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Objective: The study compared the effectiveness of carbetocin and oxytocin, administered post caesarian section for prevention of postpartum haemorrhage (PPH). Study Design: This was a prospective single center, case-control, cross sectional, observational, double ended study conducted from September 2020 to January 2022, comprising 150 female patients. Methods: The study was conducted at Hameeda Memorial Hospital Lahore in women undergoing caesarean section under regional and general anesthesia. Women were randomized to receive either carbetocin or oxytocin 5 IU intravenously. Results: Average age of patients was 34.5 years with average BMI of 27. It was noted that patients who were administered drugs had 348.6ml less blood loss than those not administered in PPH. Patients who did not received the drugs had average 800 ml blood loss. Whereas those who did had the drug had average of 451ml loss of bleed in PPH. Carbetocin showed effectiveness in preventing PPH by maintaining uterine tone. It was found that it significantly reduced the need for additional uterine contractile interventions to prevent or treat excessive bleeding after cesarean. In high-risk women, carbetocin has been found to be more effective than oxytocin in preventing blood loss greater than 500 mL during the cesarean section. Practical Implication: This study will help the gynecologists in selecting potent and safe therapeutic agents for the prevention of postpartum hemorrhages in high risk females. Conclusion: Carbetocin has been shown to be a safe and effective option for the prevention of postpartum hemorrhage in high-risk women as compared to other therapeutic agents along with potential safety margins. Keywords: Carbetocin, efficacy, safety, prevention, postpartum hemorrhage, oxytocin, uterotonic

Objective: To evaluate the laparoscopic cholecystectomy procedure in cases of acute cholecystitis. Study Design: Cohort study Place and Duration of Study: Department of Surgery, Surgical Unit-1, SIMS/Services Hospital Lahore from 1st January 2021 to 30th June 2022. Methodology: One hundred and ninety eight cases which suffered from acute cholecystitis were enrolled. The age of the cases was within 35-60 years. The cases were divided into 3 groups; group A, group B and group C. The group selection was dependent on the interval period (between the onset of acute attack and the time of presentation for treatment). Group A was the one where interval period was 7 days in group C. The laparoscopic cholecystectomy was performed and operative outcomes were evaluated. Results: The mean age of the patients was 40.66±1.5 years with more females in each group than males. The cases of gall bladder empyema/mucocele were presented at the highest 68.8%. This was followed by the cases having Gall Bladder phlegmon identified in 24.74% of the cases. The rate of complication was highest in Group B while operation time and post-operative hospital stay was highest in Group A. The conversion rate from Laparoscopic to open cholecystectomy was measured as 3.03%. Conclusion: Laparoscopic cholecystectomy is a procedure which can be successfully achieved in acute cholecystitis cases with reduced conversion rate and complication attained through surgical expertise. Keywords: Laparoscopic cholecystectomy, Acute cholecystitis, Conversion rate

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

Background: Nitric Oxide is involved in several physiological processes, including vasodilation, blood pressure control, platelet and antileucocyte activity, and neurotoxicity. When given within 4 to 6 hours after the start of stroke, nitric oxide donors (NO donors) have shown promise as an acute stroke therapy in two clinical studies. Methods: People with acute or chronic stroke were included in randomized trials of NO donors, and IPD was obtained from the trialists. The changed Rankin scale (mRS) and mortality by point in time to randomization were used to evaluate the impact of NO donor organize on practical result. Impairment, mood, and life quality were all included as secondary outcomes. Results: Glyceryl trinitrate (GTN) was used in all five studies (4,197 individuals). GTN reduced BP by 7.4/3.3mmHg as compare to the organize set. After 90 days, GTN has not altered any clinical measurements in any way, shape, or form. While GTN was linked with positive changes in the mRS (odds ratio (OR) of 0.52, 95% self-assurance gap of 0.34–0.78) and decreased mortality in 312 patients who were randomly assigned within 6 hours of the start of stroke, this was not the case for the other patients in the study. Conclusions: Little donors had no effect on the recovery of stroke victims. NO donors, on the other hand, may enhance outcomes in both ischemic and hemorrhagic stroke when specified in six hours of the start of stroke. Keywords: drugs, nitric oxide, Glyceryl trinitrate, acute cerebral hemorrhage, stroke, pharmacology

A substantial portion of cervical spine injuries occurs due to maxillofacial trauma. A delay in the identification of cervical injuries can result in major neurological issues, paralysis, and even death. Therefore, early detection of cervical fractures in patients with maxillofacial trauma is crucial. Aim: The goal of the study is to assess the incidence of cervico-spinal injuries in patients with oral and maxillofacial trauma. Methods: This cross-sectional study was carried out at the Oral and Maxillofacial Surgery department of Mayo Hospital, Lahore for the duration of one year from January 2021 to January 2022. A total of 120 maxillofacial trauma patients treated at the oral surgery department. By using computed tomography, lateral and anteroposterior X-rays; all patients were evaluated for cervical spine injuries. The dependent and independent variables' information was gathered using a structured questionnaire. Results: In 4 (3.3%) patients, cervical spine and maxillofacial injuries were found. Six males and two women were involved in the ten Cervical-spine injuries. The ratio of men to women was 4:1. Despite the low frequency of cervical injuries related with maxillofacial fractures, suitable and precise recommendations for the diagnosis and treatment of these cervical injuries must be adopted to avoid permanent disability and even death. Keywords: Frequency, Maxillofacial trauma, Cervical spine injury

