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Introduction: E-learning, defined here as ‘any learning that uses information and communication technologies is seen as one way to support the advancement of healthcare experts. The adaptability and availability of such modes of delivery are seen globally as advertising opportunities to meet key instruction plans counting lifelong learning and extending participation. Technology-enhanced learning in healthcare education ranges instructive to constructivist approaches. The student constructs new information through investigation of information and reference to involvement and understanding. Objective: To study the expectation and experiences of medical students regarding use of e-learning resources in higher education Study Design: Quantitative cross sectional Settings: Bakhtawar Ameen medical & dental college, Multan Duration: Six months i.e. 1st January 2022 to 30th June 2022 Data Collection Procedure: A pre validated questionnaire was used. Study was carried out at Bakhtawar Ameen medical & dental college, Multan. The total numbers of students were 300 who participated after taking the informed consent. The study was done by simple random sampling technique. All the medical undergraduate students of first to final years must be aged between 20-30 years age. Questionnaire consists of demographic profile, expectation and experiences of medical students regarding use of e-learning resources in higher education Results: The total number of patients who participated in the study was 300 in which 140 (46%) were males and 160 (54%) were females. The undergraduate’s student’s age is in between 20-30 years. On inquiring about student’s expectations and experiences about e learning all the parameters were rated high about e learning which shows the significance of study and p value is

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

Background: The surgical treatment of perforated duodenal ulcers is not controversial; however, the best surgical strategy is still up for debate. The perforation closure with an omental patch or without it during surgery is the basis of perforated duodenal ulcers treatment. Laparoscopic surgery can now be used to repair a perforated duodenal ulcer due to developments in minimal access surgery. Aim: In this analysis, the results of open versus laparoscopic repair of perforated duodenal ulcers were compared in terms of operating time, length of hospital stays, postoperative pain and complications after the operation, among other factors. Methods: This prospective comparative study was held at the surgical department of Agha Khan University Hospital, Karachi for one-year duration from January 2022 to December 2022. Patients were divided randomly into two groups, A and B, who underwent operations using laparoscopic and conventional methods, correspondingly, and results were compared. Results: This study found that men between the ages of 51 and 60 were most frequently affected. Laparoscopic group patients experienced much less post-operative pain, need less analgesics, minimum wound infection, and less stay in hospital than open group patients (p 0.05). Conclusions: Laparoscopic repair when performed on carefully chosen patients for perforated duodenal ulcers, it is safe, practical, and produces better outcomes than open surgery. Keywords: Omental patch, laparoscopic repair, open repair, perforated duodenal ulcer

Aim: To determine the outcome of patients diagnosed with complex fractures of tibial plateau with associated soft tissue compromise treated by using Ilizarov fixator. Study design: Prospective observational study. Place and period of study: Orthopaedic unit, Chandka Medical College SMBBMU Larkana from January 2021 to December 2021 Methods: Patients diagnosed with complex tibial plateau fracture with associated soft tissue compromise fulfilling inclusion criteria were enrolled in study. All participants were managed with Ilizarov fixator and it was removed when fracture was united clinically and radiologically. Outcome of patients was evaluated on the basis aggregate score of knee society score and knee functional score at 6month follow up. Results: Twenty seven consecutive patients met the inclusion criteria, of which 19(70.37%) were male and 8(29.7%) were female. Average age of patients was 32.37 years. All fractures healed by the end of the 4th month. Ring fixator was removed routinely at 16th weeks after initial surgery in all patients. Transient peroneal nerve injury was found in 2 patients; no patients developed deep vein thrombosis, whereas pin site infection was most common complication and occurred in 5 patients (18.5%). According to knee society score results were excellent in 15(55.55%) patients, good in 08(29.62%) patients, fair in 03(11.11%) in patients and poor in 01(3.70%) patient. Practical implication most of proximal tibial plateau fractures with soft tissue compromise are kept under observation till the soft tissue status become favorable for open reduction and internal fixation, while fixing these type of fracture with Ilizarov fixator one can provide early relief to patients and results of this study will be help for operating surgeons while managing complex proximal tibia fractures. Conclusion: complex tibial plateau fracture can be effectively treated with Ilizarov fixation method without any complication, when exposed reduction and interior fixation with plate is contraindicated due to compromised soft tissue. Keywords: Tibial plateau, fractures, Ilizarov, fixation method, outcome, soft tissue compromise

