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Background and Aim: The purpose of this research was to examine the influence of Z-Prime Plus and G-Bond on zirconia posts fracture resistance affixed to the walls of root canals. Place of Study: Avicenna Medical College Lahore Study Duration: March 2021 to April 2022 Materials and Methods: In this in-vitro experimental study, the diameter and length of each of the 20 mandibular premolars used were identical. This assured that the study's findings were comparable. Once a cut was made at the cementoenamel junction (CEJ) to prepare the teeth for root canal therapy, the teeth were randomly assigned to one of two groups (n=11) with the same number of teeth in each group. In the experiment, a single tooth from each group was chosen at random to serve as the control. A post space of approximately 10 millimeters in length was established in the remaining teeth. The following process involved etching the intracanal dentin, followed by rinsing and drying the material. The technique involved filling the canal with Panavia F2 resin cement. After applying G-Bond and Z-Prime Plus to the zirconia posts in respectively, groups 1 and 2, the placement of post was done in the canals and subsequently cemented. The photo core resin composite material was utilized in the fabrication of the cores. The longitudinal axis of the teeth was compressed by a force application to the core of central fossa o at a crosshead speed of 0.5 millimeters per minute. This was accomplished with a crosshead speed of 0.5 mm/min. The load that caused the fracture was measured and documented. To analyze the data, a t-test was conducted, and a normal distribution was also taken into account. Result: The results indicated that the average fracture resistance of G-Bond was 1088.1±330 while the average fracture resistance of Z-Prime Plus was 898.4±369 however, the difference was not statistically significant (P=0.3). Practical Implication: The influence of Z-Prime Plus and G-Bond on zirconia posts fracture resistance affixed to the walls of root canals Conclusion: There was no significant difference between the fracture resistance of zirconia posts bound with G-Bond and Z-Prime Plus to root canal walls. In contrast, G-Bond is highly advised for usage in this application due to its decreased coefficient of variation (CV) and significantly increased fracture resistance. This makes it a great option for the current endeavor. Keywords: Primer; resin composite; shear bond strength; zirconia ceramic, G-Bond, Post and Core Technique, Z-Prime Plus

Objective: The main goal of this study was to investigate the groups receiving fentanyl-propofol (fentP) against ketamine-propofol (ketP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores. Additionally, evaluated were the procedure's hemodynamic changes, postoperative pain score, complications, and endoscopist satisfaction. Methodology: A double-blinded randomized clinical trial was undertaken at the Dr. Ruth K.M. Pfau Civil Hospital Karachi's endoscopic room (DUHS) for six months. By using OPEN EPI sample size calculator, sample size was calculated. A total of 124 patients for elective ERCP were randomized into two groups by SNOSE protocol. Groups A and B, fentanyl-propofol (fentP) and ketamine-propofol (ketP), respectively, each contain 62 patients. All patients were given a loading dose of propofol 0.5 mg/kg, followed by a 75 ug/kg/minute infusion. The group fentP received fentanyl 1ml/kg (1 ug/kg) and the group ketP received ketamine 1ml/kg (0.5mg/kg). Ramsay sedation scores, the necessity for rescue sedation, and the Aldrete score post-operatively were noted. Hemodynamics during surgery and complications were also noted. Results: Sedation began noticeably earlier than usual in the group B at 0, 2 and 4 minutes (p-value 0.05). Conclusion: We were able to conclude that during ERCP, ketP had a significantly faster sedative onset than fentP, with less complication and a quicker recovery. Keywords: Propofol, KetP, FentP, ketamine, fentanyl, Sedation, Analgesia, ERCP, Monitored Anesthesia care.

Background: Physiology of the mother, changes constantly during pregnancy including reduced HGS that is require for carrying the child after delivery. Activities of daily living require manual gripping tasks that require dynamic and static contractions. Predictor of upper extremity function is Hand Grip Strength and handgrip endurance. Screening of hand grip strength during antenatal care is still uncommon. Objectives: To compare static and dynamic hand grip endurance in pregnant females and to find its correlation with deep breathing. Material and Methods: The study recruited 40 participants of primi-gravida of 1st and 2nd trimester, between ages 20 and 35 years from SHALAMAR GYNAE OPD. The participants assigned to the groups (Group 1: with DB, Group 2: without DB) based on their trimester and gravidity. Static and dynamic endurance assessed using hand held dynamometer. Results: Mean Age ± Standard deviation for deep and non-deep breathing groups was 22.85 ± 2.30 and 24.05 ± 0.514. Age had negative little or low correlation with all variables of deep and non-deep breathing groups. Peak hand grip strength was moderately correlated with hand grip endurance with deep and non-deep breathing group (r = -0.628, r = -0.566 respectively). Static hand grip endurance was weakly correlated with peak hand grip strength in deep breathing group (r = -0.239) whereas static hand grip endurance had little, if any correlation with peak hand grip strength in deep breathing group (r = -0.165). Clinical implication: Management of hand grip strength and endurance improves general well being of pregnancy. By employing deep breathing exercises hand grip strength can be improved. Conclusion: Peak hand grip strength and endurance improved markedly in 2nd trimester with deep breathing. Deep breathing can improve peak hand grip endurance and peak hand grip strength in pregnancy with increasing trimester. Whereas static and dynamic hand grip endurance has insignificant effect in different trimester. Keywords: Pregnancy, deep breathing, trimester, endurance, peak grip endurance

Background: One of the most popular surgical operations performed using a variety of techniques is a tonsillectomy. The two that are used the most frequently are the traditional cold dissection technique (CDT) and electrocautery, the latter of which is carried out using the monopolar and bipolar electrocautery procedures (BET).All techniques used during tonsillectomy are intended to lessen perioperative bleeding, the intensity of felt pain, and postoperative morbidities. Aim: To compare the outcomes of the bipolar electro cautery tonsillectomy versus cold steel dissection pediatric tonsillectomy in terms of mean-operative time and intra-operative blood loss. Setting: ENT department of Sir Ganga Ram Hospital, F.J. Medical University Lahore from 11-03-2022 to 10-09-2022 Study design: Randomized Controlled Trial Study type: Quantitative study type Methods: The sample size of 110 (55 in group A 55 in group B) was estimated by using 95% confidence level, 90% power of test with an anticipated mean loss of blood during surgery of tonsillectomy i.e. 7.38±2.81m1 with bipolar electro cautery dissection and 11.73±2.86 ml with cold steel dissection. Results: One hundred and ten patients were included as per calculated sample size with the mean age of 8.96±2.42 years. The lowest age limit of children was 5 years while the maximum age limit of children was 13 years. In group A, the mean age of children was 8.80±2.46 years. In group B, the mean age of children was 9.13±2.38 years. The difference was observed as insignificant i.e. p--value = 0.481. Of 110 patients, 67(60.91%) patients were male whereas in group B 29(52.7%) were males. Similarly in group A 17(30.9%) were females and 26(47.3%) were females. The difference was observed as insignificant i.e. p--value = 0.079.In group A, the mean operative time was 19.76±4.47 minutes. Conclusion: This study concluded that bipolar electro cautery tonsillectomy showed significantly better outcome as compared to cold steel dissection pediatric tonsillectomy. Keywords: Cold dissection tonsillectomy, Electrocautery tonsillectomy, Mean operative time, Intra operative blood loss.

