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Objective: To investigate the role and relationship of serum Vitamin B12 and Glutathione peroxidase in pregnancy with gestational diabetes mellitus (GDM). Study Design: Comparative cross-sectional study. Place and Duration of Study: Physiology Department, University of Health Sciences, Lahore Pakistan, from Feb 2019 to Mar 2020. Methodology: Ninty pregnant women were recruited, fulfilling the inclusion and exclusion criteria. Women with GDM were the cases, and those without GDM were the controls. Serum Vitamin B12 and Glutathione peroxidase were measured by ELISA. Results: Serum Vitamin B12 was significantly lower in cases compared to controls (158.98±7.38 and 357.48±42.07mg/dL, respectively, at p

Objective: To determine the seroprevalence of SARS-CoV2 antibodies in patients and healthy individuals presenting to a tertiary care hospital in Lahore. Study Design: Cross-sectional study Place and Duration of Study: Pathology Department of Surayya Azeem Hospital, Lahore Pakistan, from May to Jul 2020. Methodology: The study included clinically suspected patients of COVID-19 referred by clinicians and healthy individuals presenting to the hospital for the SARS-CoV-2 antibody test, irrespective of age and gender. Results: The SARS-CoV-2 antibody positivity was 704(59.4%) in our study. Out of 1184 individuals tested, 690 patients had a positive clinical history of COVID-19 infection, and 517(74.9%) were positive for COVID-19 antibodies. Out of 494 asymptomatic healthy individuals, positivity for COVID-19 antibodies was 187(37.8%). It was observed that positivity was significantly higher 169(44.0%) in contacts of COVID-19 infection patients compared to asymptomatic healthy individuals 18(16.3%). Conclusion: Our study shows that the seroprevalence of SARS-CoV-2 antibodies in the general public in Pakistan has greatly increased.

Objective: To evaluate serum levels of 25-hydroxyvitamin D (25-OHD) in patients with viral warts. Study Design: Comparative cross-sectional study. Place and Duration of Study: Dermatology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: One hundred patients were included in the study, 50 with viral warts (Group-1) and 50 without warts (Group2). Our study included both male and female patients of 10 to 60 years of age. Three categories were made according to their serum vitamin D levels. First, all participants were tested for serum vitamin D levels using ELISA. Results: In Group-1, 20(40%) had insufficient, and 25(50%) had deficient vitamin D levels. A statistically significant decrease in serum 25-OHD levels (p = 0.004) was found in patients with viral warts. In Group-2, 9(18%) had insufficient, and 2(4%) had deficient vitamin D levels. The mean serum vitamin D level was 22.61±10.11 in Group-1 and 45.12±24.60 in Group-2, resulting in a significant difference between patients with viral warts and those without viral warts regarding serum vitamin D levels (p=0.004). Conclusion: Patients with viral warts have deficient vitamin D levels.

Our case was a 30-year-old patient who had recently given birth via Caesarean Section two months before reporting to our hospital with pain abdomen as the chief complaint; her systemic examination, less abdominal tenderness and tachycardia, was unremarkable with only slightly raised TLC. The Diagnosis of Gossypiboma was made after a CT scan and laparotomy were done to remove the Gossypiboma with the surrounding fluid sent for culture and sensitivity test. She was kept post-operative on antibiotics and discharged after uneventful recovery.

Objective: To determine the relationship between superstitious beliefs and self-efficacy among participants and explore selfefficacy, age, education, gender and socioeconomic status as the significant predictors of superstitious beliefs among participants. Study Design: Cross-sectional study. Place and Duration of Study: Garrison University, Lahore Pakistan, from May to Nov 2020. Methodology: Total number of 200 study participants, age ranged of 18 to 50 years, were selected. The questionnaires; (1) a measure to superstitions scale and (2) general self-efficacy scale, were used to analyze the relationship between superstitious beliefs and self-efficacy with the role of ageing, education and socioeconomic status among participants. Result: Out of 200 male and female participants, study results reveal that superstitions belief and self-efficacy were correlated positively in a very small to moderate direction. Moreover, the study result showed that age (β=0.10), gender (β=0.05), socioeconomic status (β=0.91), and self-efficacy (β=0.24) were positively predicting superstitious beliefs while education (β=- 0.09) was negatively predicting the superstitious beliefs among participants. Conclusion: The results of the study showed the positive correlation between superstitious beliefs and self-efficacy among participants. Furthermore, the study concluded that participants' age, gender, socioeconomic status and self-efficacy were positive predictors of superstitious belief.

