Study aim: Our study aims to assess the predictive validity of the HACOR score in our demographic area for diagnosing non-invasive ventilation (NIV) failure in patients diagnosed with type-1 respiratory failure assessed after one hour of NIV therapy irrespective of the cause of respiratory failure. Design: Prospective, single center, single blinded, interventional study Settings and conduct: HACOR score to be assessed by the consultant on duty one hour before and after being on CPAP therapy blinded to the study protocol Participants/Inclusion and exclusion criteria: Inclusion criteria included patients with Pa02/FiO2 levels < 300 mmHg and PaCO2 levels less than 45 mmHg with PaO2 and PaCO2 (calculated by ABG (arterial blood gas) analysis) at room air or not maintaining ratio at low oxygenation therapy after administration of oxygen at FiO2 of 0.30 Exclusion criteria included patients with severe cardiorespiratory compromise, critical patients on vasopressor support, patients with poor lung compliance unable to breath in CPAP, intubated patients or those intubated less than 1 hour of CPAP, patients with a previous failed CPAP trial or on HFNO (high flow nasal oxygenation) in the last 72 hours, patients non-compliant on CPAP despite sedation and patients not willing to be included in the study. Intervention groups: One interventional group studies for the HACOR score and its predictive validity for NIV failure before and after one hour on CPAP therapy Main outcome variables: Primary variables studied were success and failure of CPAP therapy and accuracy of prediction of the HACOR score for NIV failure after 1 hour of therapy.

Study aim: The objective of this study is to compare the analgesic efficacy of intra-articular facet joint block versus transforaminal epidural injection in patients with lumbar radiculopathy. Design: A non blinded randomized controlled trial; single-center study with two intervention groups carried out from June 2023 to November 2023 Settings and conduct: The study was conducted in Anesthesia department of Combined Military Hospital Rawalpindi Participants/Inclusion and exclusion criteria: Inclusion criteria included all male and female patients between ages 30-60 years presenting in the pain clinic after confirmation of lumbar radiculopathy diagnosed by standard MRI imaging studies. Exclusion criteria included patients with debilitating cardiac or respiratory disease, tumors of the spine with or without metastatic disease, patients with known allergy to lignocaine, bupivacaine or steroids, patients with a regional block done for pain in the last one year. Intervention groups: The patients were divided into the facet-joint group (Group F) and the epidural group (Group E) Main outcome variables: Main variables were pain relief after each block and assessed on visual analog score , numerical rating scale and Oswestry disability index.

Study aim: The aim of this study is to investigate the effectiveness of interferential current therapy on pain, edema, range of motion (ROM), basic functional mobility and knee stiffness in the early postoperative rehabilitation in total knee arthroplasty. Design: Randomized Controlled Trial,After the synopsis is approved, the project will be conducted with in nine months,Non Probability Sampling Technique Sample Selection: Settings and conduct: Study Setting: Bahria International Hospital, Lahore Binding: The trial will be single-blinded because the assessor will not know which group will get treatment. Assessment: Baseline and post-treatment information will be analyzed from each participant to determine the effectiveness of each treatment. After the week of treatment, a follow-up assessment will be conducted, and all results compared during treatment. A comparison of the pre-and post-treatment ranges also will be performed. Participants/Inclusion and exclusion criteria: 52 Participants included. Both male and female patients. Age between 45 to 65 years. Participants who has undergone total knee arthroplasty for the first time Patients who are not exposed to IFC treatment pre-operatively. Exclusion criteria: Patients with causes as: Infections, Deep Vein thrombosis(DVT), Cancer and Epilepsy. Bone and joint diseases or serious diseases affecting organ function. Any patient with pacemaker or any electrical stimulator device Intervention groups: The experimental group used Interferential current therapy (IFC) in addition to conventional rehabilitation protocol. The control group received conventional rehabilitation training for the treatment of TKA. The same therapist will be employed to conduct each treatment for 20 minutes, twice a day, 3 times a week, for total of 1 week Main outcome variables: Outcome measures: Clinical and physical outcomes (Pain, Edema,ROM and Basic Functional Mobility)