Objective: The objective behind this study was to determine the frequency of gastrointestinal signs and symptoms in patients with dengue fever in tertiary care hospital Methods: A cross sectional observational study was conducted on all adult patients diagnosed with dengue disease after taken informed consent from the patients and approval from the ethical committee of the hospital. All these patients were evaluated for the presence or absence of gastrointestinal (GI) manifestations. Those who had GI symptoms were further evaluated for the frequency of different types of GI symptoms. All baseline and clinical data were taken using a structured questionnaire and then entered & analysed using SPSS v. 26. Results: A total of 174 patients who were dengue virus positive were included for final analysis. Overall mean age and SD was 29.22±8.14 years and majority belongs to young age group, ≥16 – 40 years (60.11%, n = 104). Most of our study participants were males (75.86%, n = 132). Hypertension was the most common comorbid condition observed in our study participants (12.06%, n = 21). The overall prevalence of GI manifestations in our study who were dengue positive was 62.64% (n = 109). The most common GI symptom was presence of nausea/vomiting (70.64%, n = 77). Conclusion: The prevalence of GI manifestations in patients with dengue is quite high. Nausea/vomiting was the most common GI manifestation while patients with hepatomegaly and GI bleeding were also prevalent. Keywords: Dengue fever, gastrointestinal symptoms, clinical manifestation, Pakistan

Background: Immunohistochemistry is an adjunct tool in Surgical Pathology. The fast growing use of immunohistochemistry in gynecologic Pathology has revolutionized the fields of tumor diagnostics & research. Objective: The objective of the study was to share & discuss the experience of utility of immunohistochemistry in Gynecologic Pathology, at a tertiary care hospital in Lahore, Pakistan. Patients & Methods: This was a retrospective, descriptive, cross sectional study, carried out at the Pathology Department of Fatima Jinnah Medical University, Lahore. All cases which were diagnosed after the application of immunohistochemistry during the study period from 1st July 2019 to 31st December 2020 were included in the study. Data included age of the patient, marital status, parity, clinical & radiological presentation, histopathological findings & differentials, list of immunohistochemical markers applied to the case with results & final histopathological diagnosis. Data was analyzed using SPSS version 17. Results: A total of 196 cases were included in the study. The age of the patients ranged from 14 years to 82 years with a mean age of 41 ± 7 years. The commonest use of immunohistochemistry was for histological classification of the tumors of the female genital tract, identifying precancerous lesions, differentiating primary from metastatic CA & predicting response to chemotherapy via proliferative index Ki67. The most commonly used immunohistochemical markers were CK, CK7, CK20, CD 3, CD20, ER, PR, VIMENTIN, WT 1, Ki67, CD 117, SMA, INHIBIN, p53 & p63. Practical implication This study shares the experience of use of common immunohistochemical markers in different cases of gynecologic pathology, highlighting & discussing different panels for use in different scenarios, from which other pathologists may benefit. Conclusion: Immunohistochemistry is an important ancillary tool in the evaluation of gynecologic pathology cases. However, it cannot replace conventional histopathology. It should always be used as an adjunct to histopathology, in the proper clinical & radiological context. Keywords: immunohistochemistry, gynecologic pathology, ovarian carcinoma, leiomyoma, dysgerminoma

Background: Tibial nonunion remains a significant clinical challenge despite advances in surgical management. New techniques to help manage tibial nonunion include extracorporeal shock wave therapy and percutaneous application of bone marrow aspirate. Management strategies vary based on the type of nonunion: aseptic or infected, and atrophic or hypertrophic. Extracorporeal shock wave therapy has been shown to be as effective as surgical management in patients with stable hypertrophic nonunion. Objective: To determine the efficacy of extracorporeal shock wave therapy for aseptic non-union of the tibia Methodology: A randomized controlled trail was conducted at Orthopedic Emergency department Central Park Teaching Hospital from March 2022 to November 2022. Results: In our study, out of 120 cases, 52.5%(n=63) were between 15-40 years and 47.5%(n=57) were between 41-60 years of age, mean + sd was calculated as 41.22+7.17 years, 60.83%(n=73) male and 39.17%(n=47) females. Frequency of efficacy of extracorporeal shock wave therapy for aseptic non-union of the tibia revealed in 86.67%(n=104). Practical Implication: ESWT therapy can be used as non-invasive method of treating non-healing fractures of tibia without compromising the surgical anatomy. Conclusion: We concluded that the frequency of efficacy of extracorporeal shock wave therapy for non-union of the tibia is significantly higher and the patients treated with this technique may have a benefit of non-operative procedure. Keywords: Aseptic non-union of the tibia, extracorporeal shock wave therapy, efficacy

Background: The decision to report domestic violence incidents, including burns, can be complex and influenced by various factors such as lack of confidence in police, delay in delivery of the just and social factors like that of fear, shame, and a belief that the family might be disturbed. Understandingthis trend is crucial in developing effective strategies to support and protect survivors. In matters of domestic violence of burns the victims fear to register the case in police station or any health facility. Aim: To understand the factors responsible for the failure of registering their burn incident as medicolegal issue. Methodology: Study was carried out among the victims of burns of domestic violence in the catchment area of May Hospital Lahore.The population of study comprises of urban and rural populations. The study sample comprised of 450 unfortunate victims of domestic burns for one whole year of 2018 from January to December brought in the Medicolegal Clinic of the King Edward Medical University Lahore. The data was collected on a predesigned questionnaire after due approval from Ethical Review Committee and Institutional Review Board. Results: The study results revealed that literacy level play a pivotal role in registering the incident of domestic violence a matter of legal concern being significant with a p value as 0.029. The social factors like that of confidence in the local police, the delay of the justice system and physical or emotional disturbance of the family if the fight for a legal battle in criminal domestic burn incident was found grossly significant with p value as 0.000 being very valid in growing economies. Conclusion: The study was found conclusive that literacy level and social factors like that of confidence in local law enforcement agencies, delay in delivery of the justice and family issues are the most vital social factors hindering to fight a legal battle in domestic burn incidents. Keywords: Burns, Domestic Violence, Legal Rights, Law Enforcement, Medicolegal Burns, Justice System