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

In the field of General Surgery AA is the frequent clinical condition for which patients who need emergency surgery present with abdominal pain.1 Diagnosis of this pathology is made with the help of history, patient symptoms, and clinical exam and lab investigations. Ultrasonography (USG) and computed tomography (CT) images for acute appendicitis should be considered.2 Methodology: The purpose of the study is to compare the diagnostic accuracy of Modified Alvarado Score (MAS) and Ohmann Scores (OS) in diagnosing the pathology of Acute Appendicitis, while retaining histopathology as the basis for final diagnosis. A total of 411 patients were admitted via the Accidents & Emergency Department of Mayo Hospital Lahore, meeting the inclusion and exclusion requirements having the clinical diagnosis of acute appendicitis. For each patient, both Modified Alvarado and Ohmann scores were assessed prior to undergoing the procedure, i.e. open appendectomy. Abdominopelvic assessments and laboratory results were assessed and abdominal USG was performed in all patients. Biopsy of the removed appendix was sent for histopathology to Pathology Department of King Edward Medical University. Results: For the modified Alvarado and Ohmann score; sensitivity and specificity of was 89.74%, 90.48%, 85.13% and 80.95% respectively. The positive predictive value (PPV) and negative predictive value (NPV) for “modified Alvarado score” was 99.43% and 32.2% and for “Ohmann score” it was 98.81% and 22.67% respectively. Conclusion: Both scoring system are sensitive and specific enough for diagnosis of acute appendicitis. However, sensitivity and specificity of modified Alvarado score is higher as compared to Ohmann score. Keywords: Acute Appendicitis, Diagnostic Accuracy, Modified Alvarado Score, Ohmann Score, Histopathology.

Aim: To evaluate the causes of still birth and its frequency in tertiary care hospital. Study design: Descriptive study. Place and duration of study: Department of Obstetrics & Gynaecology, Services Institute of Medical Sciences, Lahore from 1st January 2020 to 30th September 2022. Methodology: Seven thousand women were enrolled from which 100 were identified to have stillbirth and followed up till their outcome of delivery. Those women who had still birth were further followed for the causes related with still birth through their and the fetal clinical available data. All major causes were addressed related with still birth and noted in the proforma. The frequency of the cases was identified through the measurement of incidence rate. Neonates born were clinically evaluated in terms of their birth weight as well as term analysis. Results: Majority of the pregnant women were within the age group of 36-45 years. There were 54% of the women who were obese. On analysis of the associated reasons with still birth, it was observed that 27% of the pregnant women undergoing still birth were not known of the cause, while 24% and 20% had placental complication and infection respectively. Conclusion: Maternal age, infection, placental abruption and obesity are the main causes of still birth. The frequency of still birth is 1.42% in this region. Keywords: Cause, Stillbirth, Frequency

Background: Oral health is thought to be an essential part of general healthiness. Poor oral hygiene can significantly affect the quality of life which may initiate deterioration of overall health. Aim: To find out reasons or misapprehensions that stop the dental patients from getting scaling procedure. Methodology: This questionnaire-based cross-sectional study was conducted in tertiary care dental hospital of Multan from November 2019 to February 2020. Three hundred and six patients filled a questionnaire designed and tested for this study. The ethical approval (MDC-1290) was taken from the Dental Hospital, informed consent was obtained from the participants in the study. Results: Out of 306 participants, 49% participants were males and 51%were females. 24% percent participants reported that we have more than one reasons for avoidance of scaling procedure. Among other fears top-most were 16% participants believed that scaling is a painful procedure and 13% said that scaling increases the mobility of teeth. Conclusion: Now-a-days misapprehensions or fear regarding scaling has been reduced because of self-awareness programs started by social media activists Keywords: Anxiety, Fear, Mobility, Myth, Scaling, Pain, Sensitivity

Background: The human lips are the essential structure for speech, facial expression and oral functions like eating, drinking and breathing. The orthodontic treatment is very crucial for the advancement of the facial expression Lip incompetence is a condition in which the lips fail to close adequately leading to negative effects on speech, facial esthetics and oral functions. Study design: It is a retrospective study conducted at WATIM Dental College Rawat, Rawalpindi and Altamash Institute of Dental Medicine, Karachi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The patients were divided into three groups. The patients that did not follow the inclusion criteria were excluded from the study. Group I had patients with competent lips, group II had patients with their lips apart and group III had incompetent lips. There were 45 patients in each group. Results: The length of group I members was 19.8 mm for men and 18.7 mm for women, which was less than group III individuals with 20 mm and 18.9 mm average upper lip length for males and females. Group II patients had a length of 17.5mm for male patients and 16.4 mm for female patients. The P-value was calculated and the results were statistically significant. Conclusion: The length of group I members was 19.8 mm for men and 18.7 mm for women, which was less than group III individuals with 20 mm and 18.9 mm average upper lip length for males and females. Group II patients had a length of 17.5mm for male patients and 16.4 mm for female patients. Keywords: Lip incompetence and competent lips.

Background: The orthodontist and patients prefer the usage of mini-screw anchorage due to its feasibility of insertion and removal, which necessitates minimum patient cooperation, and cost-effectiveness. Aim: The aim of the study is to access the mean perception of pain using a visual analogue scale after placing the mini-screws in orthodontic patients. Methods: Using convenient sampling technique, this cross-sectional study was held at Armed Forces Institute of dentistry, Rawalpindi and Shahida Islam Dental College, Lodhran for six-months duration from July 2022 to December 2022. A total of 80 patients took part in the study. On a 10-millimeter visual analogue scale (VAS), where 10 signifies "the severe pain presumable" and 0 signifies "no pain," they were asked to rate their anticipated level of pain Results: A total of 80 patients were selected for this study with the mean age of 21.1± 2.8. The majority of subjects (60%) were female, and the posterior maxilla (48.8%) and posterior mandible (30%) were mostly implanted with mini-screws. Mostly, patients described pain on the 1st day of mini-screws insertion with mean VAS was 4.10± 1.65 and on 7th day; minimum pain was experienced with VAS of 2.9±1.09. There was a significant variation (p ≤0.01) in the VAS score between the sexes, with women exhibiting a higher VAS score (39 ± 52.7) compared to men (35 ± 47.3). Conclusion: Mini screws can more precisely carry out difficult tooth movements than the traditional anchorage used in standard orthodontic treatment. Keywords: Pain, mini-screws placement, mean pain perception and visual analogue scale.