Study aim: Assessing the Epley’s maneuver effects on reducing craniovertebral angle (less than 50-53 degrees) in patients having posterior canalithiasis due to forward head posture, vertigo after positive Dix-Hallpike maneuver Design: Randomized clinical trial Settings and conduct: The settings are The University of Faisalabad Participants/Inclusion and exclusion criteria: Inclusion criteria: Both male and female genders; reduced craniovertebral angle that is less than 50-53 degrees; computer/ laptop users; individuals with forward head posture; IT students of final year (The University of Faisalabad) Individuals with neck pain; positive Dix-Hallpike maneuver. Exclusion criteria: CVA (cerebrovascular accident); vestibular migraine; cervical spondylosis; history of fracture; upper cross syndrome; already diagnosed with Benign paroxysmal positional vertigo; other musculoskeletal conditions; other neurological conditions; mentally or emotionally unstable; brain tumor, hypertension. Intervention groups: interventional group: Epley’s maneuver control group: gaze stabilization exercises Main outcome variables: Dizziness handicap inventory, Visual Vertigo Analogue Scale.

Study aim: This study will guide the researchers to do more work on rhythmic initiation and rhythmic stabilization. It will guide the researchers to explore the effects of rhythmic initiation and rhythmic stabilization and decreases the facial weakness and increases the muscular movement. It will help them to identify the treatment techniques to improve the facial muscles, symmetry and its movement. Design: Randomized clinical trials with 32 participants of bells palsy and included by random allocation. Parallel group with blinded outcome assessment Settings and conduct: Mujahid hospital, Shahid Ahmed heera's health clinic, Allied hospital, Rubina Memorial, Faisal Hospital. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Both gender, Age of 20-40 years, Acute onset 1-3 weeks, Bell’s palsy diagnosed with House Brackmann grading index Grade3,4, Steroids intake, Facial asymmetry with facial disability index. Exclusion Criteria: Patient having psychological problems, Patient having Neurological deficits, Patient having Stroke, Patient having Multiple Sclerosis, Facial palsy , Patient having Bilateral facial paralysis. Intervention groups: Patient was divided into two groups, group A and group B. In group A, Rhythmic initiation along with kabat patterns was applied on patient 12 sessions over 4 weeks, 3 times/weeks, 10-15 min and other group is group B, Rhythmic stabilization along with kabat patterns was applied on patient 12 sessions over 4 weeks, 3 times /weeks, 10-15min. Pre and post assessment were taken before and after intervention, then compare the readings to check the effect of both techniques and its effects of neuroplasticity on bell’s palsy. After 1 month follow up was taken. Main outcome variables: Facial asymmetry and muscular weakness

Study aim: The study aims to assess the comparative effect of METs and (muscle energy techniques) with and without scapular mobilization in patients with adhesive capsulitis. This study will help to highlight various physiological effects for managing adhesive capsulitis. To study the effect of Muscle Energy Technique on pain in patient with adhesive capsulitis. Design: Pragmatic, community based, parallel group, double blinded, randomized controlled trial. Total 377 patients will be enrolled. Patients who met our inclusion criteria will be randomized into two groups. Settings and conduct: Muhammad physical therapy & rehabilitation center Multan Participants/Inclusion and exclusion criteria: Inclusion: 1. Age range (e.g 30-60 y) 2. Patients who have completed their conservative treatment for a minimum of 6 Week 3. Patients with pain and Restricted range of motion in the affected shoulder joint 5. Patients who can understand exercise programe 6. Both genders Exclusion: 1. Patients with any other pathological disease related to the shoulder 2. Patients with neurological and rheumatological disorders 3. Patients with systemic diseases affecting the musculoskeletal system 4. Patients who may be limited in their capacity to exercise due to cardiovascular, respiratory, or metabolic issues 5. Pregnant or breastfeeding ladies 6. Fractures/dislocations 7. History of acute trauma or previous surgery in the affected shoulder 8. Patients treated with corticoid injection in the affected shoulder in the last 12 months (25, 26). Intervention groups: Group A 188 (who will receive METs with combination of scapular mobilization) and Group B 188 (who will receive METs without scapular mobilization). Main outcome variables: joint range of motion, joint stiffness, adhesions, independency and quality of life in adhesive capsulitis patients.