Objective: To evaluate the antierosive effect of epigallocatechin gallate extract (EGCG) on dental erosion and to compare it with potassium nitrate containing mouthwash. Materials and Methods: This invitro study was conducted in Sardar Begum Dental College and Peshawar dental hospital, Peshawar, KPK. The Scanning electron microscope study was carried out in Centralized Resource Laboratory (CRL), University of Peshawar while Microhardness in University of Engineering and Technology (UET), Peshawar. Total 042 healthy human premolars and impacted third molars were divided into 3 groups: Group I as control (distilled water), Group II was treated with potassium nitrate containing mouthwash while Group III was treated with EGCG. The samples were placed in artificial saliva for six hours. Afterwards teeth were placed in 10ml of the respective test solutions (For each group) for 4 minutes. Samples were kept in commercial beverage for fifteen min with constant stirring at (20-25 °C) afterwards washed with distilled water and then placed in artificial saliva for an hour. The process of erosion was done in four cycles. Finally, the samples were kept in deionized water. The samples were then subjected to Scanning Electron Microscopy (SEM), and micro-hardness.Averages were taken for statistical analysis.LSD post hoc (ANOVA) test was done for analysis of the groups. Results: There was detectable difference in the dentinal tubule occlusion and hardness between the three groups. EGCG and Potassium nitrate containing mouthwash yielded better results. Conclusion: It was concluded from the present study that EGCG and potassium nitrate demonstrated antierosive effects. Keywords: Dentin hypersensitivity, Dentinal Tubule, Potassium nitrate, EGCG

Aim: We aimed this study to find the prevalence of depression among multi drug resistant (MDR) TB patients and its related determinants. Material and methods: An observational cross-sectional study was conducted at Jinnah Postgraduate Medical Center Karachi hospital, we enrolled 107 MDR-TB patients using non-probability consecutive sampling. Patients were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9). Prevalence of depression along with its determinant were assessed. We used Chi Square test for association between depression and its determinants keeping P value < 0.05 was taken as statistically significant. Results: Patients’ mean age was 32.10±6.19, male patients were higher in number as compared to female patients. In our study we found that depression was present in 52 (48.6%) patients. Depression had significant association with financial issues, family problems, treatment duration and increasing age. Practical implication: Current study assess the determinants of depression in TB patients and spreads public awareness in community about Multidrug resistance in TB and ways to avoid TB in local population. Conclusion: From our study we conclude that 52 (48.6%) patients had depression in MDR-TB patients which is an alarming situation. Financial issues, family problems, treatment duration and increasing age were found to the determinants of depression in MDR-TB patients. Keywords: Tuberculosis, Multi Drug Resistance, Depression, Truenat, Xpert, Mental disorders, psychiatric comorbidity