Objectives: To evaluate hearing improvement following successful myringoplasty based on the degree of tympanic membrane perforation. Methods: This cross-sectional study was held in the department of ENT of Aziz Bhatti Shaheed Teaching Hospital and ENT, Head and Neck Surgery department, Pak International Medical College and Peshawar Institute of Medical Sciences (PIMS), Hayatabad Peshawar for the duration from December 2021 to November 2022. Myringoplasty procedures were performed on 80 individuals in total following thorough history-taking, clinical testing, and research. Hearing was tested both before and after the operation. A variety of tables, charts, and drawings are used to present the analysed data. Results: For minor perforations, 27.81 dB was the mean air-bone gap, 7.21 dB was the mean bone conduction threshold, and 33.40 dB was the mean air conduction threshold prior to surgery. In medium-sized perforations, 32.78 dB was the mean air-bone gap, 10.10 dB was the mean bone conduction threshold and 46.21 dB was the mean air conduction threshold prior to surgery. In the instance of a large perforation, 48.86 dB was the mean air-bone gap, 62.01 dB was the mean air conduction threshold, and 15.20 dB was the mean bone conduction threshold prior to surgery. After myringoplasty, the mean postoperative air-bone gap for medium, large and small perforations was 14.22 dB, 22.62 dB and 6.24 dB, correspondingly. Using the unpaired test, it was determined that the difference in airbone gap between minor and medium sized perforations closure was statistically significant. Conclusions: After myringoplasty of large size perforations, hearing gain is improved significantly. Myringoplasty and hearing enhancement are key words. Keywords: Myringoplasty, Hearing Improvement, Tympanic membrane perforations

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

Background: Main stay of treatment of acute Bronchiolitis is general supportive care, such as oxygenation, aspiration of respiratory tract secretions, and hydration therapy. Recent research indicates that breathed hypertonic saline is a potential treatment. Objective: To compare the mean length of hospital stay and clinical bronchiolitis score of salbutamol nebulized in normal saline versus hypertonic saline in children with acute bronchiolitis. Material and methods Study Design: Randomized controlled design Setting: Department of pediatrics, Fatima Memorial Hospital, Lahore. Duration of Study: 6 months after approval of the study i.e. from 12th April 2017 to 12th October 2017. Data Collection Procedure: Relevant parameters were identified, and the CBSS was computed. Using random tables, cases were divided among two groups and given salbutamol or hypertonic saline nebs. The length of stay was determined. The Clinical Bronchiolitis Severity Score (CBSS) was recorded based on various variables. Version 17 of the statistical package for social sciences was used for statistical analysis. Result: Patients in the salbutamol group had a mean age of 13.56.66 months, while those in the hypertonic saline group had a mean age of 12.46.58 months. In the group receiving salbutamol, there were 29 males and 31 females. There were 32 men and 28 women in the hypertonic saline group. After 24 hours, the mean CBSS in the salbutamol group was 6.132.47, whereas in the hypertonic saline group, it was 4.881.75. After 24 hours of treatment, the difference in CBSS was significant between the two groups (P0.05). The mean duration of hospitalization was 3.920.81 days with salbutamol and 3.050.77 days with the hypertonic group. In both groups, there was a marked difference in duration of hospital stay (P0.05). Conclusion: Thus, hypertonic saline was more effective than salbutamol in reducing the CBSS score and duration of hospital stay. Keywords: Hospital Stay, Clinical Bronchiolitis Score, Nebulized Salbutamol, Normal Saline, Hypertonic Saline, Children, Acute Bronchiolitis.

Diabetes has become the most prevalent endocrine disorder as it has continued to increase. Diabetes mellitus cases are remarkably increasing in our country every year. Diabetes is characterized by a pathophysiology that leaves diabetic patients more prone to infection and to developing skin and soft tissue infections that are more complicated. The risk of infection is increased in diabetic patients, and their mutation potential is detrimental, resulting in a higher morbidity and mortality rate than in the general population. Infections of the skin and soft tissues (SSTIs) involve microbial invasions, and they differ in presentation and severity. A total 445 participants 15 to > 40 years of age participated in this study. Out of total respondent, 48.53% and 51.46% were male and female, respectively. Among the total, the highest percentage of the respondent were around 36- 40 years old 52 (22.70%) followed by 31-35 years old 44 (19.65%), 26-30 year old (13.27%), > 40 years old (13.10%), 21-25 years old 29 (12.66%), 16-20 years old 23 (12.04%) and 10-15 years old 20 (8.73%). Out of total 216 males, 179 (82.87%) were infected with soft and tissue infection while out of total 229 females, 206 (89.95%) were infected with soft and tissue infection. Overall prevalence of soft and tissue infection in patients of diabetic mellitus was 86.51%. The maximum respondent belonged to rural areas while minimum respondents from urban areas. 37.66% mild level of exercise was recorded in diabetic patients followed by 25.71% moderate level, and 19.74% heavy level of exercise recorded. Only 16.88% of patients recorded no level of exercise. Majority of respondents used oral medications (51.63%) followed by insulin (47.62%), do exercise (15.76%) and use nutritious food or fruits (9.59%). The study concluded that patients with poorly controlled and uncontrolled blood glucose levels were more likely to develop skin and soft tissue infections. In order to achieve favorable postoperative outcomes, it is essential to make fast and case-adapted therapeutic decisions, as well as to observe the patient's general condition and his wound on a daily basis. Keywords: Diabetes