Background: Most frequently self-reported work-related illness are due to musculoskeletal disorders. Highly repetitive tasks with grasping of the hands, repetitive flexing of the wrist, vibrations and localized mechanical pressure play a role in development of repeated stress injury. Many computer users complain about wrist fatigue, discomfort or pain after typing. Aim: To assess and compare isometric grip strength of computer operators and non-computer operators. Methods: This study was conducted at the Shalimar Institute of Health Sciences. A sample of 30 computer operators and 30 controls (non-computer operators) were recruited after screening hand ultrasonography. Purposive sampling was used. Isometric grip is measured with a hand-held dynamometer. Subjects were asked to hold the dynamometer with full exertion. Each reading is from a maximum contraction period of three seconds with a 30-second pause. Results: Average Hand Grip Strength of computer operators was 27.71±11.19kg and non-computer users was 37.05±11.09kg. The results were statistically significant with the p-value of 0.002. Practical Implications: Continuous computer use reduces hand grip strength therefore those who are having long term use of computers must go for hand grip strength exercises to maintain normal hand grip strength. Conclusion: Computer operators have less isometric hand grip strength than non-computer operators as it was concluded in this study. MeSH words: Isometric hand grip strength, computer operators, non-computer operator

Objectives: To compare the short term outcome of therapeutic hypothermia in asphyxiated newborn with standard treatment presenting after 6 hours of life. Methodology: It was Randomized controlled trial conducted in the department of Pediatric Medicine, Bahawal Victoria Hospital, Bahawalpur from December 2018 to June 2019 after taking ethical approval from institutional ethical review committee and informed written consent from parents of patients. Confidentiality of the data was maintained and it was assured that no harm to study participants is done. A total of 108 term neonates with moderate to severe HIE presenting >6 hours of life were included. Preterm infants, major congenital anomaly and overt bleeding were excluded. Then selected patients were placed randomly into Group A (hypothermia group) & Group B (conservative group), by using lottery method. Outcome variable like mortality within 1st week was noted. There was no conflict of interest in the study and funding was done by the authors. Results: The mean age of patients in group A was 17.69 ± 6.68 hours and in group B was 17.60 ± 6.65 hours. Out of 108 patients, 62 (57.41%) were males and 46 (42.59%) were females with male to female ration of 1.3:1. There was mortality within one week (short term outcome) in 07 (12.96%) patients in Group A (hypothermia group) while in Group B (conservative group), it was seen in 16 (29.63%) patients. Conclusion: This study concluded that there is benefit of therapeutic hypothermia in asphyxiated newborns after 6 hours of life and short term outcome is better after therapeutic hypothermia in asphyxiated newborns. Keywords: Asphyxia, Encephalopathy, Mortality, Cooling.

Aim: To evaluate different smile characteristics among dental students and find out gender- based association. Study design: Cross sectional observational study. Place and duration: Prosthodontic Department of Lahore Medical And Dental College, Lahore, from 1st Jan 2022, till 1st April 2022. Methodology: A total of 260 dental students were assessed for smile characteristics i.e.; smile line, smile arc, labiodental relationship and number of teeth visible during posed smile. Result: The smile line frequently observed was average smile line 52.7% followed by gummy smile line 22.3%. More male participants had average smile line whereas gummy smile line was frequently found in females. Frequently observed smile arc was consonant 63.1% followed by flat arc 22.3% and least observed arc was reverse 14.6%. Most of the participants display second premolar to second premolar teeth during posed smile 41.9%. Female display teeth up to first molar 51.5% and males up to second premolars 48.7%. Labiodental relationship frequently observed was the relation of the lips not touching the incisors 54.2%. Gender based difference with respect to smile line, smile arc, and number of displayed teeth was significant p 0.05. Conclusion: Restorations in esthetic zone should be carried out considering smile characteristics like smile arc, smile line, labiodental relation and teeth display. Gender dimorphism should be considered as an important factor that can influence the esthetic outcome of restorations. Keywords: Gum display, Labiodental relation Smile line, smile arc, smile design, tooth display

Background: The optic nerve damage with the ultimate loss of vision resulting from a clutch of diseases named Glaucoma. In many conditions including, corneal dystrophies, corneal edema, and endothelial diseases of the cornea, the important biometric is Central corneal thickness (CCT). Objective: To find the difference in mean CCT with spectral-domain optical coherence tomography and ultrasound pachymetry in patients presenting with Glaucoma. Material & Methods: The study design opted was the observational cross-section. The study was done in tertiary care hospital. A total of 180 patients were registered for the present study. Both techniques noted the CCT value of all patients. Once the data was collected, it was stored electronically and analyzed by using SPSS version 20.0. Results: 40.00±11.50 years was the average age of all the patients. There were 89(49.44%) males and 91(50.56%) females. The mean CCT was 531.01±28.54µm on OCT and 530.01±29.74µm on USP. The mean difference in CCT was 3.93±3.13µm between OCT & USP. The difference was statistically insignificant (p

Background: The kidneys filtration waste and excess water from your blood as urine. CKD when the GFR of the patient less than 15ml/min. ESKD is the final stage of CKD. HD is a common renal replacement therapy for ESRD patients. CKD may have many effects on nervous system and manifest as headache, seizure and DDS etc. Seizure is one of the complication of HD. Seizures are changes in the brain’s electrical activity. The study was conducted to assess the occurrence of seizure in hemodialysis patient and to analyze the possible causes of seizure in renal failure patient during hemodialysis. Methods and Materials: In this cross-sectional study, collected 202 samples for assessing the causes of seizures in patients on HD. In this study the selected ESRD patients with different types of seizures and causes which leads to HAS. To evaluate the occurrence of seizures in hemodialysis patients, individuals were thoroughly examined. Results: Among total of 202 hemodialysis patients, 16 patients were found suffered with seizures. Out of 16 patients, 14 patients were agreed to participate in the current study. The finding of this study showed that there are many causes of HAS but some are the most shown in this study. This study revealed that hypoglycemia, hypocalcemia (hyperparathyroidism), uremic encephalopathy, hyponatremia and use of erythropoietin for the cure of anemia in the dialysis patients are the most common causes of seizures seen. Conclusion: Some neurologic manifestations such as seizure, headache and developmental delay in patients with ESRD are seen. HAS is an important complication of HD. Moreover, treated properly in these cases for decrease of morbidity and mortality and there treatment should be told to medical professionals. Keywords: Hemodialysis, ESRD, Incidence, Seizures