Study aim: TO STUDY EFFICACY OF MILTEFOSINE AND ALLOPURINOL IN COMBINATION VERSUS MILTEFOSINE ALONE IN CUTANEOUS LEISHMANIASIS Design: Clinical trial which is parallel group, double blind, randomized, phase 3 trial Settings and conduct: Dermatology Department, CMH Quetta Participants/Inclusion and exclusion criteria: Inclusion criteria Patients of both genders, aged 18-65 years with biopsy-proven cutaneous leishmaniasis. Plus • Positive LD bodies smear on Giemsa stain • Lesions in sites not responding to local treatment or meeting WHO guidelines • Multiple lesions on body • Lesions on lower legs, over a joint, mucosa or cartilage • Lesions located on sites not compatible with local treatment • Lesions that are potentially disfiguring or disabling (i.e. on face, fingers or toes) Exclusion criteria • People with comorbidity(diabetes, hypertension, chronic liver diseases, chronic kidney disease) and or immunocompromised • Allergy to Allopurinol,miltefosine and previous history of drug reactions to any drug. • Has lesions that are limited in size (papules, nodules or ulcerated nodules) • The lesion is already self-curing • Patients enrolled in other research protocols • Pregnant and breast feeding women • Those who refused to accept the diagnostic procedures • Children under 12 years of age Intervention groups: Group A: Receives miltefosine (2.5 mg/kg) plus a placebo.(wt > 45 kg = 50 mg x TDS, < 45 kg 50mg x BID, max dose 150 mg /day) for 28 days. Group B: Receives miltefosine and allopurinol (20mg/kg) Main outcome variables: Clinical Response

Study aim: The aim of the study is to compare the effects of Whole-body vibration and PNF(proprioceptive neuromuscular facilitation) techniques on pain, sensorimotor functions and balance in diabetic peripheral neuropathy Design: Two arm parallel group randomised trial with single blinded trial with 36 participants with diabetic pheripheral neuropathy,group A recieve Whole-body vibration and grouo B recieve PNF(proprioceptive neuromuscular facilitation) technique after pre and post outcome assessment , enrolled between july 2024 to december 2024. Settings and conduct: This study was conducted at Al-Shifa clinic Ahmed pur east from july 2024 to December 2024'. Participants/Inclusion and exclusion criteria: Inclusion criteria: HbA1c level should be >154ml/dL, Age beteeen 45 to 60, both male and femle participants, presence of sensorimoter dysfunction like pain and numbness,persisted pain for 4-6 weeks,Exclusion criteria: diabetic ulcers, high surgical risks,participants with cardiac conditions, neuropathic symptoms other than included in the study. Intervention groups: Group A recieves Whole-body vibration technique by standing on a vibratory platform to get vibrational stimulation. Group B recieves PNF(proprioceptive neuromuscular facilitation) techniques where the participants' limbs are moved through diagonal patterns to achieve the desired gaol. this intervention is designed for three times a week for eight weeks Main outcome variables: primary outcome variable: pain intensity measure with Numeric pain rating scale, secondary outcome variable: sensorimotor functions measured using the Leeds Assessment of neuropathic Symptoms and Signs (LANSS) scale balance measured with Berg Balance scale (BBS)