Objective: This study was designed to determine whether or not "hypocalcemia following complete thyroidectomy in hyperthyroid patients was associated with preoperative vitamin D insufficiency." Methodology: This research was carried out in the West Surgical Ward of Mayo Hospital in Lahore, Pakistan. Total 60 patients were included in the study. Patients were divided in two groups i.e. Vit-D deficient group “with vitamin D deficiency” and Vit-D sufficient group “without vitamin D deficiency”. All the patients underwent total thyroidectomy preserving parathyroid glands performed by the same team of surgeons. Patients were assessed for signs and symptoms of hypocalcemia. Serum calcium was measured at day of surgery, post-operative day-1 and at the end of 2 weeks on follow up after surgery. Results: The mean of age in the Vit-D deficient group was 38.87±9.31 and in Vit-D sufficient group was 37.70±8.56. Majority of patients in the Vit-D deficient group were females (70.0%). In Vit-D deficient group, 13(43.3%) had hypocalcemia, while 5(16.7%) in Vit-D sufficient group (p-value 0.024). Conclusion: Pre-operative VDD “vitamin D deficiency” is linked with postoperative hypocalcemia increased occurrence after total thyroidectomy. There is a “positive correlation of preoperative vitamin D deficiency on postoperative hypocalcaemia after total thyroidectomy in patients of hyperthyroidism”. Keywords: Hyperthyroid, Total Thyroidectomy, Hypocalcemia, Vitamin D deficiency

Diabetes mellitus is the most common metabolic problem all over the world. Over 150 million people worldwide, are affected with this problem.1, 2 In Pakistan, the prevalence of diabetic patients are between 7.6% to 11%.3. Objective and Methodology: The aim of this study is to compare the relative efficacy of hydrogel and papaya dressings for diabetic foot ulcers. Patients from the General Surgery Department at Mayo Hospital in Lahore were 114 in total. Patients were randomized into: group H, who received hydrogel dressings, and group P, who received papaya dressings. Both dressings were done in ward for 20 days, every 48 hours and if wound healing occurred earlier and slough decreased then dressings were stopped and patient was discharged. The wound was assessed by photographic wound assessment tool (PWAT). Results: In Group P, mean age of patients was 52.98±8.90 and in Group H, mean age of patients was 50.98±9.62. In Group P, 34(59.6%) patients were male and 23(40.4%) were female. While in Group H 29(50.9%) patients were male and 28(49.1%) were female patients. We used Wound Assessment tool “PWAT” to compare the efficacy of these two treatment regimes. As per final “PWAT” score hydrogel dressing is more effective as compared to Papaya dressing for diabetic wound healing. i.e. Group P (Papaya dressing): 5.09±1.65 vs. Group H (hydrogel Dressing): 6.02±1.78, p-value=0.005 Conclusion: Depending upon the outcomes of this research, it can be concluded that hydrogel dressing is more useful than papaya dressing for treating diabetic wound. Although papaya dressing also have a beneficial effect on diabetic wound but still its efficacy is less as compared to hydrogel dressing Keywords: Papaya, Hydrogel, Dressing, Diabetic Foot, Wounds, Ulcer.

Objective: To evaluate the complications of ultrasound guided percutaneous nephrostomy in cases of obstructive uropathy at tertiary care hospital. Study design: Case series Duration of study: From February 2022 to August 2022. Setting: Department of Urology, Sheikh Zaid Hospital, Rahim Yar Khan. Material and methods: Total 133 patients having age between 20-40 years either gender with obstructive uropathy due to ureteric obstruction caused by (impacted ureteric stones, PUJ obstruction, carcinoma prostate involving ureters, iatrogenic ureteric injury and bladder tumors) were included in the study and post procedure complications were evaluated. Results: Mean age was 44.83 ± 13.05 years. Regarding presenting symptoms, total 94 (71%) patients had decreased urine amount, 29 (22%) patients had flank pain while 10 (7%) patients had fever. Septicemia was found in 11 (8.33%) patients, bleeding in 4 (3%) patients followed by PCN dislodgement in 8 (6%) patients. Conclusion: Results of this study revealed that septicemia was the most common complication in cases of obstructive uropathy after PCN. More than 50% patients were between 41-60 years. Male population was commonly suffered from obstructive uropathy. Most of the patients had bilateral obstructive uropathy and decreased urine output was common presenting symptom. Keywords: PCN, obstructive uropathy, nephrostomy, bleeding, blockage

Objective: To compare the outcome of clipped laparoscopic cholecystectomy and clipless laparoscopic cholecystectomy in context of biliary leakage. Study Design: Cross-sectional analytical study Place and Duration of Study: Department of Surgery Unit-II, Benazir Bhutto Hospital Rawalpindi from 1st September 2021 to 31st August 2022. Methodology: One hundred and twenty patients were included in the study and divided into two major groups. The biochemical analysis and ultrasonography was performed post 8 hours fasting. Group one had those cases which underwent clipped laparoscopic cholecystectomy while group 2 had those cases which underwent clipless laparoscopic cholecystectomy. The age of the patients was selected between 40 to 60 years and the prevalence for this sampling was considered as 20% in Pakistan. The demographic details, clinical history, signs and symptoms, clinical diagnosis based on USG, lipid profiling, and variables as post-operative time, hospital stay and ease in procedure were documented. Results: The mean age of the cases underwent clipped laparoscopic cholecystectomy was 42.3±12.11year with 40 females and 20 males who underwent those procedures. The mean age of the cases underwent clipless laparoscopic cholecystectomy was 40±11.05 years with 45 females and 15 males. The present study results evidently highlighted the fact that there were high percentage cases of biliary leakage seen in clipped cases than in the clipless cases. There were22 cases with 36.6% in clipped groups while 9 cases with biliary leakage such as 15% in clipless group. Conclusion: Clipless laparoscopic cholecystectomy is a better optional procedure with efficient usefulness in context to biliary leakage, operation time and hospital stays. Keywords: Outcome, Clipped laparoscopy cholecystectomy, Clipless laparoscopic cholecystectomy, Biliary leakage