Diabetes Mellitus is one of the major worldwide public health issues, along with socio-economic growth. Diabetes Mellitus is a chronic metabolic syndrome of several causes characterized by long-lasting hyperglycemia with the turmoil of carbohydrates. The study aimed to evaluate pharmacotherapy on rational grounds for drug-drug interactions, polypharmacy, and untreated conditions if any., For the recording of patient case histories, a standard questionnaire was designed, which includes age, sex, history, chief complaints, Clinical tests, diagnosis & patient’s family history, etc., the copy of which is appended. Considering 20 cases, different parameters were studied which showed that 17 out of 20 cases received rational therapy according to standard pharmacotherapy and the patients responded well to the prescribed therapy, 3 cases out of 20 received irrational therapy due to which they showed poor response. The percentage of the female patient was 40% and the male patient was 60%. In some of these cases, drug interactions were found and their percentage was 22.1%. The most prominent interaction occurrence was of Ramipril with metformin i.e. 18.75% and Ciprofloxacin interaction with glimepiride is 6.25% etc. In all cases, a total of 86 drugs related problems were reported. The percentage of untreated conditions was 9.3%, drug without indication 6.98%, and cost-related problems were 20.9%, etc. In some cases, concurrent diseases were also found i.e. hypertension at 37.5% and asthma at 25 was prominent. Patients with ages between 41-50 and 51-60 years have a high percentage of Diabetes Mellitus i.e. 40% and 40% respectively. The most prominent ADRs were insomnia, skin rashes, dizziness, nausea, vomiting, diarrhea, etc. Nausea, vomiting, and diarrhea are more frequent with antibiotics. Keywords: Epidemiology, Etiology, Pathophysiology, Investigations, Complications and Treatment of Diabetes Mellitus

Antibiotics have played a crucial role in the treatment of bacterial infections. Past few decades are marked with advancement of multidrug resistant (MDR) pathogens, which have endangered antibiotic’s therapeutic efficacy. Scientific world is now struggling with the crisis of MDR pathogens. This supreme matter demands careful attention or otherwise it would jeopardize clinical management of infectious diseases. Implication of alternative approaches can pave a new way in the treatment of these troublesome bacteria. Tea leaves are known to pose antibacterial activity against many pathogenic microorganisms. This review has summarized the antibacterial potential of tea leave’s extracts against resistant bacterial pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa, Helicobacter pylori, Escherichia coli, Klebsiella pneumonia, Salmonella typhi, Acenitobacter spp, Campylobacter spp. Consumption of natural products such as tea may very well replace, minimize or obliterate this complicated situation. Keywords: Anti-bacterial, Tea, Camellia sinensis, Drug resistant bacteria, Antibiotic resistant bacteria, Synergism, Polyphenols.

Background: High death rates are seen in cases with heart disease affecting the left major coronary artery. The left main coronary artery has different flow dynamics and pathophysiology than other coronary arteries. It is important to identify the best management options for patients with left main coronary artery disease based on their anatomic pattern. Objective: To compare the clinical and angiographic profiles of patients with or without left main coronary artery disease in patients undergoing angiography for ACS. Methods: An observational cross-sectional study was conducted. Invasive coronary angiography was performed on 985 adult patients diagnosed with coronary artery disease throughout a 6-month study period. The research participants were split into two groups: left main (Group 1) and non-left main (Group 2) following coronary angiography. It was determined whether there were any statistically significant variances between the two groups by comparing their demographics, risk factors, and angiograms. Results: In group 1, the mean age and SD are 54.3±8.4 and in group 2, they are 54.4±11.9. There were 748 men (75.9% of the total) and 236 females (23.9%). Out of the male participants, 630 were assigned to Group 2 (non-LMCA) and 118 were placed in Group 1 (LMCA). All of the females were present in group 2. Left main illness tends to be greater in males, as indicated by the results of the comparison research between the two groups (p=0.046). BMI comparisons across the groups indicated no statistically significant difference (p>0.05). The most common presentation was non-ST elevated ACS, which was significantly related to the LM group (p

Gingivitis is an infection caused by plaque and calculus accumulation. Gingivitis if not treated progress to periodontitis, a more advanced form of gum disease. Periodontal disease was the world's 11th most frequent disease in 2016 according to the World Health Organization. Surgical as well non- surgical periodontal therapies are carried out for periodontal disease treatment. Debridement of supra-gingival and sub-gingival calculus, along with instructions about oral health care methods are the basis of traditional non-surgical periodontal therapy (NTPS). Honey is beneficial to oral health, particularly in the cure of plaque formation, gingiva inflammation, periodontitis and odor control. Honey has antibacterial activity and is effective against both gram-positive as well as gram-negative bacteria. Honey's antibacterial and anti-inflammatory characteristics can promote the granulation tissue formation and enabling damaged cells to be regeneration. Materials And Method: This review followed the guided framework from the approach of Arksey and O'Malley for the scoping review (2005). The methodology was chosen because it has a five-stage framework. Exclusion & inclusion criteria were made and 60 articles were selected. Articles were searched from the PubMed, Google Scholar and other search engines. Results: Based on the data retrieved we concluded that honey can be used as a medium for non-surgical periodontal therapy. Honey have antibacterial and anti-inflammatory properties due high osmolarity, acidic nature and hydrogen peroxide as well non-peroxide components of honey and is used by many researcher for cure of periodontal disease but still there is not very strong evidence that locally given honey affects periodontal tissue healing. Despite this, all of the pockets had a good periodontal repair. Honey's efficacy in the treatment periodontal disease is still not well established and still questionable. To substantiate these findings from the literature, more research will be required.

Background: Combined spinal-epidural (CSE) anesthesia is a novel technique that decreases the amount of anesthetic required yet with greater anesthetic effect compared to spinal or epidural anesthesia alone. Recent studies showed that epidural volume extension (EVE) with saline further increased the anesthetic effect of this combined approach resulting in longer two-segment regression time. However, literature was scarce in the local context that provides the basis of the present study. Aim: The study focuses on the comparison between the mean duration of two-segment regression time in patients who underwent lower limb surgery treated with CSE and CSE plus EVE with saline. Methods: It was a randomized controlled trial and included 60 patients of both genders who range between 20-60 years. They belong to ASA class I and II and underwent lower limb trauma surgery with CSE anesthesia which were further randomly divided into two treatments groups. The patients of Group-A received EVE in addition to standard CSE while Group-B received standard CSE alone. The outcome variable was the mean two-segment regression time which was compared in these two groups. Results: Mean age of selected patients was 35.75±10.60 years. Study included 35 (58.3%) male and 25 (41.7%) female patients. The mean duration of surgery was 79.65±12.92 minutes while the mean BMI was 27.78±3.25 Kg/m2. Nineteen (31.7%) patients were from ASA Class-I and 41 (68.3%) patients associated with ASA Class-II. The mean two-segment regression time was substantially longer in the CSE plus EVE group as compared to the group receiving CSE alone (83.77±7.56 vs. 59.97±6.22 minutes; p-value