Study aim: To compare the impact of stretching exercises with and without kinesiotaping on pain levels, disability, and range of motion in shoulder flexion among dentists with rounded shoulders. Design: A double blinded, randomized clinical trial with sample size of 58 patients, enrolled between January 2024 & September 2024 Settings and conduct: Double blinded study conducted at physiotherapy OPD of Ibne Siena Hospital & Research Institute, Multan. patient and assessor are blind Participants/Inclusion and exclusion criteria: Inclusion criteria: 1)Patients with rounded shoulders diagnosed by physiotherapist. Calculate scapular index using formula (CP to SN)/(PLA to TS) *100 2) Both males and females 3) Age group 30-50 years 4) Patients with shoulder flexion limitation. 5) Patients with shoulder pain are included in the study 6) Dentists who treat more than 8 patients daily 7) Evidence of shoulder pain induced limitations in activities of daily life 8) Mobile Screen time should be less than 04 hours per day Exclusion criteria: 1) Individuals with frozen shoulder 2) Individuals with shoulder injury 3) Fracture or shoulder joint dislocation 4) Individuals with diabetic neuropathy 5) Neurological disorders like epilepsy or surgical procedures Intervention groups: Along with standard physical therapy kinesio-taping with approximately 50 to 60% stretch. 1st kinesiology tape applied from anterior aspect of acromion to spinous process of T10 vertebra. 2nd kinesiology tape was applied to same area with 50% overlay. Taping applied after every 3 days for 24 hours. Sessions given twice a week for 4 weeks lasting 30–40 minutes. Main outcome variables: Pain disability Shoulder flexion range

Study aim: To evaluate comparative effects of post isometric relaxation technique and straincounterstrain in patients with piriformis syndrome. Design: In the randomized clinical trial, participants were randomly assigned to either the Post-Isometric Relaxation or Strain Counter-Strain therapy groups, ensuring unbiased distribution. Both groups received standard conventional treatments, with each group getting its assigned therapy. This design improved the reliability and validity of the results. Settings and conduct: Participants were selected from Outdoor Patient Department of Allied hospital, National hospital Faisalabad Participants/Inclusion and exclusion criteria: Participants were eligible if they were aged 30-50 years, of either sex, with unilateral piriformis muscle involvement and positive FAIR and Beatty tests. Exclusion criteria included pregnancy, SIJ pain, lumbar radiculopathy, malignancy, previous hip, knee, or ankle surgery, pre-existing musculoskeletal abnormalities in the lumbar spine. Intervention groups: Both groups received 15 minutes of hot packs, 30-second piriformis stretches, and hip abductor strengthening. Group A received Post-Isometric Relaxation therapy with resisted piriformis contractions, while Group B had Strain Counter-Strain therapy with gentle pressure on the piriformis trigger point. Each additional therapy was given three times per session, three times a week, for four weeks. Main outcome variables: OUTCOME MEASURES A primary outcome measure was pain which was assessed by Numeric Pain Rating Scale (NPRS). Secondary outcome measures were hip abduction and internal rotation range of motion that was measured through universal goniometer and Lower Extremity Functional Status was assessed by Lower Extremity Functional Scale (LEFS).

Study aim: To determine the effect of deep transverse friction massage along with the nerve gliding exercises in the management of carpal tunnel syndrome patients Design: A Randomized Clinical Trial with two groups, not a blinded study of 3rd phase with 11 patients in each group, which is 22 in total Settings and conduct: Mujahid Hospital, Social Security Hospital, District Health Quarter Hospital Participants/Inclusion and exclusion criteria: positive Phalen's test, positive Tinel test, positive Duncan's test, both genders of patients with unilateral hand, age 20 to 40, moderate pain(4-7), No neurovascular surgery, No neurovascular condition of neck or upper limb, No neurological condition, No musculoskeletal problem of upper quadrant, No myofascial pain syndrome, No upper extremity trauma, No pain with orthopedic condition, No fracture, No post-traumatic stiffness, No osteoarthritis pain, Not pregnant, No diabetes mellitus Intervention groups: group A: TENS, Nerve gliding exercises, soft tissue massage Group B: TENS, nerve gliding exercises Main outcome variables: Pain, Wrist ROM, The Grip Strength, Functional Disability