Objective: To assess the demographics, clinical features and outcomes of PPD poisoning in such patients. Design of the Study: It was a prospective study. Place and Duration of Study: In this cross-sectional study, the prospective study data of 47 cases were collected from Department of Forensic Medicine and Toxicology, Loralai Medical College, Loralai. Patients and Methods: From 2019 to 2022, data of 47 cases was taken worth of information were gathered from hospitals' medical records for this prospective study. Information on the subject's demographics, ingestion method, clinical features, and mode of administration was recorded using a standardized format. In addition to monitoring mortality rates, hospital stays, tracheostomies, and the efficacy of mechanical ventilation, a number of other metrics were collected. For continuous variables' means and standard deviations (SDs) were calculated. However, percentages were calculated for categorical variables. Results of the Study: Out of 47 patients, 38 (80.85%) were females and 9 (19.15%) were males. During first year of the study, only six cases were reported while in succeeding years cases increases rise rapidly and reached to fifteen in last year final year of the study. Majority of the patients 16 (34%) belong to age group 20-24 years. Nearly, 85% of the patients belong to the rural areas. Moreover, the rate of PPD poisoning in married women increases alarmingly from one case in 2019 to nine cases in 2019. Practical Implication: Currently, there is limited data available on this poisoning as it has emerged as a new tren in our local hospitals. So, the rationale of this study is to evaluate the clinical presentation and outcome of the PPD poisoning in our part so that effective preventive and treatment strategies can be implemented at the onset which would certainly decrease the morbidity and mortality associated with this deadly poisoning. This study can lay down a base for local administrative authorities to consider formulating a law for strict handling of the PPD poisoning at local level and for education of the population. Conclusion: There is a significant amount of distress and death that comes along with PPD poisoning. In order to effectively handle poisoning situations, doctors must be aware of the clinical features and therapeutic choices. In addition, PPD-containing hair colours should be banned because they are so dangerous. Keywords: Poisoning, Suicide, Hair-Dye, Cervicofacial Edema, Paraphenylenediamine, Kala Pathar

COVID-19 has become a global pandemic which has affected millions of people worldwide. It has become a global issue for the people of the world. The current study aimed to find whether there is any relationship between spirituality, Occupational stress and work family conflict among COVID-19 rescue responders or not. A sample of 180 COVID-19 rescue responders was selected through purposive sampling by selecting 5 rescue responders from each district of Punjab Province. Co relational research design used for this study and Data was collected by administering Health Safety Executive Standard Indicator Tool for occupational stress, Work Family Conflict Self Efficacy scale for work family conflict and Multidimensional Measure for Islamic Spirituality to rescue responders. Data was analyzed though SPSS by using statistical processes of regression, correlation and moderation along with calculating Percentage and frequencies of responses. Results of the study showed that spirituality moderates the relationship between occupational stress and work family conflict among COVID-19 rescue responders. It also showed that there was no significant effect of demographic variables on occupational stress, work family conflict and spirituality. This study is the first study on COVID-19 rescue responders. More research work may be done by other researchers to fully explore different aspects of spirituality, occupational stress and work family conflict among Rescue responders and emergency responders. Keywords: Spirituality, Occupational stress, Work Family Conflict, COVID-19, Rescue Responders.

Objective: To compare the outcomes of Bracka’s and Snodgrass techniques in hypospadias repair among the patients admitted at Liaquat University Hospital, Jamshoro. Methods: Prospective study was conducted at the plastic surgery unit, Liaquat University Hospital, Jamshoro from January 2018 to December 2019. All male children aged between 6 months-15 years, given consent of participation, having distal hypospadias and were not previously operated for hypospadias (primary cases) with chordee, good prepuce and wide urethral plate were included. The study was ethically approved from university ethical review committee and informed consent taken from the parents / guardians. Study participant children were divided in two equal groups according to the surgical technique used. Group I (Snodgrass procedure) and Group II (Bracka’s procedure). Pre and post-surgical examination of patients were performed to determine any complications and evaluate the cosmetic results. Results: Total 100 participating pediatric patients of Hypospadias were included in the study. The mean age of study participants was 3.4±2.2 years with age range between 6 months and 15 years. Statistically significant difference (p

Background: A stroke occurs when the central nervous system is disrupted by brain injury caused by a cerebrovascular hemorrhage, resulting in hemiparesis, nerve dysfunction, and muscular weakness but the use of innovative modalities for stroke is still unknown. The objective of this study is to investigate the comparative effects of whole-body vibration (WBV) training and squatting performance in chronic stroke patients. Methods: we reviewed 86 chronic stroke patients with the commencement of more than 6 months in physical therapy department of central park medical college, Lahore (2021-2022). An independent examiner randomized the patients individually after doing the baseline assessment. 86 ambulatory patients (51 men and 35 women) who are recruited in hospital. Results: During 2020-2021, 86 chronic stroke patients were investigated in hospital of whom all patients had a pre-existing medical condition like uncontrolled hypertension and diabetes. Total number of participants is N=86. Number of male participants N=25 and females N=18 in group A. Number of male participants in group B is 23 while number of females is 20. The participants in both groups demonstrated a significant increase in balance and mobility scores after 6 weeks of WBV training. Experimental group having 6th week BBS mean, standard deviation, 52.37, 1.92 and Control group having 6th week BBS mean, standard deviation 45.25, 4.18 respectively. The participants in both groups demonstrated a significant increase in balance and mobility scores after 6 weeks of WBV training but more pronounce results in experimental group. Conclusions: The results of this study concluded that whole-body vibration exercise with routine physical therapy treatment is very effective in improving balance, mobility, postural control, muscle strength, tone, power output, coordination reduced muscle spasticity and functional disability in patients with chronic stroke. Keywords: Whole-Body Vibration, Berg Balance Scale, Squats Exercise, Mechanical Vibrations