Introduction: Physical and sedentary activities have been distinguished as possibly modifiable hazard components for many diseases, counting mental ailment, and may be effective targets for open health policy and intervention. However, the relative commitment of physical activity versus sedentary conduct to mental wellbeing is less clear. Objective: To identify the psychological effects of sedentary behaviour among medical students Study Design: Quantitative cross sectional Settings: M Islam Medical College Gujranwala Duration: Three months i.e. 1st January 2022 to 30th March 2022 Data Collection procedure: The study was conducted at M Islam Medical College Gujranwala to identify the psychological effects of sedentary behaviour among medical students. The cross sectional study conducted over 200 medical students. The Korean form of the Perceived Stress Scale (PSS), which was developed by Cohen et-al, was utilized in this study. Anxiety was measured with the Beck Anxiety Inventory (BAI), a self report scale that was created by Beck et al. Depression was measured utilizing the Center for Epidemiological Studies-Depression Scale (CES-D). Results: The total number of students who were participated in the study was 200 in which 82 were males and 118 were females. Psychological effects of sedentary behaviour among medical students on hourly basis, week days and on weekends were calculated. BMI, Mean and standard deviation were calculated in regard to stress, anxiety and depression. Practical implication Conclusion: Stress, anxiety, and depression are genuine mental wellbeing issues among college student groups. The sedentary behavior of college students was found to be significantly related to their mental problems in the present study. Be that as it may, until now, research has rarely been conducted to identify the mechanisms or interceding variables that clarify the relationship between sedentary behavior and stress, anxiety, and depression. Keywords: Sedentary behaviour, stress, psychological, anxiety, depression

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.

Introduction: Addictions and mental sickness are among the foremost expensive diseases in the world, according to a Worldwide Burden of Illness research, but they often go unnoticed. There's a coordinate correlation between substance use disorder (SUD) and destitute treatment compliance, course and result, more vagrancy, more unemployment, criminal offenses, suicide and more awful overall functioning among individuals with mental sickness. A few large epidemiological studies have been conducted in industrialized countries to look at the predominance of SUD among individuals with mental sickness Objective: To find out the frequency of depressive illness among carers of drug addicted patients Material and Methods Study design: Quantitative cross sectional Settings: Niazi welfare foundation teaching Hospital Sargodha Duration: Four months i.e. 1st January 2022 to 30th April 2022 Data Collection procedure: Cross sectional study was conducted on 100 patients. Each patient demographic profile was recorded. Psychiatrists and psychologists took the interview and explained the purpose of study. Caregivers of patients with drug addicted were rule out for anxiety and depression. Results: The total number of patients was 100 in which 82 were males and 18 females. BMI of the patients was 24.5+ 12.7 and the mean age was 35.5+ 7.5. Majority of the patients belong to poor socioeconomic status as 68%. The living area of patients are 45% in urban and 55% in rural. The patients having depression percentage is 84% and anxiety 80%. Conclusion: This study highlighted the findings that carers of patients who used psychoactive substances shown serious sadness. On the one hand, the seriousness of medication-related challenges is clearly connected to the advancement of uneasiness and discouragement to others. Keywords: Depression, Anxiety, Psychoactive, drug, Caregivers

Background: COVID-19 pandemic globally challenged the healthcare sector as well as posed a serious threat to mental health among both young and adults rendering people with a sense of uncertainty and loss. Objective Aim: To assess the psychological burden among the adolescent population during the pandemic and lockdown. Methodology: A cross sectional study was moderated by the research team at the Department of Psychiatry and Behavioral Sciences, Jinnah Postgraduate Medical Center between April 2020 to October 2021. All individuals between the ages of 13 to 17 years were included. The proforma was circulated among residents of the province of Sindh that assessed the emotional symptoms, conduct problems, hyperactivity-inattention, peer relationship problems, and prosocial behaviors among participants. Results: The mean SDQ score was 24.97 with a standard deviation of 6.62. The mean scores for emotional symptoms, conduct problem, hyperactivity, peer problem, and prosocial Scale were 5.47, 6.82, 5.85, 6.82, and 3.02, respectively. A significant relationship was revealed between mental health stability and witnessing a death of a known person due to COVID-19 infection (p=0.003). Furthermore, the study found that Sindhi individuals had significantly higher scores as compared to other ethnic groups (p=0.002). Conclusion: The young population is as equally stressed as adults and may suffer from substantial anxiety during the pandemic. Therefore, parents should be encouraged to create an atmosphere of support and goodwill. Keywords: Adolescent, coping mechanism, covid19, pandemic, psychological distress