Study aim: To assess the efficacy of short-term, pulsed itraconazole regimen compared to placebo in preventing the recurrence of PV following successful initial treatment over a 4 month period. Design: Community based, parallel group, double blind, randomized controlled trial. Settings and conduct: All participants will receive initial treatment with itraconazole (Cap Itraconazole 100mg twice daily for 7 DAYS).Following successful initial treatment after 1 week, cured participants will be randomly assigned to either the itraconazole group (Group A) or the placebo group (Group B).Group A will receive Cap Itraconazole 200mg twice a day in a month for 4 consecutive months and Group B will receive placebo. Participants will be assessed with scheduled follow-up visits on monthly intervals for 4 months and then after further 2 months to see sustained response Study will be conducted in Cmh quetta Participants/Inclusion and exclusion criteria: Inclusion criteria ● Confirmed diagnosis of PV by clinical examination supported by Wood’s lamp examination ● Age range:13 to 50 years ● Not taken antifungal medication in previous 1 month ● Ability to adhere to treatment and follow-up visits Exclusion criteria ● Known hypersensitivity to itraconazole or other triazole antifungals ● Liver disease or abnormal liver function tests ● Pregnancy or Nursing mother ● Concurrent use of medications known to interact with itraconazole ● Active fungal infections other than PV ● Immunodeficiency or immunosuppressive therapy ● Any other medical condition deemed a safety risk Intervention groups: After initial treatment,Group A will receive Cap Itraconazole 200mg twice a day in a month for 4 consecutive months and Group B will receive placebo. Main outcome variables: Treatment of Pityriasis versicolor based on clinical response and negative wood's lamp examination.

Study aim: To find the KDIGO guidelines effects in Cardiac surgery patients, prone to Acute Kidney Injury. Design: Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site Settings and conduct: Study was conducted at Afridi medical complex, Peshawar. The outcome assessor was blinded in the study. Participants/Inclusion and exclusion criteria: Inclusion: Age 50-80 years with both gender. Participants who maintain central venous pressure (CVP) between 8 and 10 mmHg and mean arterial pressure (MAP) >65 mmHg. Exclusion: Patients with end-stage renal disease on dialysis, recent kidney transplantation and contraindications for participation (e.g., pregnancy, severe comorbidities). Intervention groups: Experimental group: Patients in the intervention group underwent a rigorously controlled administration of the KDIGO recommendations (the "KDIGO CT surgery bundle"), which included the consequent actions: avoiding nephrotoxic substances, stopping angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEi) for the first fourty eight hours following operation. Control Group: The standard of treatment for persons in the control group included instructions to maintain central venous pressure (CVP) between 8 and 10 mmHg and mean arterial pressure (MAP) >65 mmHg. As soon as the hemodynamic status stabilized and hypertension appeared, patients were given angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs). Main outcome variables: The incidence of AKI within the first 72 hours following heart surgery served as the main variable.

Study aim: This study aims to compare the efficacy of topical Anagain 4% versus topical Minoxidil 5% in the treatment of androgenetic alopecia. Design: Community based, parallel group, single blinded, RCT Settings and conduct: In this study 38 patient with moderate to severe AGA are enrolled after explaining thoroughly the course and purpose of study. Patients are randomly assigned one of the two groups, one receiving topical Anagain 4% and the other receiving topical Minoxidil 5% solution twice daily for 6 months. Participants/Inclusion and exclusion criteria: Inclusion criteria A. Clinical diagnosis of AGA B. Age range of 18 - 55 years, C. Patients who haven’t received topical or systemic treatments for AGA within 3 months prior to the study. D. Patient who gave consent for the study Exclusion criteria A. Those with other causes of hair loss such as fungal infection such as taenia capitis, inflammatory or scarring alopecia, hyper-androgenism or other hormonal disorders B. Hypersensitive to the medications C. A history of severe systemic disease (renal, cardiovascular hepatic and lungs). D. Pregnant or breastfeeding patients Intervention groups: Intervention group 1: Patients in the first group will be treated with Topical Anagain 4% (1 cc twice daily). Intervention group 2: Patients in the second group will receive topical Minoxidil 5% (1 cc twice daily) for 6 months. Main outcome variables: Number of hairs, Change in photographic pictures and patient satisfaction score.

