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Background: Dengue fever is a viral disease caused by four different serotypes of dengue viruses from DENV, transmitted mostly by the Aedes aegypti mosquito. The disease has history of many outbreaks mostly in tropic and sub-tropic countries, costing many lives annually, with millions in mild to complicated forms, bringing stress to health systems and economies of poor countries. Dengue epidemic occurred in Pakistan in 2010 with 257 deaths during the epidemic and prevalence of 16580 cases in Rawalpindi, repeated epidemic in 2015, 2017, 2018 and 2019 with higher prevalence. Objective: To determine the frequency of dengue hemorrhagic fever in patients of dengue fever and to compare mean platecrit and platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever. Materials And Methods: The design of this study was an observational cross sectional study design. This study was conducted in the Department of Infectious Diseases, Holy Family Hospital, Rawalpindi and the duration of this study was 6 months after the approval of synopsis i.e 1st May 2021 to 30th Oct 2021. Patients fulfilling selection criteria were enrolled in the study from emergency of Department of Infectious Diseases, Holy Family Hospital Rawalpindi. Informed consent was taken. Then patients were evaluated and divided for severity score (annexure I). Reports were assessed for Platelet indices including platelet count, mean platelet volume, platelet distribution width (as per operational definition). All this information were recorded on proforma (attached). Results: Total 150 participants were enrolled in the study as per the inclusion criteria. Mean age in the study was 38.42+13.74 whereas there were 94 (62.7%) male and 56 (37.3%) female patients who were included in the study according to the inclusion criteria. Among 150 patients, 28 (18.7%) patients were presented with dengue hemorrhagic fever in patients of dengue fever. Mean Platecrit indices in patients with or without dengue hemorrhagic fever due to dengue fever in the study was 0.26+1.62 vs 0.08+0.02 (p-value 0.552) whereas mean platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever in the study was 64.19+41.11 vs 78.10+32.74 (p-value 0.097). Practical Implication: To determine the frequency of dengue hemorrhagic fever in patients of dengue fever and to compare mean platecrit and platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever Conclusion: The study concluded that different indices of platelets within different forms of dengue fever to assess the severity of the disease process may serve as an early indicator of disease progress and severity which will help to decide early intervention. Keywords: Dengue Fever, Hemorrhagic, Platelet, Indices, Serotypes, Epidemic, Participants

Introduction: To determine reliability of leukocyte count on admission for prediction of mortality among patients with organophosphorus intoxication. Early prediction can help in preventing the poor outcome and improved management. This is cost and time effective method and better management and preventive protocols can be developed. Objective: To determine the diagnostic accuracy of leukocyte count in prediction of mortality in patients with organophosphorus intoxication keeping actual mortality as gold standard. Material and Methods: The design of this study was a Cross sectional study design. The duration of this study was six months from 31-03-2020 to 30-09-2020 and this study was conducted in the Department of Medicine (unit II), HFH, Rawalpindi. A total of one hundred and sixty (n=160) patients of either gender between age between 16-85 years who were confirmed cases of organophosphorus poisoning were enrolled. Leukocyte count levels were noted at the time of admission and patients were monitored for 7 days in the hospital for mortality. Results: The results showed that sensitivity, specificity, positive predictive value, negative predictive value and accuracy of raised leukocytes counts (>12000/uL) at admission as 60.4%, 77.8%, 50.0%, 84.3% and 73.1% respectively. ROC curve showed best cutoff value of raised leukocytes counts (>12000/uL) at admission as 10253/uL, where sensitivity of 72.1% and specificity of 58.1% was achieved. Area under the curve (AUC) was calculated as 0.707. Practical Implication: To determine the diagnostic accuracy of leukocyte count in prediction of mortality in patients with organophosphorus intoxication keeping actual mortality as gold standard Conclusions: Raised leukocytes counts (>12000/uL) at admission allowed prediction of mortality in patients with organophosphorus poisoning with reasonable accuracy. Our study results showed sensitivity, specificity, PPV, NPV and accuracy of 60.4%, 77.8%, 50.0%, 84.3% and 73.1% respectively. Keywords: Leukocyte Counts, Organophosphorus, Poisoning, Mortality, Intoxication, Predictive Value, Morbidity.