Acute appendicitis is the most common indication for surgery in patients admitted to hospital for acute abdominal pain. In about 20% of cases, acute appendicitis is complicated, leading to local or diffuse peritonitis mostly. Although urgent appendicectomy is still the recommended treatment for acute uncomplicated appendicitis and also antibiotic treatment can cure acute appendicitis or can be the first line of treatment. In the Current study we assessed the efficacy of amoxicillin plus clavulanic acid by comparison with emergency appendicectomy for treatment of patients with uncomplicated acute appendicitis. In this Study open-label, non-inferiority, randomized trial, adult patients (aged 18–68 years) with uncomplicated acute appendicitis, as assessed by CT scan, were enrolled at Pakistan Instiute of Medical Sciences (PIMS) Hospital Islamabad Pakistan. A computer-generated randomization sequence was used to allocate patients randomly in a 1:1 ratio to receive amoxicillin plus clavulanic acid (3 g per day) for 8–15 days or emergency appendicectomy. The primary endpoint was occurrence of post intervention peritonitis within 30 days of treatment initiation. Non-inferiority was shown if the upper limit of the two-sided 95% CI for the difference in rates was lower than 10 percentage points. Both intention-to-treat and per-protocol analyses were done. The Current research Result show that Of 243 patients randomised, 123 were allocated to the antibiotic group and 120 to the appendicectomy group. Four were excluded from analysis because of early dropout before receiving the intervention, leaving 239 (antibiotic group, 120; appendicectomy group, 119) patients for intention-to-treat analysis. 30-day post intervention peritonitis was significantly more frequent in the antibiotic group (8%, n=9) than in the appendicectomy group (2%, n=2; treatment difference 5•8; 95% CI 0•3–12•1). In the appendicectomy group, despite CT-scan assessment, 21 (18%) of 119 patients were unexpectedly identified at surgery to have complicated appendicitis with peritonitis. In the antibiotic group, 14 (12% [7•1–18•6]) of 120 underwent an appendicectomy during the first 30 days and 30 (29% [21•4–38•9]) of 102 underwent appendicectomy between 1 month and 1 year, 26 of whom had acute appendicitis (recurrence rate 26%; 18•0–34•7).The Current result conclude that Amoxicillin plus clavulanic acid was not non-inferior to emergency appendicectomy for treatment of acute appendicitis. Identification of predictive markers on CT scans might enable improved targeting of antibiotic treatment. Keywords: Amoxicillin, clavulanic acid versus appendicectomy

Objective: The purpose of this research was to identify how often individuals with COPD suffer from depression and what variables may be contributing to their feelings of depression. Study Design: Cross-sectional study Place and Duration: This cross-sectional study was conducted at Department of Psychiatry, Lady Reading Hospital, Peshawar in the period from April, 2022 to September, 2022. Methods: Total 220 patients of both genders had age 20-85 years were included in this study. All the patients had chronic obstructive airway disease were presented. Patients' full demographic information, including age, sex, BMI, job status, and smoking history, was collected after obtaining informed written consent. Association of depression and its severity were recorded among all cases. We used SPSS 24.0 to analyze all data. Results: One hundred and forty (63.6%) cases were males and eighty (36.4%) were females. Patients mean age was 61.03 ±7.48 years and had mean BMI 25.6±7.26 kg/m2. Majority 150 (68.2%) cases were unemployed. 135 (61.4%) cases were smokers. We found a high frequency of depression in 130 (59.1%) patients in which 60 cases were had severe depression. Older age, living alone and unemployment were the risk factors of depression among COPD patients. Conclusion: We concluded in this study that frequency of depression among COPD patients were high found in 59.1%. Depressive symptoms were shown to be associated with several different risk factors in COPD patients. Older COPD patients, men, those who are retired or jobless, and those who do not have a significant other are at a higher risk of depression. Keywords: COPD, Depression, Old age, Severity