This study describes anti-hyperglycemic effect of Momordicacharantia extract commonly known as bitter melon. Random blood glucose levels were observed before and after plant extract administration. Powdered form of plant extract was used as an oral treatment. Diabetes was induced in animal (mice) models by using streptozotcin which is an artificial diabetes inducer. Maximum anti-hyperglycemic effect and blood glucose level reduction was observed in individual treatment of Momordicacharantiaextract (500mg/kg) which was 75% ± 1.3. This treatment was more effective as compared to Amaryl (3mg/kg) which shows effectiveness of 52% ± 2.4 and Glucophage (500mg/kg) which shows effectiveness of 29% ± 2.1. Results indicate that bitter melon contain anti-hyperglycemic proteins which are helpful in diabetes treatment without any toxic side effects. Still more research, experiments and testing needs to be perform. Keywords: Amaryl; Anti-hyperglycemic effect; Blood glucose levels; Body weight; Diabetes mellitus

Background: Cardiopulmonary resuscitation (CPR) knowledge and training among junior doctors is very important as the junior doctor is mostly the first one to attend the patients in emergency room. Unfortunately, they don’t have enough knowledge. Healthcare professionals need to have hands-on practice regularly in order to retain the BLS skills. Aim: To determine the frequency of adequate knowledge of basic life support among Post graduate residents. Method:A Descriptive, Cross-sectional study was conducted from November 2017 to May 2018 in the Children’s Hospital Lahoreand from June 2022to August 2022 in Government Kot Khawaja Saeed Teaching Hospital, Lahore. A total of 96doctors of all 4 years of postgraduate training program of either genderwere included. A questionnaire was prepared. It included demographic data and BLS knowledge assessment. It was distributed to participants who met the inclusion criteria. It did not contain the name of the participant and confidentiality was maintained. Questionnaire was collected back after the completion and knowledge score was noted as described in questionnaire. Score >8 was taken as adequate knowledge. Results: Mean age was 28.76 ± 2.29 years. Out of 96 participants, 70 were from Children Hospital and 26 from Govt. Kot Khawaja Saeed Teaching Hospital KEMU, 50(52.08%) were males and 46(47.92%) were females. The male to female ratio is 1.1:1. Mean time duration since BLS course attended was 9.12±4.54 months. Mean score was 11.78±3.98. This study has shown frequency of adequate knowledge of basic life support among pediatric residents in 57(59.38%) participants and remaining 39(40.62%) participants showed no adequate knowledge. Conclusion: It is concluded that frequency of adequate knowledge of basic life support among postgraduate residents is good. Keywords: Basic life support (BLS), Pediatric Advanced Life Support, residents, adequate knowledge.

Aim: The purpose of this study was to evaluate the differences between PHILOS and T plates in terms of functional recovery and fracture union after proximal humerus fractures. Study Design: Prospective study Place and Duration: Bahawal Victoria Hospital, Bawalpur/Nishtar Hospital, Nishtar Medical University, Multan. Jun 2020-January 2022 Methods: There were a total of 48 patients, both sexes, ranging in age from 20 to 75. All the included patients had humerus fractures and admitted to hospital for operation. Age, sex, BMI, fracture aetiology, and fracture side were recorded together with other pertinent demographic information after obtaining written consent from the patients. Patients were equally divided in two groups. Group I received Proximal Humerus Internal Locking System (PHILOS) in 24 cases and group II 24 cases received T platting. Patients were followed for 12-months. Post-operative functional and union outcomes among both groups were assessed. We used SPSS 26.0 to analyze all data. Results: There were 36 (75%) male patients and 12 (25%) females among all cases. In group I mean age was 47.9±8.42 years with mean BMI 23.6±4.23 kg/m2 while in group II mean age was 50.3±7.29 years and had mean BMI 24.5±3.42 kg/m2.RTA was the most common etiology found in group I 13 cases and 12 cases in group II. Right was the most common affected side among all cases 15 in group I and 14 in group II. Mean operative time of T plates 131.3±12.16 minutes were higher as compared to PHILOS 121.2±17.40 minutes. Blood loss was also higher in T plates as compared to PHILOS with p value

Objectives: To examine the occurrence of pneumonia linked with a ventilator in the neonatal intensive care unit and to determine the related risk factors. Purpose of study: To better identify the associated morbidity and mortality, pathophysiology, and recommended measures to avoid this disease, paediatric VAP diagnosis methods must become more standardized and exact. Study design: A cross-sectional study Place and Duration: This study was conducted at Aga Khan University hospital from May 2021 to May 2022 Methodology: This study includes a total of 70 participants admitted in neonatal intensive care unit. All the patients were put under the ventilator for more than 2 days. At the time of admission, the X-ray of the chest was performed, and it was also performed every day. When certain organisms were present on the tracheal aspirate, ventilator-associated pneumonia (VAP) was diagnosed. After 2 days of ventilation, microbial analysis and gram staining were done for tracheal aspirates. They were later examined to determine the occurrence of nosocomial pneumonia and what are the risk factors linked with it. A Chi-square test and t-test were conducted to examine all the data. A confidence level of 0.05 was set. Results: Pneumonia associated with the ventilator occurred in 31.4% of the participants where a large number had developed it between 4-14 days after intubation. There were certain risk factors that were determined in our research. They include the use of H2 blockers, invasive lines, low PaO2/FiO2, and re-intubation. There were two things (use of steroids and enteral feeding through nasogastric) that were not linked with the occurrence of this pneumonia. The patients who were in the group of ventilator-associated pneumonia were having a longer time period of stay and mechanical ventilation. Practical implication: In newborn and paediatric intensive care units, VAP continues to be a significant and unresolved problem. The results of this study will highlight the numerous elements that significantly contribute to ventilator-associated pneumonia. Conclusion: The occurrence of pneumonia associated with ventilators is high. Those patients who were having above mentioned risk factors should require pay special attention towards prevention. Keywords: pneumonia, ventilators, ventilator associated pneumonia, neonatal intensive care unit

Background: Primary dysmenorrhea is the common gynecologic problems, particularly among adolescent girls. The pain is severe during the first and/or second day of bleeding & usually lasts up to 72 hours. More than 55 to 80% of post-menarche women are thought to experience primary dysmenorrhea. Both vitamin E and a placebo may lessen dysmenorrhea-related pelvic pain, although vitamin E appears to do more significantly Objective: To find the role of vitamin E in the treatment of Primary dysmenorrhea Methodology: This randomized placebo-controlled trial was conducted at JankiDevi Jamiat Singh Maternity Hospital Lahore and Sir Syed Hospital Karachi from 1stJune 2021 to 31stMay 2022. Sample size 70 with age 16-28 years with unmarried women; regular menstrual cycles; no urogenital disorders; no previous history of abdominal or pelvic surgery. To check severity of pain we used Visual Analog Scale (VAS) & Cox Menstrual Symptom Scale (CMSS) was used for grading the pain duration. Pain duration was categorized as follows: score 1: ≤0-0.5 hours of pain; score 2: 0.5-1 hours of pain; score 3:>1 hour of pain; score 4: >1 day of pain. Two groups were formed from the sample. Vitamin E 400 units/day in two divided doses was prescribed for the first group to begin the treatment course (5 days in a month,), and Placebo was given to the second. Data was entered and analyzed in SPSS. Result: Total 70 were enrolled. There were 35 women given Vitamin E and 35 were given placebo. In Group 1, the mean age was 21.57+ 3.35 and in Group 2, the mean age was 22.0+3.05.Before treatment, the mean of VAS pain score was 49.29 in Vitamin E group ad placebo group was 58.71mm and after treatment, the mean of Vas pain score was reduce to 34.60 in vitamin E group and placebo group was 44.48. A significant difference was found the severity of pain and duration between the pre- and post treatment in both groups. Table: 2,3 As the comparison indicates, no significant differences were found regarding severity of pain and duration between the groups. ( p < 0.05). This study will help the practioners,gynecologist for in the treatement of primary dysmenorrheal further this will also open the doors for further researches in this field. Conclusion: Vitamin E helps to relieve pain in primary dysmenorrhea. It can be considered as a universal medicine in the treatment of primary dysmenorrhea since it is a very simple way for pain control with fewer side effects and is cost-effective. Keywords: Dysmenorrhoea, Vitamin-E, nausea, vomiting, gastrointestinal symptoms