Objective: To compare the effect of Amitriptyline and Pregabalin in treatment of painful diabetic neuropathy. Material and Methods: The design of this study was Randomized Controlled Trial study design. This study was conducted in the Department of Medicine in, Holy Family Hospital, Rawalpindi and the duration of this study was Six months after the approval of synopsis i.e from 1st November 2019 to 1st May 2020. Approval from ethical committee of the hospital was taken. Written informed consent was taken from patients. Consent form is attached with this. Patients were randomly allocated into two groups by lottery method. The dose of Pregabalin was used as 50mg thrice daily for a period of six weeks and label as group-A and group B received amitriptyline as 25mg once daily before bedtime for a period of six weeks as prescribed by a senior consultant who was blind to object of the study. At the start and end of treatment pain was marked by patients on Visual Analogue Scale (VAS) and numerical score. It was noted on the Performa. Results: Total 100 patients were included according to the inclusion criteria of the study. The dose of Pregabalin was given in patients in group-A and group-B received amitriptyline. Mean age (years) in the study was 55.87+6.43 whereas there were 55 (55.0) male and 45 (45.0) female patients who were included in the study according to the inclusion criteria. In our study, frequency and percentage of effect (pain relief) among Pregabalin and Amitriptyline in treatment of painful diabetic neuropathy was 27 (54.0) and 11 (22.0) respectively which was statistically significant (p-value 0.001). Practical Implication: In this study Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of amitriptyline and Pregabalin in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Conclusion: The study concluded that Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of Pregabalin and amitriptyline in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Keywords: Amitriptyline, Pregabalin, Neuropathy, Pain Relief, Diabetic Sensorimotor Polyneuropathy, Prevalence.

Background: Human papilloma virus is a large group of DNA containing viruses that infect squamous epithelium of skin or uncornified mucous membrane. Aim: To compare the outcomes of MMR vaccine V/S 5 fluorouracil in treatment of palmo-plantar warts in patients among male and female patients. Study Design: Experimental study. Methodology: In order to collect the data, simple random sampling technique was used. Enrolled patients (n=102) were divided into two groups. Group-A received intra-lesional MMR vaccine (0.1-0.5mal) while other group received intra-lesional 5-Fluorouracil (0.1-0.5mal) injection. Both groups received intra-lesional injections in warts at 2 weekly interval for 3 months. SPSS v 23 evaluated data. Chi-square test was used to compare the gender distribution, results, responder and recurrence between both groups with p-value less than 0.05 as significant. Results: Mean age of the patients of group A was 30.5 ± 6.0 and the mean age of patients of group B was 28.2 ± 8.7 years. In Group A, 33 patients (58.9%) were responders, while in Group B, 43 patients (76.8%) were responders. P-value (0.043) suggested that the difference in response rate between the two groups was statistically significant. Practical Implication: This study compared the efficacy of two different treatment options that were commonly used in palmo-planter warts management. Secondly, it added to local literature regarding their efficacy in comparison to each-other. Conclusion: It was concluded that intra-lesional 5-FU was more safe and effective treatment in comparison to injection MMR for palmo-planter warts as it showed high response rate with low recurrence. Keywords: Efficacy, MMR Vaccine, Response Rate, 5-Flourouracil and Intra-lesional Injection.