Objective: To evaluate satisfaction of outpatients with respect to administrative services and the level of satisfaction towards the various facilities available in an outpatient department of a tertiary care hospital. Study Design: Hospital based transverse situational analysis. Place and Duration of Study: Combined Military Hospital, Malir Cantt, from Nov 2018 to Dec 2019. Methodology: Data was collected from 756 participants, using an “Outpatient Feedback Form” to evaluate the satisfaction level of patients. Nonprobability, convenient sampling technique was used to select study participants. Data was analyzed in Statistical Package of Social Sciences, version 22. Result: The patient satisfaction was present in 388 (51%) followed by 235 (31%) participants graded the Outpatient department facilities (OPD) as excellent and good respectively. However, only 16 (3%) were disgruntled with the present OPD administrative and medical service of the hospital. Conclusion: Overall the study showed a good satisfaction level of patients with OPD services received from the hospital. Hospital administration has managed to deliver excellent quality services towards betterment in every discipline and created an example for other hospitals to become an effective part of the healthcare delivery system.

Objective: To determine medians of pregnancy-associated plasma protein-A (PAPP-A) and free β subunit of Human Chorionic Gonadotropin (hCG-β) in the first trimester of healthy pregnant women visiting tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) from May 2018 to May 2019. Methodology: Healthy pregnant women with a singleton pregnancy reported for an antenatal checkup in Obstetric OPD, Pak Emirates Military Hospital (PEMH) and Combined Military Hospital (CMH) Rawalpindi were included in the study. PAPP-A level was determined by enzyme-linked immunosorbent assay (ELISA) method using PR 4100 Microplate Reader®, and serum hCG-β were analysed on random access IMMULITE 2000®. Results: A total of 135 pregnant women were enrolled in the current study. The mean age of subjects was 27.66 ± 4.24 years, mean maternal weight was 59.91 ± 8.87 kgs and mean gestational age was 10.37 ± 1.16 weeks. Median value of PAPP-A was 1289.43 mIU/L (range: 510.8-5965.99) and hCGβ was 120985 mIU/ml (range: 23592-290000). Conclusion: Median values of PAPP-A and HCGβ can be used to calculate (Multiple of Medians) MoM during the first trimester in tertiary care setup.

Objective: To evaluate the level of anxiety and depression in children and adolescents with congenital heart disease in pre and post-surgical intervention period. Study Design: Quasi experimental study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: After written informed consent from parents and approval of hospital ethical committee 152 children and adolescents with congenital heart disease were included in the study. Demographic and clinical data was recorded on relevant proforma. In addition to clinical assessment the level of anxiety and depression were objectively measured with the help of Urdu version of Hospital Anxiety and Depression Scale by the mental health specialist a day before and 15 days after surgery. Results: The mean age of participants was 14.5 ± 3.3 years. Out of 152 participants, 80 (52.6%) were females, while 72 (47.4%) were males. Level of anxiety and depression was found higher in the preoperative period being 44 (28.9%) and 52 (34.2%) which dropped significantly in the postoperative period to 16 (10.5%) and 8 (5.3%) respectively. Majority of the patients had Tetralogy of Fallot i.e., 52 (34.2%) followed by Ventricular Septal Defect in 24 (15.7%) and Atrial Septal Defect in 18 (11.2%). Females were more likely to have depression than males (p-value=0.01). Conclusion: We found significant decrease in anxiety and depression in the postoperative period.

Objective: To determine the safety and efficacy of transcatheter closure of atrial septal defects and to evaluate the initial, midterm and long-term results of the treatment. Study Design: Cross sectional study. Place and Duration of Study: Department of Paediatric Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, from Jul 2017 to Jun 2018. Methodology: Sixty-four patients underwent transcatheter closure of atrial septal defect. Size of the defect was measured by Transoesophageal/Transthoracic. Follow up was carried out at twenty-four hours, one month, six months and at twelve months. Early, Midterm and late complications after device occlusion were analysed using SPSS-22 statistical software. Results: Minimum size of atrial septal defect on echocardiography was 7 mm and maximum size was 31 mm with mean of 18.3 ± 5.7 mm. The procedure was successful in 96.8% cases. There was only one device embolization (1.56%). Cobrahead” configuration malformation of the device occurred in one case (1.56%). Mitral valve regurgitation did not occur in any of the case. There was no residual shunt across the device in the present study. ECG abnormalities associated with transcatheter closure did not occur in any of the patient. In intermediate and long-term follow up, no complication like cardiac erosion was seen in all cases under study. Conclusion: Transcatheter occlusion of ASD with device was found effective and safe procedure with minimal complication rate, short hospital stay, good short, intermediate and long-term results.