Study Objective: The objective of my study is assess the quality of life in coronary artery disease patients using WHO QoL BREF and to identify the different variables and factors which are affecting the quality of life in CAD patients in our population in general and the economic progress of the country in particular. Material & Methods: The study design will be cross-sectional and purposive sampling technique will be used. The study population will be the patients presenting in cardiology OPD of Shalamar hospital & Punjab Institute of Cardiology Lahore. Inclusion criteria will be the patients of both sexes above 30 years and exclusion criteria will be the patients with ailments other than coronary artery diseases. Results: A total of 611 CAD patients includes in for the research. 305 from Public & 306 from private hospital. Mean age was 56 years out of which 377 (61.7%) were male patients and 234 (38.3%) were females. Out of 611 patients that were included in the study 19 (3.1%) rated their quality of life very poor; 265 (43.4%) poor; 200 (32.7%) neither poor nor good & 127 (20.8%) good. Conclusion: The study showed life’s quality and general wellbeing, with the majority of patients having a "poor" life’s quality . The relationship among quality of life and patients' perceptions of health and age was statistically significant.

A total of 44 Staphylococcus aureus isolates have been reactivated and diagnosed by using bacteriological and biochemical methods and confirmed by VITEK 2 compact system. The specimens were obtained from several causes included vagina, urine, nose wounds and burns. The results of virulence factors investigation showed that 70.5% of S. aureus isolates were beta hemolytic, 56.8% have Dnase activity, 45.5% were gelatinase positive and 91% were biofilm producer. The results showed a great prevalence of MDR strains of S. aureus with significant p value (

The aim of this study was to compare between different methods in identifying Helicobacter pylori in saliva, oral swabs and biopsy specimens obtained from patients’ chronic gastritis and peptic ulcer disease. Methods: A total of 100 tissue biopsy, saliva and oral swab samples were collected and tested for identification of H. pylori using urease test, culture media and PCR for detection of 16sRNA and virulence CagA and VagA genes. Results: It was found that the biopsy results in all methods have high percentage 85% with the exception of CagA gene that gave a high percentage 71% in saliva samples, there were 82.05% urease positive using saliva sample and 43.59% using swab sample, 59.65% positive saliva culture and 38,60% positive swab culture, regarding 16sRNA, there were 70.59% saliva sample positive and 43,53% positive swab sample. H pylori detection by cag A gene of saliva in comparison with biopsy was 87.50% and of oral swab 41.67%, however by VagA gene the result of saliva was 31.25% and of oral swab was 16.67%. Conclusion: All detection method that done by using biopsy sample more accurate and give reliable result. Saliva sample using in detection H.pylori is attractive for use in population based prevalence surveys for H. pylori infection. Keywords: H. pylori, saliva, oral swab ,16SrRNA, VacA,GagA

Background: Among the female population, incontinence of urine varies 23-45%. Significant symptoms of urinary incontinence found in about 7%, of which 50% are urinary stress incontinence (USI). It is an unintentional urinary leakage from the urethra, during physical activity such as coughing, sneezing, laughing or exercise. Objective: To find the frequency of urinary stress incontinence (USI) and to find the long term impact of mode of delivery on urinary stress incontinence (USI). Methodology: Study Design: Cross sectional study Settings: Department of Obstetrics & Gynecology, Janki Devi Jamiat Singh Hospital Procedure for data Collection: 252 Patients with 48 to 58 years of age who answered questions related to urinary incontinence were included in the study. Data was entered and analyzed in SPSS. Age was presented as mean and ±SD. Mode of delivery, USI and Parity, etc… were presented as frequency and percentage. Chi square test was applied to compare the association between urinary stress incontinence with mode of delivery. p-value less than 0.05 was considered as significant. Results: Total 252 patients included, the mean age was 53.45+13.24 years. Most of the females 133(52.8%) had 52-57 years of age group. Number of Women who had vaginal deliveries were 165(65.5%) and those who had Cesarean section were 87(34.5%). The frequency of USI was reported as ‘never’ by 113(44.8%); ‘occasionally very less often’ by 63(25.0%); ‘sometimes with sneezing, coughing but not always’ by 47 (18.7%); and urine always leak with coughing and sneezing i-e severe USI by 29(11.5%). Severity increased with parity, and the frequency of USI was higher in women who had vaginal deliveries compared to cesarean deliveries. There was significant impact of mode of delivery on urinary stress incontinence. (P >0.05) Conclusion: The conclusion of the study is that the prevalence of USI was lowest among nulliparous women and higher in multiparous women. Frequency of urinary stress incontinence was higher in women who had multiple vaginal deliveries compared to cesarean deliveries. Other Significant risk factors for severe USI were age, multiparity and high body mass index (BMI >30). Keywords: Mode of Delivery, Parity, Urinary Stress Incontinence

Background: Distal penile hypospadias is one of the common congenital abnormality. It is the anomaly of anterior urethral and penile development. Objective: The purpose of the study is to find the outcomes of TIP urethroplasty in distal penile hypospadias in the pediatric patients. Study design: This retrospective study was conducted at the urology department of our institute hospital for the duration of six months from February 2022 to July 2022. Material and Methods: Out of all the patients that visited hospital during a course of 1 year, 250 had distal penile hypospadias. There were 45 individuals that were less than 2 years of age, while the remaining patients were more than 2 years of age. There were 210 patients that were included in the de novo hypospadias type and 40 had recurrent type of hypospadias. Results: Chordee was found in case of 50 patients, most of the patients had their chordee disappeared during the degloving of the penis. Running sutures were in use of 200 patients while 50 reported about interrupted use of suturing. There were 25 patients that used no stent after surgery, however, the stent was used by 150 patients for 3 days. Conclusion: TIP urethroplasty is an effective and reliable method that can be used for the treatment of distal penile hypospadias as it has less rate of complications and is suitable for primary as well as redo operations. It covers neourethra by the moving corpus spongiosum or by any flap. Keywords: TIP urethroplasty and penile hypospadias.