Background: Warts are lesions that grow on the human skin due to infection named human papilloma-virus (HPV) type 1, 2, and 4. More than 100 types of HPV virus have been identified now. Aim: To compare the efficacy of adapalene and electrocautery therapies in managing plane warts. Study design: Randomized Control Trial. Methodology: A total of 52 patients via non probability consecutive sampling technique with plane warts were enrolled and randomly divided into 2 equal groups. The patients of Group A were treated with 0.5% Adapalene gel (applied twice daily over the lesions for maximum 3 months or until resolution of warts) and patients in group B were treated with electro-cautery procedure fortnightly for maximum 3 months or until resolution of warts). Patients were assessed after every 2 weeks for initial 3 months and then these patients were followed monthly for another 3 months and final outcome was seen at 6 months. Data was evaluated by using SPSS version 23. Student-t test was applied with p-value than 0.05 taken as significant. Results: The mean duration of wart resolution was observed as 45.92±19.22 days in the adapalene group, while the electro-cautery procedure took 45 ± 17.81 days for wart clearance. There were no statistically significant differences in the complications between the two groups (p=0.60). Practical Implication: Although successful outcomes have been achieved in many studies by using Adapalene and electrocautery separately for treating warts but none of the published research compares these two treatment modalities (Adapalene vs electrocautery) for treatment of plane warts as per our knowledge. Therefore to fill this gap, this study was designed to compare the efficacy of adapalene and electrocautery therapies. Conclusion: It was concluded that Both Adapalene and electrocautery are effective in treatment of plane warts and there are no statistically significant differences in the complications/side effects of these two treatment modalities. Keywords: Adapalene Gel 0.1%, Electrocautery, Plane Warts, Clinical Outcomes and Effectiveness.

Background: Almost 50% males face a health issue called androgenic alopecia and even almost 21 million women are affected too. Aim: To determine the efficacy difference of platelet rich plasma for treatment of androgenic alopecia among patients. Study design: Quasi experimental method. Methodology: In order to collect the data, the purposive sampling technique was used. Enrolled patients (n=102) were divided into two groups. Each group received PRP infections after every 1 month for 3 months. Follow up was done at 3 and 6 months. Results were assessed by standard photographs and Hamilton Norwood scale for men and Ludwig scale for women. SPSS v 23 evaluated data. Chi-square test was used to compare the efficacy of Platelet Rich Plasma for treatment of androgenic alopecia between genders. Results: Mean age of the study participants was 27.1±4.5 years. Independent sample t test revealed that the mean age of the female participants was significantly higher than male participants (p < 0.001). There was 100% response rate of PRP treatment for androgenic alopecia in both genders. Practical Implication: This study helped researchers in exploring the efficacy of PRP as a remedy for hair re-growth as it is cheap and safe. Secondly, it added to local literature regarding androgenic alopecia. Conclusion: It was concluded that sub-dermal PRP injections were effective among both genders with androgenic alopecia. Keywords: Efficacy, Androgenic alopecia, Response Rate, Treatment Options and Plasma Rich Proteins.

When compared to the open cholecystectomy, laparoscopic cholecystectomy (LC) has the benefits of less post-operative pain and quicker return to work. However, up to 80% of individuals after laparoscopic surgery still experience significant pain and needing pain relief. Methodology: The reason for this research was to compare the results of LC performed with and without LPP. LC requires the surgeon to choose a pneumoperitoneum pressure that maximizes working space while avoiding unintended side effects. This study used a Randomized Controlled Trial (RCT) design, and it was done at the West Surgical Ward at Mayo Hospital in Lahore. The study enrolled 60 participants who met the inclusion criteria. The patients were split in two groups: Low-pressure pneumoperitoneum-LPP (Group A) (06-10 mm of Hg) and pneumoperitoneum at standard pressure (SPP) is part of Group B. (12-16 mm of Hg). All had opted for a LC to treat their symptomatic gallstone disease. At 4, 8, and 24 hours following surgery, the severity of postoperative shoulder pain (if present) was evaluated using a visual analogue pain scale (VAS). The frequency of postoperative nausea and vomiting was assessed at 4, 8, 12, and 24 hours. Results: The patients were 35.63 years old on average. Majority of these two groups has no complications. Based on the data, we discovered that the frequency of episodes of nausea/vomiting in both groups was very low and that only a few patients had bouts of nausea/vomiting in the 4 hours and 24 hour time intervals. Conclusion: We have come to the conclusion that LP laparoscopic surgery is a viable and risk-free alternative to SP laparoscopic operation for the treatment of benign gall stone disorders. Our findings lead us to the conclusion that LPP is a superior option for the LC since it reduces the post-operative pain in the shoulder and the risk of PONV while not significantly increasing the risk of intraoperative complications. Keywords: Benign Gall Stone, Treatment, Low-Pressure Laparoscopic Surgery