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018. Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit. Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively. Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.

Objective: To determine the effect of bilateral oophorectomy on the periodontal status of otherwise healthy women when compared with normal controls. Study Design: Mixed-method study. Place and Duration of Study: Riphah International University, Islamabad, from Apr to Sep 2016. Methodology: A total of 24 women with and without oophorectomy procedures were recruited. Twelve women who has undergone radical hysterectomies at least 6 months prior to the evaluation were recruited for this investigation. These women underwent a comprehensive oral examination with detailed documentation of their periodontal status following a thorough medical/dental history. An age- and sex-matched control population underwent a similar examination. Results: Statistically significant results were noted for probing, color, consistency, texture and contour of gingiva with the p-value of 0.007, 0.001, 0.002, 0.005 and 0.037 when the results were compared with the control population. Conclusion: Bilateral oophorectomy does not compromise the periodontal health of otherwise healthy women.

Objective: To find association of red blood cell indices and erythrocyte sedimentation rate (ESR) in COPD patients. Study Design: Retrospective case control study. Place and Duration of Study: University of Health Sciences Lahore, from Oct to Dec 2019. Methodology: This study was conducted at University of Health Sciences Lahore after approval from Institutional Review Board of University of Health Sciences Lahore. The Data was assessed by IBM-SPSS version 24. Significance of the associations was assessed by Fisher’s Exact test and independent sample t-test. Results: The continuous variables of our data were having normal distribution hence their mean ± standard deviations were calculated. Mean age of the cases with COPD was 56.22 ± 11.34. Mostly were males (91%). The prevalence of the cases and the controls was also calculated by comparing them with different demographic variables. It was found to be highly statistically significant when compared with age (p=0.04). Age group of 51-65 was also more affected with COPD then the other age groups. Patients with lower socio-economic group were found to be more affected by COPD then those from other socio economic groups. When association of COPD was seen with different red blood cell indices then it was striking to find out that the mean corpuscular hemoglobin concentration (MCHC) was significantly associated (p=0.03). Erythrocyte sedimentation rate was also found to be strongly associated with COPD cases (p=0.001). Conclusion: Hence it is concluded that the red blood cell indices and ESR have a strong association with COPD.

Objective: To assess the effects of oral fluids and intravenous fluids in terms of frequency of improving Amniotic Fluid Index during third trimester of pregnancy having oligohydramnios.Study Design: Comparative prospective survey. Place and Duration of Study: Obstetrics and Gynaecological Department of Fauji Foundation HospitalRawalpindi, from Apr 2018 to Oct 2018. Methodology: A total of 100 patients with singleton pregnancy (50 in each group) at gestational age of 28-37weeks and AFI of 5cm or less than 5cm were included. Non probability consecutive sampling technique wasused. Ethics approval from hospital ethical committee and research board was taken. Patients were randomizedinto 2 groups (50 patients each) by lottery method. Group A was instructed to drink 2 liters of water per day fora time period of seven days and patients in group B was given 2 liters of 5% D/W which was in addition to theirnormal fluids intake. Amniotic fluid index was measured pre hydration and post hydration in both groups. Datawas analyzed using SPSS-21. Results: Mean age of the patients was 33.62 ± 5.45 years and 34.70 ± 4.76 years for groups A and B respectively.In group A and group B mean gestational age was 34.28 ± 1.85 weeks vs 34.32 ± 1.82 weeks. In group A, 44 (88%)..............