Aim: To determine the histopathologic healing patterns after tonsillectomy done by dissection ligation versus electrocautery technique. Setting: ENT Unit II of Fatima Jinnah Medical University Sir Ganga Raam Hospital Lahore Duration: 1st July 2021 to 30th June 2022 Study Design: Randomised control trial Sampling: Total of 106 patients were included and divided into 2 groups with probability simple random sampling. Methods: All patients of 10 to 18 years of age with history and examination that was consistent with recurrent tonsillitis were included. Group A underwent tonsillectomy with dissection-ligation technique and Group B with electrocautery. At 7th post operative day tissue samples were taken from palatopharyngeal arch and sent for histopathologic evaluation and healing was graded as good, fair and poor. Patients with acute inflammatory conditions of tonsil or suspicion of malignancy, post tonsillectomy hemorrhage and those with co morbidities were excluded. Results: Mean age of Group A was 13.79 years and in Group B mean age was 13.54 years. When we calculated the association of inflammation, granulation tissue formation, pattern and orientation of collagen fibers between the two groups, the resulting p value was

Background: The muscles that sustain body posture and the neck posture both have an impact on the cervical muscle, which is also frequently injured. The upper trapezius muscle is most frequently affected by trigger points, which is a common and prevalent condition. Aim: To assess the effectiveness of ELDOA exercises at the cervical spine and treating trigger points in the trapezius and levator scapulae. Methodology: The Ibn-e-Siena Hospital and Research Institute in Multan conducted a quasi-study. The participants were divided into two groups using a coin flip as a sampling method with the study sample size of 26. The Goniometer, Numeric Pain Rating Scale and Neck Disability Index were used to collect data from patients between the ages of 18 and 40. Results: An independent t-test was applied. Mean age ranged from 24.70±5.75 in the experiment group and 25.18±5.61 in the control group. The patients have radiated pain in control group was 3 (30%), trapezius trigger point7(70%) andlevator scapulae 3(30%) while in experimental group, pain radiating 6(60%), trapezius trigger point6(60%) and levator scapulae 4(40%). The post-results data revealed that the p values for the NPRS, Algometry and NDI significant differences were 0.025, 0.025, and 0.00, respectively. Conclusion: The results of the current investigation, the ELDOA approach considerably reduced discomfort, cervical ranges, and neck impairment brought on by trigger points. Keyword: Neck pain, Trigger Point, Skeletal Muscle, Myofascial Pain, Active Soft Tissue Release

Objectives: To identify levels of the physical activity and patterns of eating habits among medical students of Islamabad and to determine the association of BMI with physical activity and eating habits among medical students of Islamabad. Study Design and Setting: A cross-sectional survey was done in a private and public medical college of Islamabad. Methodology: A total of 463 MBBS students of 1st year to 5th year were included and data was collected by non-probability convenience sampling. Before initiating study enrolment an ethical approval for study was gained from the institutional ethical board. After signing the consent form, the questionnaire was filled formally. Data was analyzed by SPSS 22.0. P value < 0.05 was considered as statistically significant Results: 236 of our population were normal and 117 of our population were overweight, whereas 59 were underweight and 51 were obese. Lack of time for physical activity in time table was the most common occurring barriers of physical activity. The most common occurring barrier to optimum eating practices were lack of money, tasty fast food and don't like home cooked food. Results showed statistically significant relationship between the hours of exercise per week and the BMI status. The Chi-Square value (P-Value) for physical activity and eating habits in association with BMI were 0.228 and 0.570 were insignificant. Conclusions: Results concluded that bad eating habits and lack of physical activity affects the BMI. Individuals in obese group had increased BMI, lack of physical activity and bad eating habits. Keywords: BMI, PAL, Obesity, Medical

Objective: To depict and characterize CT patterns of omental pathology and to determine the validity of omental caking in diagnosis of ovarian cancer. Methodology: A cross-sectional study was conducted in a tertiary care center between January 2020 to February 2021. In this study, 64 consecutive female patients with omental pathology, scheduled for biopsy, surgery and follow up were included. All CT scans were reviewed and findings were discussed with the consultant radiologists. The results were compared and confirmed on histopathology by either open surgical biopsy or per-cutaneous needle biopsy. Result: A total of 64 patients were enrolled in the study. Omental caking on computed tomography was identified in 44 (68.8%) patients. Presence of Omental caking was significantly associated with ovarian cancer (p

Aim: To assess the treatment preference of dentists working in Karachi for clinically managing pulp exposures and their choice of material for Direct Pulp Capping. Methods: A cross-sectional survey performed from 1st Nov 2018 to 15th April 2019 by selecting a simple random sample of 600 dentists from the 15 dental colleges. Total of 600 questionnaires was sent to the participants with the request to return it on or before 15th April 2019. Results: Significantly high number of responders, regardless of their clinical experience, handle pulp exposures with RCT in case of exposure ≤ 1mm (p=0.001), carious exposure (p=0.001) and mechanical exposure(p=0.001). The frequency of practitioners performing total caries excavation with definitive restoration was significantly higher (p=.001). The frequency of using Calcium Hydroxide (CH) for DPC was significantly higher (p=.001) as compared to other materials. Conclusion: It appears as if current evidence-based philosophy of conservative approach to deal with pulp exposures has not yet been completely adopted by responding clinicians and tendency to treat pulp exposure through RCT prevails. The majority of the dentists still employs CH as a material of choice for DPC. Keywords: Dental Pulp Capping (MeSH); Pulp Capping Agents (MeSH).