The study of breast diseases and their epidemiology deserves special attention. Another reason that grants special value to the breast diseases is the way it affects women health both physically and mentally. The commonest breast symptom is breast lump. Breast lumps are the most common symptom bringing patient to a breast clinic. They are also the most common cause of serious trouble for the patients keeping in view the increased incidence of breast cancer. This is partially due to increased awareness among females. In this study we detected the frequency of clinically palpable breast lumps and their causes and treatment presenting to the breast clinic of a busy private sector hospital. Methods: Study design: Descriptive case series Place of study: Department of Surgery, Holy family Hospital Karachi Duration of study: 1 year (from July 2020 till June 2021) Study population: All females presenting to the breast clinic within the mentioned period Data collection procedure: All the information was taken by the patient through history. Informed consent was taken for examination. Further investigations according to the triple assessment protocol were done in patients who presented with a lump to ascertain the exact nature and etiology of lump. All the data was then entered in a predesigned proforma. Results: A total of 126 patients presented to the breast clinic in Holy family Hospital. The number of patients presenting with breast lump was just above half of the total patients i.e 66 patients (52%).Out of these 66 patients, majority was benign i.e 53 patients(80%) with malignant lumps accounting for 13 patients,20 % of the total patients with breast lump.60(48%) patients presented with symptoms other than breast lump. The most common symptom other than lump was pain followed by nipple discharge, skin diseases etc. Conclusion: Breast lump was the most common symptom in patients presenting to our breast clinic and majority were benign and did not require surgery. Keywords: Clinically Palpable, Breast Lump, Triple Assessment

Introduction: Dopamine (DA) is essential for the central nervous system (CNS) regulation of neurological, psychological, behavioral, and hormonal processes. Objective: In order to establish the viability of peripheral blood lymphocytes (PBL) as a molecular tool for examining DA dysregulation in neurological diseases, this research sets out to establish current characterization of the DA system in PBL. Methods: This study was carried out at Khyber teaching hospital from Jan 2022 to April 2022. Twenty-three (23) patients suffering with Parkinson's disease (PD) participated in that research (average age 56 years, mean disorder length 28 months). Nine of these participants received treatment with direct dopamine agonist medications, whereas the other 14 patients were drug-naive (levodopa-naive group). Results: Norpramin, a noradrenaline uptake blocker, established its efficacy at dosages numerous times elevated than blockers of dopamine uptake, but the serotonin uptake inhibitor Prozac was inactive. Dopamine transporter immunoreactivity levels varied significantly across groups, according to the ANOVA analysis (KW=27, P=0.001). Conclusion: PBL may function as a biological probe to identify DA transmission disruption in neuropsychiatric illnesses and to track the efficacy of pharmaceutical therapies Keywords: dopamine, dopaminergic system, peripheral blood lymphocytes, neuropsychiatric disorders

Background: The needs of iron for mother and fetus considerably increase during pregnancy. Its deficiency can be harmful to the mother’s health and the fetal in terms of birth weight. Aim: To examine the relationship between hemoglobin level and fetal birth weight. Methods: This was an observational study, conducted in Govt. Hospital Samanabad, Lahore between April 2021 and April 2022. A total of 106 pregnant women through non probability convenience sampling were recruited in our study. The patients were divided into two groups according to low and normal hemoglobin level. The hemoglobin

McArdle’s disease is a Glycogen storage disease (type V) which is caused due to the inherited deficiency of myophosphorylase enzyme required for the breakdown of muscle glycogen. It typically presents with complaints of exercise intolerance, early fatigability, and muscle aches. The disease can be complicated by rhabdomyolysis in severe cases. We present the case of a 27 years old male with McArdleʼs disease who presented with bilateral lower limbs weakness associated with muscle aches and dark colored urine which later turned into anuria. Diagnosis of acute renal failure complicating rhabdomyolysis in background of McArdle’s disease was made. Keywords: Glycogen storage disease, Glycogen phosphorylase, myopathy, rhabdomyolysis