Objective: To determine different treatment options in patients of Patent Ductus Arteriosus with pulmonary hypertension beyond neonatal period. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was carried out in Pediatric Cardiology department of Rawalpindi Institute of Cardiology, from Jan 2017 to Jan 2019. Methodology: Patients having PDA with pulmonary hypertension were included in the study. Treatment options were divided into percutaneous catheter device closure, surgical ligation of patent ductus arteriosus and palliative treatment. Any adverse event during the procedure was documented. Stratification was done in regard to gender and age group. Post stratification chi square test was applied and p-value less than or equal to 0.05 was considered as significant. Results: Total number of patients included in the study were 37. Mean age (years) of patients (Mean ± SD) was 19.21 ± 8.76. Mean ± SD pulmonary artery pressure was 56.43 ± 11.55 mmHg. Percutaneous catheter device closure was successful in 24 (64.9%) patients, in 7 (18.9%) patients primary surgical PDA ligation was done, 3 (8.1%) patients were advised palliative treatment and in 3 (8.1%) patients adverse events occurred during percutaneous device closure and were thus referred for surgical ligation. Patent ductus Arteriosus Occlutech device was used in 18 (48.6%) patients, Occlutech VSD device was used in 7 (18.5%) patients and in 1 (2.7%) patient AGA duct occluder was used. Conclusion: In patients with patent ductus arteriosus and pulmonary artery hypertension, percutaneous catheter device closure is a safe and effective procedure.

Objective: To assess the occurrence and intensity of Giardia and Ascaris infestations in children of both genders reporting with diarrhea. Study Design: Comparative cross sectional study. Place and Duration of Study: Paediatrics department, Combined Military Hospital, Gilgit, from Jul 2016 to Jul2018. Methodology: Patients of either gender with worm infestation were included in the study. Patients more than13 years old were excluded. The sampling technique used was non probability consecutive sampling. The stoolexamination (R/E) for the diagnosis of worm infestation was done. Stratification was done with regards to age,mother education, gender, type of water used and post stratification chi square test was applied. p-value was0.613 when calculated for the manifestation between both genders. p-value ≤0.05 was considered significant. Results: Total number of patients in our study was 100. Among them, males were 65 (65%) and females were 35(35%). Mean age of patients in our study was 4.20 ± 2.61 years (Mean ± SD). Abdominal pain being most common symptom in 43 (43%) of patients. Majority of the patients were from 2 to 10 years of age, 79 (79%). Helminthic infestation was the most common observed in 52 (52%) whereas Protozoal infestation was observed in 48 (48%) patients. The most common parasite isolated was Giardia 41 (41%) followed by Ascaris 36 (36%). p-value of 0.613 was found between both gender. Conclusion: In our study Helminthic infestation was more common. The most common parasite isolated wasGiardia followed by Ascaris.

Objective: To determine the causes of right lower abdominal pain in females of child bearing age and compare the diagnostic value of clinical, laboratory and sonographic parameters in these patients. Study Design: Prospective comparative study. Place and Duration of Study: Department of Surgery, Combined Military Hospital Sargodha, from Nov 2018 to Oct 2019. Methodology: The study included 92 female patients between the age of 13 to 45 years who presented in Surgical Department with pain right lower abdomen and underwent surgery with a pre-operative diagnosis of appendicitis. Intra-operative findings were recorded and final diagnosis was made by peroperative macroscopic examination. Data consisting of symptoms, signs, investigation and final diagnosis was analyzed. Results: Mean age of the patients was 21.3 ± 3.7 years. Out of 92 study subjects, 78 (84.68%) had appendicitis while 14 (15.21%) were having gynaecological disorders. The rate of negative appendectomy was 15.21%. The most common gynaecological disorder was ruptured ovarian cyst seen in seven patients (7.6%). Most of the symptoms and signs were common in acute appendicitis and gynaecological disorders except migration of pain to the right iliac fossa which was seen in appendicitis only. Rise in leukocytes and neutrophil counts and a positive ultrasound for appendix were seen only in about 50% of the appendicitis patients. Conclusion: A considerable number of females of child bearing age with gynaecological disorders presented with symptoms and signs simulating as acute appendicitis. Out of the three parameters, not a single parameter was 100% efficient in diagnosing the cause of pain.