Multidrug-resistant Escherichia coli have become a main public health distress in Pakistan and many countries, causing failure in treatment with the resultingenormous health burden. The current study was aimed to find the prevalence of E. coli among clinical isolates and their antibiotics susceptibility pattern using standard procedures. The Purpose of the present study to investigate the Prevalence and antibiotic susceptibility pattern of E. coli detected from clinical patients visiting Khyber teaching hospital Peshawar. In this study a total 415 sample were isolated from the patient of Khyber teaching hospital (KTH) Peshawar. The collected samples were processed for identification including Gram staining and biochemical test. Furthermore, the antibiotic susceptibility pattern of all the positive strains of E. coli was tested using selected antibiotic discs by disc diffusion method as per CLSI guidelines 2019.A total of 415 samples, 112 clinical isolates yielded the growth of E. coli using standard procedures. Out of 112 isolates, 52% were recovered from male patients while 60% were females. The positive samples were obtained from urine (58%), pus (14.3%), swab (8.9%), sputum (10.7%), and others 8.0% respectively. The highest sensitive drugs are FOS (99.1%), AK (98.2%), TZP (97.3%), MEM (93.8%), TGC (91.1%), CN (89.3%), SCF (78.6%), DO (65.2%), CT (60.7%), F (49.1%), ATM (27.7%) AMP (23.2%), CAZ (23.2%), CPM (22.3%) , CRO (19.6%) ,CTX (13.4%) and the lowest sensitive drug is CIP which is (7.1%) . The drugs which show high resistance are CIP (92.9%), CTX (86.6%), CRO (80.4%), CPM (77.7%), CAZ (76.8%), AMP (76.8%) , ATM (72.3%) , CT( 39.3%) , DO (34.8%), SCF (21.4%), CN(10.7%),TGC(8.9%), F(8.9%),MEM(6.3%) ,TZP(2.7%),AK (1.8%) ,and the lowest resistance drug is FOS (0.9%).Drug resistance monitoring and the epidemiological analysis of patient data are needed regularly and can be useful for the adequate management of antimicrobial resistance. Key words: Multidrug-resistant, Antimicrobial Resistance, Clinical Isolates, Bacteria, Peshawar

Background: So far more than 253 million cases & more than 5 million casualties worldwide, while more than 1 million cases and more than 28 thousand casualties have been reported in Pakistan due to pandemic of Novel Corona Virus (COVID19). At the end of December 2019, a pneumonia outbreak began in Wuhan China, which then quickly spread to entire world. The viral pneumonia was named “Corona Virus Disease (COVID19)” by WHO on 11th February 2020. On March 11, 2020; WHO declared this outbreak as “Pandemic”. Its mode of transmission includes contact transmission through mucous membranes of nose, mouth & fomites, and direct transmission through sneeze, cough and inhalation of droplets. It can be transmitted indirectly or directly via saliva, aerosols formed throughout clinical procedures and via contact. Clinical symptoms included fever, muscle ache or pain, cough. Incubation period of 1–14 days. In this pandemic, dentists are rated as highly exposed health care professionals to this disease Aims: To describe Coronaviruses and its modes of transmission and to discuss treatment considerations and precautionary measures or clinical strategies adopted by Oral health professionals to protect themselves and to prevent the spread of coronavirus in the dental setup Methodology: Since it’s a Literature review article, so no methodology was required as such Results: It’s a Literature review article Conclusion Standard precautionary measures and highly responsible behavior of a dentist will prevent the spread of this disease especially from asymptomatic patients. Keywords Aerosols generation, COVID-19, Dental procedures, Oral health professionals, Pandemic, Precautionary measures

The purpose of this study was to determine how common vitamin D insufficiency is among TB patients between the ages of 2 and 12. Specifically, a descriptive and cross-sectional research strategy was used for this investigation. The research was conducted in the Faisalabad, Pakistan location of the DHQ Hospital's Pediatric Medicine Division. Material and Methods: In this study, total 93 patients presented to the out-patient department of Pediatrics Medicine, DHQ Hospital, Faisalabad were selected from: December, 2021 to May, 2022 and informed written consent was taken. Blood sample 3 ml of each patient was sent vitamin D levels for presence or absence of vitamin D deficiency. Results: Among the 93 cases, 44.09% (n=41) were between 2-6 years of age whereas 55.91%(n=52) were between 7-12 years of age, mean+sd was calculated as 7.14+2.22 years, 54.84%(n=51) were male whereas 45.16%(n=42) were females. Frequency of Vitamin D deficiency among children suffering tuberculosis age 2-12 years shows that 49.46% (n=46) had vitamin D deficiency. Conclusion: We concluded that the frequency of vitamin D deficiency is higher among children suffering with tuberculosis age 2-12 years; however, further multicenter studies are required to validate our results. Keywords: Children, tuberculosis, vitamin D deficiency, TB

Aim: To compare advantages and postoperative outcomes of harmonic scalpel versus conventional homeostasis in patients undergoing near-total thyroidectomy at a tertiary care hospital. Material and Methods: Total 34 patients were recruited in the study, and were equally distributed in two groups using blocked randomization. Operative time, post-operative fluid drainage, post-operative blood loss, mean hospital length, and occurrence of hypocalcemia were assessed in two groups. Results: In group A, mean operative time was 89.71±13.34 Mins while in group B it was 105±6.75 Mins, statistically significant difference was observed. In group A, post-operative blood loss observed was 61.47±8.27 ml, and in group B 74.47±12.80 ml (P < 0.05). The mean post-operative fluid drainage recorded in group A was 45.29±6.98 ml and in group B 69.06±10.83 ml (P < 0.05). In group A, mean hospital length was 2.18±0.72 days and in group B 3.41±1.12 days (P < 0.05). In group A, occurrence of hypocalcemia was 2 (11.8%) and in group B 3 (17.6%) (P > 0.05). Conclusion: In terms of operation duration, mean hospital stay, postoperative fluid drainage, and postoperative blood loss, harmonic thyroidectomy provides a secure and efficient substitute for traditional homeostasis. Keywords: Conventional Homeostasis, Postoperative Blood Loss, Harmonic Scalpel, Thyroidectomy

Objective: Effectiveness of aspiration under ultrasound guidance in breast abscess in terms of early resumption of breast feeding. Study Design: Randomized controlled trial Place and Duration: Mardan Medical Complex and Teaching Hospital and Jinnah International Hospital, Abbottabad, from November, 2021 to April, 2022. Methods: There were a total of 140 female participants. The patients ranged in age from 16 to 50. After obtaining the patient's written consent, demographic information including age, weight, height, and body mass index were collected. Breast abscess diagnosed on clinical examination and ultrasound breast were included. Seventy patients were assigned to Group I and treated with percutaneous aspiration, whereas the same number were assigned to Group II and underwent incision drainage. Early breast feeding was restored in both groups and compared for their respective outcomes. The entire dataset was analyzed using SPSS 20.0. Results: We observed that the percentage of patients in group I who were able to resume breast feeding was 61 (87.1%), and in group II was found in 42 (60%) patients. The level of comfort experienced by patients in group I 60 (85.7%), as compared to group II 35 (50%), was significantly greater. Conclusion: In this study, we came to the conclusion that percutaneous aspiration in breast abscess was successful and effective in comparison to incision drainage, with less problems and a high percentage of satisfaction among the women. Keywords: Incision drainage, Breast abscess, Percutaneous aspiration