Background and Aim: The retrieval of the gallbladder is a key event in laparoscopic cholecystectomy and significantly contributes to postoperative infections and pain. The GB is extracted through an umbilical or epigastric port. The goal of this single-center study was to compare GB retrieval via epigastric versus umbilical port in terms of postoperative site pain and infections. Materials and Methods:In this single-center study, 60 Cholelithiasis patients under went laparoscopic cholectystectomy (LC) for symptomatic gallbladder disease during the period from November 2020 to April 2021 at surgery department of Gambat Institute of Medical Sciences, Gambat Sindh Pakistan. The patients were selected out of the operating room for GB retrieval via umbilical port (Group-I with n = 30) versus epigastric port (Group-II with n = 30) randomly.All 60 patients had routine blood tests such as CBC, SGOT, SGPT, PT, and urine examinations. Until their bowels recovered, all of the patients were kept nil by mouth and on parenteral fluids. They were closely monitored in the post-operative period, with special attention paid to recording the pulse rate, temperature, and level of pain on a 24-hour basis. Results:Chronic Cholecystitis patients chosen randomly from the cholecystectomy list to have their gallbladder delivered through an umbilical or epigastric port.Group I had median pain (IQR) of 5 (1.5), 4 (1), and 2 (1) when compared to group II's median pain (IQR) of 4 (1), 2 (1), and 1 (0.5) one day after the procedure (p-value=0.001), at the time of hospital discharge (p-value0.001), and one month post-surgery (p-value0.001).In group B, there was a clear regression in postoperative pain from the day of surgery until a month later (p-value0.001). Conclusion:According to our findings, umbilical ports are preferable to epigastric ports in terms of post-operative pain, but there is an increased port site infection and hernia risk. Keywords:Cholecystectomy, Umbilical port, Epigastric port, Gall bladder retrieval, Laparoscopic.

Objective: To determine the efficacy of oral voriconazole in the treatment of dermatophyte infections (tinea corporis and cruris) Methodology: A total of 200 patients of both sex with age group 18-60 year having dermatophyte infection of body and groin were enrolled in this study. Each patient was given oral voriconazole 200 mg twice a day (tablet vorif 200 mg) for two weeks. Follow up was done at end of 2nd, 4th and 12 weeks. Efficacy was assessed clinically in the form of complete healing of lesion leaving behind post inflammatory pigmentation or normal skin. Study duration was 3 months. Patients were assessed for any possible side effects at each appointment. All of the patients were truly monitored and checked for their compliance to drug. The data was recorded on preformed Proforma for each patient. Results: Out of 200 cases, 133 were new, 42 were relapsing and 25 were resistant cases. Total efficacy was noted in 164 patients (82%) of all study cases. Male and female showed efficacy in 81% and 82% of cases respectively (Table 1). Patients belonging to age group 18-40 year showed 86 % efficacy and patients belonging to age group 41-60 year showed 76% efficacy (Table 2). From all new, relapsing and resistant study cases, 90 %, 71% and 58% showed efficacy to treatment respectively (Table 3). Conclusion: In our population oral voriconazole is efficacious in the treatment of tinea corporis and cruris. Keywords: Dermatophytes, Efficacy, Voriconazole