Objective: To assess the perspectives and health anxieties of gynecological and obstetric patients during Covid-19 pandemic. Study Design: Cross-sectional study. Place and Duration of Duration: This study was conducted in emergency and outpatient clinics of Gynecology& Obstetrics Department, Combined Military Hospital Rawalpindi Pakistan, from Apr to May 2020. Methodology: Two hundred and thirty patients participated in this study by answering a pre-designed questionnaire. All the patients were interviewed by the same doctor to minimize bias. Eleven questions were asked exploring their perspectives and anxieties regarding Novel Covid-19 pandemic, its effects on their healthcare and the challenges faced by the healthcare providers. Statistical analysis was done by using statistical package for social sciences (SPSS-22). Results: The mean age of the respondents was 33.5 years. 71.3% were pregnant women and 34.8% were gynecological patients. Undergraduate, postgraduate and healthcare professionals were 33.9%, 58.3% and 7.8% respectively. 95.5% of the participants were aware of risk of COVID-19 pandemic and 60.8% knew about its adverse effects. 62.5% visited for regular antenatal. 85.2% had a good opinion about the attitude of the doctors and 93.9% were satisfied with their treatment. 92.1% were not interested in revisiting the hospital again. 80.8% had no apprehensions about the health workers protective gear while 69.5% thought that protective measures were good. 80.8% opined that the hospital environment was hazardous and 78.2% they would not recommend it to their friends. Conclusion: This study concluded that gynecological and obstetric patients have different opinion about risk, safety measurements, environmental condition, stress and attitude of doctors during COVID-19 pandemic according to age and educational status

Objectives: This study compared efficacy of two methods of placental delivery at the time of cesarean section that is spontaneous and manual removal of placenta in terms of excessive blood loss during caesarean. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at the department of Gynaecology and Obstetrics, Combined Military Hospital Multan, from Nov 2016 to Apr 2017. Methodology: Participants having similar demographic and clinical characteristics, were selected and divided into 2 groups. Group A underwent removal of placenta spontaneously, while group B underwent manual removal of placenta. The total amount of blood suctioned and sponges soaked during surgery were noted whereas, haemoglobin level at 6 hours post-operatively was noted for difference of ≥2 gm/dl as significant. Results: In our study, mean maternal age and mean gestational age of study population was 26.77 ± 3.47 years and 36.96 ± 1.44 weeks respectively. Significant blood loss (>1000ml) was observed in 28 (20%) patients in group A, and in 47 (33.6%) patients of group B. Difference in pre-operative and post-operative haemoglobin levels of >2gm/dl was observed in 14 (10%) patients in group A and 28 (20%) patients in group B. Difference in number of patients having significant blood loss and significant decrease in haemoglobin levels between two groups was significant (p=0.01, p=0.019 respectively). Conclusion: Manual removal of placenta was related to more blood loss as compared to spontaneous removal of placenta so spontaneous removal should be given preference on manual removal during caesarean section.

Objective: To compare platelet rich plasma against local steroid injection in patients with chronic plantar fasciitis in terms of mean pain and functional scores. Study Design: Quasi-experimental study. Place and Duration of study: Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, from May 2016 to Apr 2018. Methodology: A total of 120 patients having chronic plantar fasciitis were included in the study and were split into 2 groups. The group “A” (n=60) patients were injected with a single dose of autologous platelet rich plasma. The group “B” (n=60) patients received a single dose of methylprednisolone added with a local anesthetic agent. Functional and symptomatic evaluation was done using the American foot and ankle score and the visual analog scale respectively at baseline and at 6 months follow-up. Results: Mean visual analogue score was 7.83 ± 0.99 at baseline and 3.43 ± 1.30 at 6 months follow-up in group “A” and 7.90 ± 1.06 and 4.97 ± 1.16, respectively, in group “B” (p

Androgen insensitivity syndrome (AIS) is a condition in which the target cells are unable to respond to androgenic hormones. This inability can be complete or partial. Although the individual is a genetic male due to the presence of Y chromosome but clinical presentation can vary ranging from a complete male to full female habitus. There are also individuals that lie in between these two extremes depending upon the severity of the condition. Gender assignment in such patients poses a great challenge for the care givers, parents and the patients. We report a very rare case of 10-year old phenotypic female who presented in outpatient department with bilateral inguinal hernia and during management she turned out to be a patient of complete androgen insensitivity syndrome (CAIS).