Aim: To determine the impact of Continuous Positive Airway Pressure therapy on body weight in Obstructive Sleep Apnea patients and assess the relationship between the weight change and other associated symptoms of Obstructive Sleep Apnea. Methods: From a Tertiary care Hospital, Karachi we enrolled 184 Obstructive Sleep Apnea patients of both gender with age more than 18 years of whom 92 patients were exposed to Continuous Positive Airway Pressure while 92 patients were not exposed. In a pre-and post-treatment, information on height, weight, Body mass Index, and neck circumference were recorded. Sleep score was evaluated through Epworth Sleepiness Scale. Results: Results revealed that CPAP effects on weight and BMI. 24% of participants exposed with CPAP gained weight (p=0.03) whereas 72% of participants reduced the weights (p=0.004). The paired t-test showed the mean difference of 3.53±7.5kg (mean±SD, p-value: 0.00). The multivariate analysis showed that CPAP lessens the poor concentration (OR: -4.852; p-value

Diabetes mellitus (DM) is a chronic metabolic syndrome which results from deficiencies/defects in the pancreatic insulin secretions or insulin action on the target tissues. Purpose: To compare the beneficial effects of Metformin, N -acetylcysteine and L-arginine on dyslipidemia and hyperglycemia in Streptozotocin-induced diabetic rats. Study Design: Randomized controlled trial. Methodology: A total of 35 rats were used with 5 rats randomly allocated in 7 groups. Diabetic model was created by using streptozotocin (35 mg/kg) single dose intraperitoneal (IP). After 48 hours the animals with blood sugar concentration more than 300 mg/dl were considered diabetic. First group and second group were controls with Diabetic Mellitus (DM) rats. The group three, four and five with diabetic rats were given Metformin, N -acetylcysteine (NAC) and L-arginine (L-Arg) respectively. The sixth group of diabetic rats was given combination of Metformin and NAC while the seventh group of diabetic rats was given Metformin and L-Arg. All groups were treated for four weeks. At the end of the experimental period, groups were compared for fasting blood glucose. Statistical analysis: SPSS 25.0 statistical software was used to analyze the whole data. The difference between all the groups was analyzed using One-Way Analysis of Variance (ANOVA). Results: Significant improvement, with regards to the BSF test in L-Arginine Group, Metformin plus L-Arginine Group and the Metformin plus N-acetylcysteine group. Conclusion: It was concluded that in streptozotocin induced diabetic model, hyperglycaemia was significantly attenuated by the use of novel antioxidants; L-Arginine and N-acetylcysteine. Keywords: Hyperglycemia, L-arginine, Metformin, N-acetylcysteine and Streptozotocin.

Objective: To determine the effects of elastic intramedullary nails used for fixation of femur diaphyseal fractures in paediatric patients. Method: This prospective observational research was done from April 2020 to June 2021. 52 paediatric patients diagnosed with femur diaphyseal fractures with mean age from 6 to 12 years were enrolled in this study. All patients were admitted and subsequently operated for treatment of femur fracture using elastic intramedullary nail in retrograde fashion. Patients were in structured follow up till radiological union realized. Flynn scoring criteria was applied to evaluate the functional outcomes at 6 months after surgery. Results: The average age of patient enrolled was 9 years (6- 12 years), all 52 patients were in follow up for average 26 weeks (14-36 weeks). Fracture union was observed in all operated children in mean time of 9 weeks (range 6-12 weeks). Four participants suffered superficial skin infection at entry site. Two patients had limb length discrepancy upto1.5cm and two patients had varus angulations up to (10º) and in two patients proximal migration of nail was noted. According to Flynn Criteria outcome was excellent in 38 patients (73.1%), satisfactory in 12 patients (23.1%), poor in 2 patient (3.8%) respectively Conclusion: Fixation of femoral diaphyseal fracture with intramedullary elastic nail in paediatric patients is better option. One can achieve excellent results, satisfactory radiological and clinical bony union, with lowest complication rate, so it could be regarded as a favorable fixation implant for management of diaphyseal femur fractures in pediatric age group. Keywords: Fracture, femur shaft, elastic intramedullary Nail, Paediatric patients.