Aim of the study: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment (chemical sphincterotomy) in terms of recovery time, frequency of recurrences and complications. Study design: This was a prospective descriptive study. Place and duration:In the Department of Surgery,Lahore General Hospital, Lahore during the time period fromJanuary 2021 to August 2021. Material and methods: The study included 80 patients with chronic anal fissure, regardless of age and sex, after the history and clinical examination. All these patients were operated on under general or spinal anesthesia after obtaining consent and routine examinations. Lateral internal sphincterotomy was performed and patients with OPD were followed for 6 to 8 weeks to determine the benefit of the procedure. Results: The study included 57 men and 23 women (M: F ratio 2.2: 1) with a history of pain, bleeding, discharge with or without sentinel tagduring defecation. The average age was 36 and ranged from 20 to 55. The fissure was found in the majority of patients at 6 O clock position (91.2% for men and 52.2% for women). The duration of symptoms was longer in women due to social problems. LIS was used in all patients. Patients were followed in OPD at weeks 1, 2, 4 and 6. Most of the patients fully recovered after 4 weeks. Occasional constipation occurred in 31 (54.4%) men and 11 (47.8%) women. The study found crater ulcers in all 80 patients. All patients had a history of painful bowel movements (100%), but 24 men (42.1%) and 12 women (52.2%) had bleeding and discharge. In 51 male patients (89.5%), the fissure was in the posterior and anterior midline in 3 patients (13.1%). Half of the patients had anterior fissure and the other half had posterior fissures. The sentinel tag was observed in 46 (80.7%) men and 17 (73.9%) women. 11 (19.3%) men and 6 (26.1%) women reported liquid stool incontinence, while 15 men (26.3%) and 9 women (16.9%) reported flatus incontinence. No relapse was observed in all patients after 4 months. Conclusion: As long as the patient is willing to accept the risk of transient fecal incontinence, we can accept the Gold Standard of Treatment (LIS) as first-line therapy for chronic anal fissure. Keywords: Lateral internal sphincterotomy, Chronic anal fissure, Fecal incontinence.

Objective: To compare the efficacy and safety between onlay mesh technique and sublay mesh technique in patients undergoing paraumbilical hernia repair. Study Design: Retrospective/Observational Place & Duration: In the department of surgery, Muhammad Teaching Hospital, Peshawar and Fauji Foundation Hospital, Rawalpindi and conducted during the period from March 2021 to August 2021. Methods: A total of 166 patients with both genders having ages 18 to 65 years who were undergoing para-umbilical hernia repair were included. Patients demographic including age, gender were recorded after informed consent. Patients were equally divided into two groups Group O and Group S. Group O (83 patients) received onlay mesh technique and Group S (83 patients) received sublay technique. Outcomes such as post-operative pain, wound infection, seroma formation and hospital stay were recorded and compare the results between both groups. Results: In group O 48 (57.83%) patients and in group S 47 (56.63%) patients were females while 35 (42.17%) and 36 (43.37%) patients were males in group O and S. There was significant difference in term of post-operative pain 6.01+2.26 vs 3.58+1.44 (P-value

Aim: To evaluate the effectiveness of surgical decompression versus local corticosteroids for carpal tunnel syndrome in improving clinical outcome and to determine the length of symptom relief Study Design: This was a comparative, longitudinal and interventional study. Place and duration of study: OPD and A&E department of Orthopedics Surgery and Traumatology (DOST) Unit I, King Edward Medical University/ Mayo Hospital Lahore. duration of study was 1 year after approval of synopsis. Methodology: Cases of carpel tunnel syndrome with age 18 years and above were included. The diagnosis of carpel tunnel syndrome was based on general physical examination, nerve conduction studies and additional radiological test.). A total 64 patients were selected randomly. They were divided into two groups. GROUP “A” was treated by surgical decompression. Group “B” was treated by local corticosteroids. They were follow up at 3 months, 6 months and 1 year. All the procedures were done by single surgical team. Outcome measuring tools symptom severity scale(CTS) and functional status scale (CTS) were used. Results: In group A and B the mean age of patients was 45.44±8.39 and 47.22±9.72 years respectively. Mean symptoms severity scale in group-A was higher when compared to group-B at 3 months, 6 month and 1 year with p-value < 0.05. Moreover mean functional severity scale was also improved in group-A when compared to group-B at 3 month, 6 month and 1 year with p-value < 0.05. Conclusion: Through this study we conclude that surgical decompression of carpal tunnel versus local corticosteroid injection in terms of clinical outcome improvement and to assess the length of symptomatic relief. Keywords Hand surgery, carpel tunnel syndrome, conservative treatment, steroid injection, surgical decompression