Objective: To determine the age distribution, gender and pattern of congenital heart diseases in pediatric and adult population in a newly developed tertiary care centre. Study Design: Retrospective observational study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi, from Jan 2016 to Dec 2016. Patients and Methods: Data of patients presenting for the first time in pediatric unit between Jan 2016 to Dec 2016 was collected. It consisted of 5128 echocardiographies, all done by consultant pediatric cardiologist. Demographical profile, gender predisposition and various types of heart defects were analyzed using SPSS version 17. Results: Among enrolled patients 2461 (48%) were females and 2666 (52%) were male patients. The ages of patient ranged from newborn babies to adults upto 60 years of age. Out of five thousand one hundred twenty eight (5128) echocardiographies done, 82.9% had congenital heart defects and two hundred fifty five patients (5%) had acquired heart defects. Acyanotic heart defects were more common (72%). Among acyanotic heart defects Ventricular septal defect (VSD) was the most common lesion 1172 (27%) of all congenital heart defects. In cyanotic heart defects Tetrology of Fallot (TOF) is most common 468 (10.9%). 632 (54%) of VSD cases were male. Pulmonary stenosis was most common obstructive lesion 170 (4%) follow by Aortic stenosis 63 (1.5%). Mital valve prolapse was most common congenital valvular lesion 89 (2.1%). Dilated cardiomyopathy was most common congenital cardiomyopathy 129 (3%). Sixteen case of Eisenmenger syndrome were diagnosed with female preponderance (F:M 1.6:1). Conclusion: Late presentation of VSD with complications and TOF were the common phenomenon in our setup. Identifying the pattern of diseases and their presentations can help to devise effective programme for early diagnosis and interventions in congenital and pediatric heart diseases.

Objective: To evaluate the effectiveness of needle assisted laparoscopic repair (NALR) of inguinal hernias inchildren. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pediatric surgery, Pak Emirates Military Hospital, Rawalpindi, from Aug 2017 to Apr 2018. Material and Methods: A total of 50 patients were included in the study. All the patients were diagnosed with inguinal hernias on the basis of history given by parents and clinical examination. All patients underwent NALR of inguinal hernias after preoperative workup and informed written consent. Pneumoperitoneum was created in all cases by open method. Transumblical 3mm port was used for telescope along with a single 3mm port in lower abdomen for grasping forceps. Internal inguinal ring was closed by transfixing it with a loop suture using 22 G spinal needle and 2/0 prolene suture. Operative time and presence of contralateral processus vaginalis was noted. Patients were followed up at four weeks and three months for postoperative complications. Results: Age of the patients ranged from 12 years, Mean ± SD was calculated as 40.36 ± 37.74. Regarding inguinal hernia site, n=17 (34%) have right sided hernia, n=13 (26%) have left sided hernia while bilateral hernia were present in n=20 (40%), 9 patients (18%) were found to have occult patent processus vaginalis peroperatively. Mean operative time ranged from 9 minutes to 25 minutes with Mean ± SD calculated as 15.94 ± 5.30. All operations were completed laparoscopically without need of conversion to open herniotomy. There were no intraoperative complications; No case of matachronous contralateral inguinal herniaor hydrocele formation and wound related complications during follow up at 4 weeks and 3 months. Conclusion: LNAR of inguinal hernias in children is an effective, quick and safe technique which can be easily learnt due to its simplicity to perform. This technique can be employed in both male and female pediatric population with promising results. One main advantage is the ability to pick up the occult patent internal ring which can be repaired in the single stage to prevent the development of metachronous inguinal hernia in the later age.

Objective: To compare the outcome of intra-articular hyaluronic acid injection with oral non-steroidal antiinflammatory drugs in knee osteoarthritis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient orthopedics department of Combined Military Hospital, Rawalpindi from February 2015 to July 2016. Patients and Methods: A total of 60 patients with knee osteoarthritis were enrolled as per inclusion and exclusion criteria by non-probability consecutive sampling. Thirty patients were assigned to group “A” and were given intra-articular injection of hyaluronic acid 20 mg (2 ml) into the knee joint aseptically for five consecutive weeks. Group “B”, having thirty patients, was given oral non-steroidal anti-inflammatory drug Celecoxib 200mg/Naproxen 500mg twice daily after meals for twelve weeks. Outcome measure was mean pain score using visual analogue scale at twelve week follow-up. Results: Statistically significant improvement in mean pain score on visual analogue scale at twelve week followup was found in patients of group “A”, with improvement in score from 7.2 ± 0.92 at the start of the study to 5.6 ± 1.23 at twelve week follow-up (p