Aim: To access the diagnostic value of the mean platelet volume in children with acute appendicitis. Study design: A case control study Place and duration: In the Surgical department of Bilawal Medical College for Boys LUMHS, Jamshoro and Sheikh Zayed Medical College/ Hospital Rahim Yar Khan for six-months duration from July 2021 to December 2021. Methods: 150 total patients were selected with the WHO formula with SD 1.09, 80% power, 5% significance level with cases to control ratio of 1:1 and expected populace 7.55. The patients were selected with simple random technique of sampling (lottery method). The continuous variables of both groups were compared by means of the t-test. To determine the association of MPV with other variables; correlation test was applied. Results: The study included 150 patients; 35 (46.7%) are men and 40 (53.3%) are women in the study group and 34 (45.3%) men and 41 (54.7%) women in the control group. 8.21 ± 3.51 (1-15 years) was the mean age of the patients in the study group and the mean age of the controls was 8.69 ± 3.51 (1-15 years). The specificity for raised neutrophil and WBC values was 91% and 89%, and the sensitivity was 77% and 84%, respectively. The sensitivity and specificity to MPV reduction was 87% and 54%. Conclusion: The increase in the leukocytes and neutrophils is significantly associated with acute appendicitis diagnosis. It is less costly and less time-consuming which cause more attention to MPV values during complete blood counts in the acute appendicitis diagnosis among pediatric patients. The low MPV levels are encountered in children with acute appendicitis. Keywords: High white blood cell count, acute appendicitis, specificity, mean platelet volume (MPV).

Aim: To compare local infiltration of Tramadol vs. Bupivacain in postoperative cholecystectomy in terms of mean pain score. Study Design. Randomized controlled trial. Place and Duration of Study: Department of Surgery, CMH, Muzaffarabad, Azad Kashmir from December 2018 to December 2019. Methodology: Total of 100 patients with 50 in each group. Cholecystectomy done with wound infiltration using Tramadol (T) in group A while Bupivacain (B) in group B at time of skin closure. Postoperative pain assessment was done by using visual analogue score (0-10) a 12 hours. Results: One hundred patients with mean age of 46.93±10.23 years were studied and male to female ratio was almost 1:2.5. The mean pain score at postoperative day one at 12 hours was recorded as (VAS 3.5±1.787) in group A (Tramadol) while mean pain score recorded as (VAS 6.0±1.195) in group B (Bupivacain).The p value was found significant

Objective: To find out the prevalence of acute otitis media among febrile children presenting at a tertiary healthcare facility. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Pediatrics, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1st January 2021 to 30th June 2021. Material and Methods: A total of 118 children of both genders aged 2 to 11 years with fever (temp>100.4 0F) for a minimum duration of 6 hours were included. Demographic data along with presenting symptoms were noted. Auroscopy/otoscopy was performed in all cases for the diagnosis of AOM. All the study data was entered into SPSS version 26.0 for statistical analysis. Results: In a total of 118 children, 67 (56.8%) were male. Mean age was noted to be 4.9±4.2 years (ranging between 2 to 12 years) and 62 (52.5%) children were aged between 2 to 5 years. Mean duration of fever was 6.20±1.7 days (ranging between 3 to 9 days) while 75 (63.6%) children had duration of fever above 5 days. Mean maximum reported fever was 103.04±1.1 0F. Irritability, dizziness, restlessness and diminished appetite were the most frequent symptoms noted in 98 (83.1%), 67 (56.8%), 61 (51.7%), and 58 (49.2%) patients respectively. The prevalence of AOM was observed in 27 (22.9%) febrile children. Conclusion: The prevalence of acute otitis media among febrile children was high. High index of suspicion for acute otitis media should be made whenever febrile children are presenting to pediatric healthcare facilities. Keywords: Acute otitis media, febrile, irritability, dizziness.

