Inguinal hernia repair is one of the most performed surgical procedures worldwide. The introduction of prosthetic mesh has significantly reduced recurrence rates and transformed the management of groin hernias. Among the various tension-free techniques developed, the mesh plug repair, popularized by Rutkow and Robbins in the 1990s, emerged as a simple and effective method that combines a conical polypropylene mesh plug inserted into the hernia defect with supplementary mesh reinforcement when necessary. The procedure gained widespread acceptance because of its technical simplicity, short operative time, low recurrence rates, and suitability for ambulatory surgery. However, concerns regarding mesh-related complications, including migration, chronic pain, erosion into adjacent organs, and foreign body sensation, have led to increasing scrutiny of the technique. Recent international hernia guidelines have increasingly favored flat mesh repairs and laparo-endoscopic approaches over mesh plugs. This review discusses the mesh plug repair, its clinical outcomes, advantages, limitations, complications, and contemporary role of mesh plug repair in inguinal hernia surgery. We also compare the mesh plug repair with the other open mesh inguinal hernia repairs and the laparoscopic inguinal hernia repairs.

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.

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.

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.