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Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.

Background: Habitual cotton bud usage can result in cerumen impaction caused by pushing the cerumen deep into the canal, trauma to ear canal by damaging the surrounding epithelium, tympanic membrane perforation and otitis externa due to the infection with bacteria or fungi on already damaged epithelium. Objectives: The main objective of this study is to understand the perception of masses about cotton buds, their attitude towards its usage and also to investigate the factors that increase its usage. Methodology: This is a descriptive cross-sectional study done from August, 2019 to October, 2019. The study was carried out among patients visiting the Out-Patient Department (OPD) of ENT at District Headquarter Hospital, Rawalpindi. A descriptive analysis showing frequencies and percentages of responses was carried out using the Statistical Package for Social Sciences (SPSS) v.23.0 (IBM, Armonk, US). Results: Out of 250 questionnaires distributed, 196 were correctly filled giving us a response rate of 76.8%. The age ranged from 15 to 75 with a mean of 33.6(SD=13.46). The majority was being formed by males (61.5%). A majority of patients 104(54.2%) considered that use of cotton bud is beneficial for the ear while 72(37.5%) had a neutral response. Out of 192 respondents, 82(42.8%) were of the view that usage of cotton buds could be hazardous. Most of the participants 166(86.5%) used cotton buds by themselves without someone else’s advice. Using cotton buds after having a bath (42.7%), once a week (58.3%) was a common practice among respondents. Most of participants (69.8%) were using cotton buds for more than one-year. Conclusion: As is evident in the results of our study, the habit of using cotton buds is still prevalent in our community, which signifies a major lack of awareness. Thus, efforts must be made to educate the population regarding the potential harm that this seemingly inconsequential practice can cause in the long run. Keywords: Cotton bud use, Ear pain, Tertiary care Hospital, wax removal.

We consider the effect of auditor tenure on the level of managerial fraud and the extent of auditor qualification of reports. We consider two conflicting effects. As auditor tenure increases, the auditor's ability to detect fraud increases (the learning curve effect), which reduces the manager's fraud incentives. On the other hand, the auditor may become more sympathetic towards management (the loss of independence effect), which may increase fraud incentives. In order to analyse these issues, we develop an auditing game in which the manager makes an unobservable decision whether or not to commit fraud. The auditor then decides whether to perform a basic or extended audit. The level of audit affects the probability of fraud-detection. Following the outcome of the audit, the auditor then decides whether to issue a qualified or unqualified report. In equilibrium, the effect of auditor tenure on fraud and report qualification depends on whether the auditor's ability or the auditor's loss of independence dominates. Interestingly, longer auditor tenure may result in lower levels of report qualification due to two possible reasons; either an increase in auditor empathy (turning a blind eye to fraud), which suggests that auditor tenure may lead to more fraud, or an increase in the auditor's ability to detect fraud, which acts as a deterrence, leading to less fraud. Next, we consider evidence regarding the relationship between auditor tenure, managerial fraud and report qualification. First, we test our model using a database comprising a ten-year history of UK entities filing qualified financial statements in order to empirically test the relationship between length of auditor tenure and report qualification, and the impact of auditor change. We confine our analysis to simple qualification of financial statements. Our empirical results suggest that auditors with longer term relationships with their clients are less likely to qualify accounts in later years, and consider the impact of this on audit planning. Second, we conduct a survey of bankers, accountants and auditors in Pakistan regarding their perceptions of the relationship between auditor tenure and auditor independence. Finally, we develop and conduct a behavioural experiment regarding the effect of client-auditor relationships on report qualification. We conclude by considering the ethical dimensions of our model, and we provide policy implications in relation to the ongoing debate regarding mandatory turnover of auditors.