Objective To evaluate effectiveness of Ponseti technique in treatment of clubfoot in children from 2 years to 5 years of age Material and methods: Our study is Descriptive case series done at Department of Orthopedic Surgery, SMBBMU, Larkana, from April 15, 2019 to October 14, 2019. Patients fulfilling inclusion criteria attending Ponseti clinic of SMBBMU, Larkana were incorporated in our study. After getting consent, procedure was explained in detail with merits and demerits. Treatment was labeled effective if Pirani score after treatment ≤1/6. Bracing phase with Dennis Brown shoes was started for maintenance of the corrected foot after post tenotomy cast removal. Data was collected and entered into the performa attached. Results: Mean and standard deviation for age was 4.08±2.17 years. Among 71 patients, 48 (67.6%) patients were male and 23 (32.4%) were female. Positive family history was found to be in 8 (11.26%) patients. Modes of delivery shows that 46 (64.8%) patients had gone through C-Section while 25 (35.2%) had normal vaginal delivery. Efficacy of Ponseti technique was noted in 52 (73.2%) patients. Conclusion: From the studies it was shown that Ponseti technique for club foot in both presenting earlier or late is safe and effective. Keywords: Clubfeet, Congenital Talipes Equinovarus, Ponseti Technique, Pirani Score

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease causing morbidity and mortality in all population worldwide. It is present in 1 to 2 % in world's population Objective: To determine the frequency of RA in young females presenting with multiple joints pain using ACR Diagnostic Criteria for RA. Methodology: This study was Descriptive Cross-Sectional Study done at the Department of Medicine, Hayatabad Medical Complex, Peshawar for duration of six months from February 2021 to August 2021. In this study a total of 156 patients were observed to assess the frequency of rheumatoid arthritis in young females with multiple joints pain using ACR Diagnostic Criteria. Results: Serology of RF and ACPA among 156 patients was positive in 93(59.6%) patients and Negative in 63(40.4). Acute phase reactants CRP and ESR among 156 patients were abnormal in 91(58.3%) and Normal in 65(41.7%) patients Conclusion: Our study concludes that in young females with multiple joints pain, the frequency of rheumatoid arthritis was high by using ACR diagnostic criteria. Young females are prone to develop rheumatoid arthritis but remain undiagnosed and this may lead to adverse outcome and failure in prognosis and treatment. If it is diagnosed in early stage it may add to good health outcome and quality of life. Key words: Rheumatoid arthritis; multiple joints pain, ACR Diagnostic Criteria

Introduction: Comminuted fractures of patella are usually dealt with partial or complete patellectomy which compromise the extensor mechanism. Claw plate is newly introduced device to fix comminuted fractures, which provide easy and efficacious method of preserving patella and is used in selected cases. Methods: This prospective observational case series was conducted at orthopaedic department Chandka Medical College (SMBBMU) Larkana from March 2020 to May 2021. Twenty one cases were selected via consecutive sampling with comminuted fracture of patella who were treated with newly introduced claw shape patellar plate. Age of patients was ranging from 18 years to 70 years. All patients were admitted in tertiary care hospital and were operated by senior surgeon. During procedure patella was approached through anterior mid line incision over knee, fracture reduced and fixed with claw shape patella plate. Post operatively patients were assessed on subsequent follow up visits and outcome of procedure was observed on the basis of functional (Clinical) and radiological results. The functional (clinical) outcome was measured on basis of Lysholm knee score and radiologically x-rays of knee were done to see union pattern. Final outcome of procedure was concluded after 6 month of operation. Results of all patients were compiled and analysed by using statistical package for Social Sciences (SPSS) Version 21 Results: Twenty one patients were enrolled in our study, among them 15(71.4%) were male and six (28.6) were female; the mean age of patients was 42.52 years. The mean length of operation was 55 minutes (40 to 72 minutes). Bone union on radiograph was observed at 20th weeks after surgery in all patients, mean age of fracture healing was 11.5 weeks, (Ranges from 6th to 20th week). At final evaluation found excellent results in 12 (71%) patients, five (29%) patients obtain good results, while four patients lost follow up. Conclusions: Partial or complete patellectomy can be avoided in comminuted patella fractures and patella can be preserved in these fractures by using claw shape patella plate. Keywords: Comminuted fractures, Patella, Claw plate.

