded using a structured proforma. Asthma control was assessed using the Asthma Control Test (ACT). Patients were categorized as having controlled or uncontrolled asthma according to their ACT score. The association between selected clinical and treatment-related factors and asthma control was assessed using appropriate statistical tests. Results: Among the 30 participants, 17 (56.7%) were females and 13 (43.3%) were males. The largest proportion belonged to the 31–45-year age group (33.3%). Overall, 18 (60.0%) patients had controlled asthma, while 12 (40.0%) had uncontrolled asthma. Previous exacerbation was significantly associated with uncontrolled asthma (p=0.017). Longer duration of asthma (>10 years) was also significantly associated with poor control (p=0.018). Incorrect inhaler technique was significantly more frequent among patients with uncontrolled asthma (p=0.026). Similarly, poor medication adherence showed a significant association with uncontrolled asthma (p=0.018). Smoking exposure and comorbidities showed higher proportions among patients with uncontrolled asthma but did not demonstrate statistically significant associations. Conclusion: Uncontrolled asthma was common among adults attending the Medicine Clinic. Previous exacerbations, longer disease duration, incorrect inhaler technique and poor medication adherence were important factors associated with poor asthma control. Routine assessment of asthma control, inhaler technique and medication adherence may help improve asthma management.

Introduction: Fatigue is a common problem faced by health care professionals all over the world due to long working hours, but it is more prevalent among anesthesiologists, especially among trainees, adversely affecting the quality of health care and resulting in more complications in patients; it also hurts the mental and social health of trainee anesthesiologists. Materials and Methods: A Cross-sectional study was carried out in hospitals in Sindh that offer FCPS (Fellow of College of Physicians and Surgeons) and MCPS (Member of College of Physicians and Surgeons) training in anesthesia. Results: A total of 98 anesthesiologists were enrolled in this study. Out of which, 59(60.2%) were females. The median (IQR) age was 28(27-30). 56(57.1%) were getting trained in private institutes. The majority of them were in the first year and third year of residency, 29(29.6%) and 24(24.5%), respectively. No association was found between age, gender, institute of training, and year of residency and fatigue status [p=0.456, p=0.116, p=0.506, p=0.505]. While as expected fatigue participants reported more subjective feeling of fatigue, less concentration, less motivation, and less physical activity in comparison to non-fatigue participants (40.1±8 vs 24.6±8; p=0.000, 22.5±4 vs 14.2±5; p=0.000, 17.3±5 vs 9.3±4; p=0.000, 13.7±4 vs 8.2±4; p=0.000respectively). Conclusion: The majority of anesthesia trainees turned out to be fatigued in training institutes of Sindh, resulting in less concentration, less motivation, and less physical activity; hence, we believe that trainees must be provided with better resting facilities during on-call hours to improve the quality of health care in our institutes.