Objective: The purpose of this study is to ascertain the prevalence of preeclampsia-related acute renal injury among patients who report to a tertiary care facility. Methodology: This Cross-sectional study was conducted at King Edward Medical University and allied hospitals in Department of Nephrology/Mayo hospital Lahore and department of Gynecology, Lady Atchison Hospital Lahore, affiliated with King Edward Medical University. After obtaining the patient's informed consent, if the patient is able to give it; otherwise, consent was obtained from the attending guardian; the study included all 180 pregnant females with acute kidney disease who were in the third trimester of pregnancy and were presenting for delivery. Patients' ages ranged from 15 to 50 years. Women who were pregnant and had a blood pressure reading that was greater than 140/90 mmHg after 20 weeks of pregnancy and who had proteinuria on a urine dipstick examination were recorded. This information was taken from a previous record. The laboratory at King Edward Medical University and Mayo hospital in Lahore was where all of the investigations were carried out. Following the establishment of a diagnosis, the patients were then treated in a hospital environment in accordance with the protocols. Results: Patients' mean ages were 30.21+5.35, their mean blood pressure was 154.27+108.15 mm Hg, their mean serum creatinine was 4.39+0.28 mg/dl, the mean frequency of urine protein was 112.22 percent, and the mean frequency of preeclampsia-induced AKI in pregnancy was 26.11 percent. Conclusion: This research led me to the conclusion that preeclampsia-induced acute kidney damage occurs frequently and must be detected and treated effectively to prevent maternal mortality and morbidity and to improve foetal outcome. A nephrological workup should be performed on women with pre-eclampsia if their proteinuria and hypertension persist longer than 6-8 weeks after delivery. Keywords: Pre-eclampsia, acute kidney injury, frequency

Objective: To compare short term post-operative complication of laparoscopic transabdominal preperitoneal (TAPP) and Lichtenstein’s tension free hernia repair. Study Design: Randomized clinical trial. Place & Duration of Study: Surgical Unit of Khyber Teaching Hospital (KTH) Peshawar during the period of 6 months from 1st January, 2020 to 30 June, 2021. Material and Methods: In this study 492 cases of inguinal Hernia with 246 in each group. For group A, laparoscopic TAPP repair were performed with 10cmx 15cm polyprophlene mesh (prolene-Ethicon) and were fixed with tackers (Protack 5mm fixation device - covidien). For Group B Lichtenstein’s repair were performed through supra inguinal incision, using 10cmx 15 cm polypropylene mesh (prolene- ethicon). Then the patients were monitored for short term post-operation complication post-operatively. Results: Our study shows that in Group A(Laparoscopic TAPP) mean age was 42 years with SD ± 8.13 and in Group (Lichtenstein repair) mean age was 45 years with SD ± 8.13. In Group A (Laparoscopic TAPP) 99% patients were male and 1% patients were female while in Group B (Lichtenstein repair) 99% patients were male and 1% patients were female. In Group A(Laparoscopic TAPP), urinary retention was 5(2%), hematoma was 5(2%), surgical site infection was 10(00%), Ischemic orchitis was 2(1%), seroma was 20(8%) While in Group B (Lichtenstein repair). urinary retention was 25(10%), hematoma was 39(16%), surgical site infection was 66(27%), Ischemic orchitis was 5(2%), seroma was 54(22%). Conclusion: Frequency of short term post operative complication are higher in Lichtenstein’s tension free hernia repair as compare to laparoscopic transabdominal preperitoneal (TAPP) group. Keywords: Short Term, Post-Operative Complication, Laparoscopic Transabdominal Preperitoneal (TAPP), Lichtenstein’s Tension Free, Hernia Repair.

Background and Aim: Anemia is an extra intestinal manifestation of inflammatory bowel disease that frequently causes complications. In inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease, anemia is mostly caused by iron deficiency which impacts the patient's quality of life [1, 2]. The present study aimed to assess the anemia in ulcerative colitis patients in remission. Methodology: A cross-sectional study was conducted on 82 ulcerative colitis patients at the Department of Medicine and Gastroenterology, Jinnah hospital, Lahore from February 2021 to January 2022. All the patients were assessed for anemia based on Mayo clinical score

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e.

Objectives: To compare the perinatal outcome (low birth weight, preterm delivery) in women with 28 weeks assessed on LMP were selected for this study. Patients were divided into two groups (A & B) according to their inter-pregnancy interval i.e.

Objective: The purpose of this study is to determine the comparative outcome of obesity in ischemic heart disease. Duration of Study: July, 2021 to Dec, 2021 Place and Duration: CCU department D.G. Khan Medical College and Teaching Hospital Dera Ghazi Khan Methods: This research included 180 participants of both sexes. Patients were between the ages of 22 and 80 years old, according to the study. As part of their informed written permission, researchers collected demographic information such as age, sex and BMI. Patients were divided in two groups, group I had 90 obese patients and group II had non obese 90 patients. Follow up among patients were taken in duration of 12 months. Both groups' outcomes were evaluated and compared in terms of increase in risk factor of IHD, myocardial infarction and mortality because of these factors. SPSS 22.0 was used to analyze complete data. Results: There were 55 (61.1%) males and 35 (38.9%) females in group I and in group II 46 (51.1%) males and 44 (48.9%) females in group II. The mean age of the patients in group I was 41.4±11.62 years and had mean BMI 32.14±21.86 kg/m2 while in group II mean age was 38.41±12.42 years with mean BMI 25.2±11.34 kg/m2. 40 (44.4%) patients in group I and 45 (50%) patients in group II was educated. In group I 25 (27.8%) patients were smokers, 19 (21.1%) patients had DM and in group II 27 (30%) were smokers and 5 (5.6%) cases had DM. We found increase in Ischemic heart disease in 65 (72.2%) cases of group I and in group II IHD was found in 11 (12.2%) cases. Frequency of Myocardial Infarction was also higher in obese patients than non-obese cases. Systolic and diastolic blood pressure was also higher in obese patients. HDL was lower in obese patients while cholesterol, LDL, triglycerides and CRP was found higher in obese patients. Mortality in obese patients with IHD was 12 (13.3%) but no any mortality found in non-obese cases. Conclusion: In this study we found that obesity and increase in weight is a significant risk factor for ischemic heart disease and myocardial infarction and because of these diseases patients had poor outcomes with increase in rate of deaths. Keywords: MI, IHD, Mortality, Obese, Smoking