Background: Pregnancy induced hypertension is a fetal disease resulting into morbidity and mortality of female as well as its neonate. Objective: To find the incidence of pregnancy induced hypertension in Pakistani women. Study Design: Cross sectional study Place and Duration of the Study: Department of Obstetrics & Gynaecology, Sandeman Provincial Hospital, Quetta from 1st March 2019 to 31st March 2021. Methodology: Seven hundred and twenty eight females were identified with pregnancy induced hypertension from all the pregnant women attending the outdoor were enrolled. Each female was checked for their protein urea as well as systolic and diastolic blood pressure according to standard operating protocol. Socio-demographic, clinical and family history were documented. Results: Among all pregnant women, 150 were identified as pregnancy induced hypertensive with a 20.6% incidence of pregnancy induced hypertension. The mean value systolic blood pressure value was 144.3±5.2 and of diastolic as 83.1±5.2 in pregnancy induced hypertension women. Conclusion: Family history, obesity and renal diseases are the main factors associated with pregnancy induced hypertension with an incidence of 20.6% among pregnant women. Keywords: Pregnancy induced hypertension, Body mass index, Pregnant women, Hypertension

Background: Dengue infection has been observed to cause critical outcomes in mother as well as child from an infected pregnancy. Objective: To assess the maternal and neonatal outcomes of dengue infected pregnancy. Study Design: Prospective study. Place and Duration of Study: Department of Obstetrics & Gynaecology, Sandeman Provincial Hospital, Quetta 1st August 2018 to 28th February 2021. Methodology: Fifty pregnant females were enrolled after their dengue confirmation either by NS1, IgM or IgG test. Clinical and demographic information was recorded. Pregnancy and neonatal outcomes were noticed by following the patients until delivery and postpartum period and the new born if infected then up to post 6 months of delivery. Results: The mean age of patients was 25.5±3.5 years. Out of the total pregnant dengue infected females 60% had multigravida. Fifty percent of females came for clinical assistance in their third trimester. Post-partum hemorrhages were common in 6% patients. Vertical transmission was seen in three cases where two did not survive and had intra uterine death. Maternal mortality was seen in 14% of total cases. Conclusion: Morbidity, preterm labor, vertical transmission, intrauterine death are some of the maternal and neonatal outcomes of dengue infected pregnancy. Keywords: Dengue, Pregnancy, Neonatal outcomes, Maternal outcomes

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

Objectives: To assess the incidence and risk factors of scar dehiscence. Methodology: This was a prospective observational study where a total of 210 patients were involved over a period of six months (May 2020 to November 2020) who came to Sandeman Provincial Hospital, BUMHS gynaecology unit 1. The parturient were above the age of 18 and had previous uncomplicated lower segment caesarean sections. Patients with previous classical caesarean section and ruptured uterus diagnosed pre or intra-operatively were excluded from the study. Sampling technique: Non-probability convenience sampling technique will be used. Results: In this study, the mean age of the patients was 31.57 ± 4.26 years, the mean gestational age was 34.43± 4.45 weeks. The incidence of scar dehiscence was observed in 47 patients. Conclusion: Uterine Scar Dehiscence is one of the factors that increases fetal and maternal morbidity and mortality rate. Its incidence is found to be related with C-sections, inadequately short intra-pregnancy time interval, preterm delivery, VBAC and trial labour. In this study, the incidence of scar dehiscence was 22.38%. Keywords: Previous one caesarean section, scar dehiscence, scar tenderness