Objective: To evaluate the efficacy of intradermal tranexamic acid (TA) verses fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%)therapy in the treatment of melasma. Study Design: Randomized comparative trial Place and Duration: Study was conducted at outpatient dermatology department of Sheikh Zayed hospital Rahim Yar Khan for period of six months i.e from September 2020 to February 2021. Methods: Total 110 patients (age 18-40 year) of both genders having melasma on face were enrolled. Patients details demographics, age, sex and body mass index were recorded after taking written consent. Patients were divided into 2-groups. Group I had 55 patients and received intradermal tranexamic acid and group II had 55 patients andwere given topical fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%) cream. Follow up was taken for 2-months to determine efficacy and safety. Complete data was analyzed usingSPSS 22.0 version. Results: Out of 110 patients 60 (54.54%) were females and 50 (45.46%) were males. Mean age of the patients in group I was 29.15±5.14 years with mean BMI 24.16±7.22 kg/m2 and in group II mean age was 28.17±5.18 years with mean BMI 23.61±2.48 kg/m2. Most of the patients (85 or 77.27%) had mixed melasma followed by dermal (16 patients /14.54%) and epidermal melasma(9 patients/8.18%). We found that malar-type pattern of melasma was most common, found in 66 (60%) of cases. A decrease in MASI score from baseline (15.4) was found 2.4 in group-Iand 5.6 in group-II. In group II erythema, hypertrichosis, hypopigmentation and acneiform lesions were the side effects found but there was no clinically significant side effect found in group I patients. Conclusion: We found in this study that use of intradermal tranexamic acid (TA) in the treatment of melasma was effective and safe because there were no clinically significant side effects found after this treatment and reduction of MASI score was also significant. Keywords: Triple combination, Melasma, MASI, Intradermal tranexamic acid

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum

Objective: This study was planned to assess the frequency of facial palsy in general population and its impact on the quality of life of patients. Method: This descriptive crossectional investigation was conducted in Neurology department of a tertiary care hospital of Lahore from March, 2021 to June, 2022. Sample size was 168 patients with facial palsy out of 246. Data was collected using purposive sampling technique. Frequencies and percentages were calculated for gender, incidence of facial palsy and quality of life. Mean and standard deviation was calculated for age. Results: Total number of patients had facial palsy were 168 out of 246 which was 68.29%. Males were 36.90% whereas females were 63.10%. Face palsy of left side was found among 34.25% patients and 65.75% patients had facial palsy of right side. Conclusion: Incidence rate of facial palsy was above average and patients reported poor quality of life after facial palsy. Keywords: Facial Palsy, Quality of Life, Depression, Facial nerve.

Introduction: Oral lichen planus (LP) is a chronic inflammatory condition and this inflammation leads to alteration in lipid metabolism and increase the cardiovascular risk factors. Objective: To determine the prevalance of dyslipidemias in patient with oral lichen planus coming in dermatology outdoor of Sheikh Zayed Hoapital Rahim Yar Khan. Methods: It was a case control study that was conducted at Department of Dermatology, Sheikh Zayed Hospital Rahim Yar Khan during October 2016 to April 2017. In this study there were total 50 cases of oral LP and 50 controls of both genders with age range of 15 to 60 years. The cases of both the groups underwent fasting lipid profile in terms to look for serum total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol. Results: In this study there were total 100 cases out of which 50 were cases of oral LP and 50 were controls. In cases groups there were 27 (54%) males and 23 (46%) females while in control group there were same number of males and females were taken with p= 0.85. The mean age in case group was 37.22±8.15 years while in control group was 35.66± 7.78 years while the mean BMI was 24.42±2.21 and 25.11±3.01 respectively. The mean difference in cases and controls in terms of serum total cholesterol, TG, HDL Cholesterol and LDL cholesterol was found statistically significant. Conclusion: Dyslipidemias are common in cases with oral lichen planus and all its parameters have significant association with it especially TG. Keywords; LP, Dyslipidemia, LDL, HDL, TG