Background: Approximately 9.4% of the global population is affected by the acne. It is one of the most prevalent types of disease around world. Acne scars are produced after a severe attack of acne. Objective: This comparative study was carried out to find the outcomes of two main acne treatments carried out by dermatologist. Study design: It is a randomized and controlled based study conducted at Dermatology department of Liaquat University of Medical and Health Science, Jamshoro and Sir Syed Medical College and Hospital Karachi for the duration of six months from February 2022 to July 2022. Material and Methods: The study comprised of a total of 120 patients, among them there are 49 males and 71 females, divided in three groups. Group 1 contains patients who experienced dermapen microneedling technique. EMLA cream was applied to the face of patients for 40-60 minutes and then microneedling was performed gently. Every 2 weeks microneedling session was carried out and a total of 6 sessions were given to the patients. Results: The patient’s response to the treatment given was also evaluated by using the standard global scar grading system. The three groups reported statistically significant results. Most of the patients reported about improvement in group 1 and 3, however in group 2, 31 patients showed no improvement. Conclusion: The use of microneedling is much more effective than glycolic acid peeling, but if both techniques are used in an alternative manner, it not only gives positive results but also makes skin healthy smooth and shiny. Keywords: Microneedling, glycolic acid chemical peel and acne scars.

Background and aim: The recurrence of urinary stones occurs in two thirds of patients within a 20-year period, making urinary stones a common pathology. Among urology pathologies, kidney stones rank third behind urinary infections and conditions of the prostate. The present study intended to assess various factors affecting the extracorporeal shockwave lithotripsy (ESWL) outcome in urinary stone treatment. Methods: This cross-sectional study was carried out on 136 urinary stone patients who underwent extracorporeal shockwave lithotripsy in the Department of Urology, Sahiwal Teaching Hospital, Sahiwal for the duration from September 2021 to August 2022. Computed tomography confirmed the presence of stones and measured the size (3-20 mm), distance from skin to stone, location, and density in Hounsfield units. Patient’s characteristics such as estimated rate of glomerular filtration and BMI were measured. A successful ESWL requires at least a 3mm residual renal stone fragment in post-therapy, and at least a complete clearance of ureteric stones at the end of treatment. SPSS version 26 was used for descriptive statistic. Results: Of the total 136 urinary stone patients, there were 108 (79.4%) male and 28 (20.6%) females. The incidence of stones present in proximal ureter, mid, and distal ureter was 72 (52.9%), 7 (5.1%), and 57 (41.9%) respectively. All the patients underwent ESWL 1.5 times (average), and the success rate in first, second, and third session was 67.8% (n=92), 83.8% (n=114), and 91.2% (n=124) respectively. The overall success rate of ESWL was 80.9%. A multivariate analysis revealed that HU [OR=0.89, 95% CI, 0.96-0.98, P=0.001) and stone size [OR=0.79, 95% CI, 0.62-0.98, P=0.051] were significantly affecting the first ESWL session success rate. Third session success rate was significantly affected by stone size [OR=0.76, 95% CI, 0.58-0.95, P=0.015]. Stent associated higher failure rate [OR=6.425, 95% CI, 2.132-18.235, p=0.001] and ESWL failure was three-times higher in females than in male. Conclusion: The present study found that the overall success rate of ESWL in urinary stone treatment was 80.9%. ESWL success rates were affected by stone size and HU. Patients' pain and fragmentation levels should be considered when adjusting the intensity of ESWL. Keywords: Urinary stone treatment, Outcomes, Extracorporeal shockwave lithotripsy

Background: Asymptomatic bacteriuria is the occurrence of bacteria in the urine sample without any clinical symptoms. The odds of asymptomatic bacteriuria increase due to the hormonal growth during pregnancy. Methodology: The data was collected from a sample of size 167 pregnant women using self-structured questionnaire. The questionnaire was based on two sections. The questionnaire was tested using Cronbach alpha. The data was collected using convenient sampling. The frequency distribution of the risk factors was given. The binary logistic regression analysis was performed to access the major risk factors that enhance the odds for asymptomatic bacteriuria in pregnant women. Results: The past history of UTI was seen as a significant risk factor. The overall incidence of asymptomatic bacteriuria was found in 22 pregnant women and among these, approximately 9% had past history of UTI. About 44.9% of the pregnant women showed a past history of UTI. Conclusion: Most of the pregnant women fall in the age group 26-32 years. The significant factor is age group for asymptomatic bacteriuria. Advancement in age enhance the odds for the asymptomatic bacteriuria. History of UTI is found as a significant risk factor. Keywords: Asymptomatic bacteriuria, pregnancy, infections

Objective: The purpose of the present investigation was to ascertain how drug resistance in pancreatic cancer organoids affects the efficacy of chemotherapy. Study Design: Retrospective study Place and Duration: Jinnah International hospital, Abbottabad, 15th March- 15th September, 2022 Methods: A total of 72 patients of both genders with pancreatic cancer were presented in this study. After obtaining written consent from participants, we recorded detailed demographic information about them, including their age, sex, and body mass index. Pathological evaluation of tumour regression grade (TRG) was compared to data on the dose and schedule of neoCTx treatment. SPSS 22.0 was used to analyze all data. Results: This study had 43 (59.7%) males and 29 (40.3%) females. 22 (30.6%) patients were aged between 18-30 years, 25 (34.7%) patients had aged between 31-40 years, 15 (20.8%) patients had aged 41-50 years, and 10 (13.9%) patients had aged> 50 years. In a study with 15 CTx-naive PDO lines, 8 showed a distinct response to FOLFIRINOX or Gem/Pac. As much as 34.7 per cent of patients with NeoCTx PDOs experienced an unfavorable reaction to their neoadjuvant treatment. Modified treatments in which the lowest successful individual medicine was eliminated from the full regimen showed no meaningful change in PDO response. Conclusion: It is possible that drug testing on CTx-nave PDAC PDOs and neoCTx PDOs will help determine the optimal neoadjuvant and adjuvant treatment regimens. In order to increase the proportion of patients completing the course of neoadjuvant treatment, it may be beneficial to individualize poly-chemotherapy regimens by removing chemicals with low effectiveness. Keywords: Pancreatic Cancer, Chemotherapy, Drug Resistance, Tissue Organoids

Introduction: Diabetes mellitus is a significant precursor of CAD. Patients hospitalised for suspected myocardial infarction had type 2 diabetes at higher rates than the general population, increasing the likelihood of cardiovascular complications. Hospitalized individuals with CAD have a worse prognosis if they also have diabetes mellitus. Objective: With this study, we want to quantify the prevalence of unrecognised diabetes mellitus among Acute Coronary Syndrome patients at a tertiary care hospital in Lahore. Study design: Cross sectional study Setting: Department of Cardiology, Bahria Town Hospital, Lahore Duration: Six months (09-2018 to 03-2019) Data collection procedure: One hundred forty patients who fulfilled the study's inclusion and exclusion criteria were included. Using a standardised questionnaire, we were able to collect information such as age, gender, and type of ACS (STEMI, Non-STEMI, or unstable angina). Diabetes was diagnosed by measuring fasting blood sugar and haemoglobin A1c in a serum sample of 3 cc. It was noted that untreated diabetes mellitus was present. Results: There were 110(78.6%) males and 30(21.4%) females in our study. The mean age of patients was 57.08±12.72 years. The mean height was 171.95±14.37 cm, mean weight was 80.70±11.23 kg and mean BMI was 26.89±3.64. There were 63(45%) patients with family history of diabetes. There were 60(42.9%) patients with Non-STEMI, 52(37.1%) with STEMI and 28(20%) with unstable angina. The mean HbA1c of the patients was 6.11±0.86. There were 10(7.1%) patients with undiagnosed Diabetes mellitus. Conclusion: 7 percent of ACS patients have diabetes mellitus that has not been diagnosed. Keywords: Undiagnosed Diabetes Mellitus, Acute Coronary Syndrome, type 2 diabetes, family history, STEMI

Aim: To determine the prevalence of anemia in pregnant women in Punjab. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics & Gynaecology, DHQ Hospital, Faisalabad from 1st October 2021 to 31st March 2022. Methodology: One hundred and fifty pregnant females were enrolled, clinically assessed for their anemic status and were divided into two groups in reference to suspicion of anemia. Group A had those pregnant females who were suspected for anemia while group B were with no suspicion of anemia. Both Group A and Group B had 75 pregnant females. The complete blood count and serum analysis of ferritin, iron and folic acid was performed in each patient after withdrawal of 5cc blood. The demographic details of each patient as well as dietary habits in context of meat, fruit and vegetables from last month were also documented. Results: There were 37.3% pregnant females within suspected anemia group while 36% pregnant females in no suspected anemia group. The frequency of abortion was higher in group A than B with an odds ration as 1.17-1.18. There were more over weight and obese women in suspected anemia Group A while under-weight were more common in Group B. Pregnant females in Group A were consuming less amount of meat, fruit and vegetables than females in group B. The suspected anemia pregnant females blood analysis reports showed 74.6% been iron deficient in comparison with 41.3% non-suspected pregnant females Conclusion: Anemia was prevalent in both suspected and unsuspected group and 75% of the suspected anemia group were also iron deficient. Keywords: Iron deficiency anemia, Pregnancy, Hemoglobin, Incidence, Developing countries

Aim: The aim of this study was to compare the healing and functional outcomes of metacarpal bone fractures treated conservatively versus surgically. Study design: A longitudinal study Place and Duration: This study was conducted at Ghulam Mohammed Mahar Medical College Sukkur Pakistan. from June 2020 to June 2021 Methodology: The study comprised a total of 80 people with varied forms of metacarpal fractures. The fractures were treated conservatively or surgically in the orthopedic department. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, which was used to assess the ability to execute various tasks, inspired the creation of the questionnaire. The least level of disability was assigned a score of 0, and the most degree of disability was assigned a score of 100. Results: In the DASH questionnaire, a scale score ranging from Zero to 100 was calculated. The greater the score, the worse the scenario. The majority of the subject obtained a score of 21 to 25, suggesting that they were generally pleased with their therapy. The Michigan questionnaire was used to assess patient satisfaction as the next questionnaire. Patients' primary expectation is restoring maximum hand function, and the functional outcome is critical. Conclusion: Most metacarpal fractures have a satisfactory outcome with nonoperative therapy because there is a lot of tolerance for angulation and shortening. Physical therapy and mobilization are critical components of treating these fractures and are an important part of the rehabilitation process. More study is required to help develop a definite treatment regimen while maintaining our patients' quality of care and overall wellness. Keywords: Fracture, Metacarpals, Conservative Treatment