Study aim: The objective of this study is to compare the post-operative analgesic efficacy of ultrasound guided transversus abdominis plane (TAP) block versus intra-thoracic epidural catheter in patients undergoing abdominal laparotomy. Design: A non blinded, Quasi experimental interventional, single center study with two intervention groups carried out from march 2023 to September 2023. Settings and conduct: The study was conducted in Anesthesia Department of Combined Military Hospital, Rawalpindi. Participants/Inclusion and exclusion criteria: Inclusion criteria included all ASA-I and II male and female patients between ages 20-60 years presenting for elective or emergency abdominal laparotomy. Exclusion criteria included patients with cancer, tumors or metastatic disease, low ejection fraction, respiratory compromise, post chemotherapy, allergic to bupivacaine or lignocaine or unwilling to be included in the study, infection at site of block, coagulation disorders, patchy or failed epidural insertion and failure to perform TAP block after three unsuccessful attempts. Intervention groups: The patients were divided into the TAP block group (Group TAP) (n=60) and the epidural group (Group Epidural) (n=60). Main outcome variables: Primary variable observed was mean time to first rescue analgesia and objective patient satisfaction in both groups.

Study aim: The objective was study the effects of routine physical therapy with and without Action observation on freezing of the gait andfunctional mobility in patients with Parkinson’s disease. Design: Randomized, parallel group design of 21 patients, single blinded randomized control trial. Settings and conduct: Study was conducted at THQ Civil Hospital Daska. The study population was consisted of Parkinson's Disease, The study was single blinded. The outcome assessors did not know while they were receiving experimental or conventional treatment Participants/Inclusion and exclusion criteria: Inclusion 1. The participants with set diagnostic criteria of UK society for Parkinson’s Disease Bank Criteria based on clinical findings. 2. Age between 50 to 80 3. The patients were selected on the condition of severely affected gait and enrolled if there was freeing of their gait minimum once in a week (having a score of 1 on FOG outcome tool in item No.2) and having a larger episode of greater than 2 seconds (and if have 2 scores on the FOG item No. 4) 4. Hoehn & Yahr criteria with labeled as stage ≤ 3 Exclusion Criteria: 1. Any of the substance abuse ,illness systematic disease and neurological issues that can affect the outcomes including cognition level 2. Implantation for deep brain stimulation 3. Cognitive impairment, in particular patients with a Mini mental State Examination (MMSE) score < 24 4. Visual or acoustic limitations. Intervention groups: Group A-(Routine Physical Therapy) Group (B) (RPT+ AOT) In this group patient were treated with action observation therapy (AOT) as well as with routine physicaltherapy (RPT). Main outcome variables: Freezing of Gait and functional mobility.

Study aim: the aim of the study is to compare the effectiveness of spencer technique and isotonic stretching in patients with stage-II adhesive capsulitis Design: Pragmatic, parallel-group, single-blind, randomized clinical trial Settings and conduct: The trial is conducted in Allied Hospital Faisalabad. Subjects are chosen according to inclusion criteria. Subjects are blinded as they don't know their treatment protocol and group. Participants/Inclusion and exclusion criteria: Inclusion Criteria • Patients aged between 40-60 years • Gender included both male and female. • Patients having frozen shoulder of stage 2. • Patient having restricted ROM. Exclusion Criteria • Patient with recent history of surgery. • Patient with Rheumatoid arthritis • Patient with history of any trauma/fracture of shoulder region. • Subject with neurological deficit Intervention groups: Both groups will receive baseline treatment protocol capsular stretching of shoulder joint and isometric strengthening exercise of flexor, extensor, abductors, adductors, external rotators, internal rotators. Group A will be given Spenser Technique for 1 set of 10 repetitions. Group B will be given isotonic stretching for 1 set with 5 repetitions. Main outcome variables: Pain, Range of Motion, Shoulder Disability

Study aim: The objective of this study is to compare the block quality along with sensory and motor characteristics when comparing the pericapsular nerve block (PENG) with the fascia iliaca block in patients undergoing total hip arthroplasty. Design: Single blind, randomized by non-probability consecutive sampling via lottery method assessing post-operative pains scores after the two techniques in a single center study Settings and conduct: Will be done according to the inclusion criteria given. Patients undergoing total hip arthroplasty will be undergoing one of the two blocks (PENG or FIB) pre-operatively according to standard methods of NYSORA Patients will be blinded to the block performed by the consultant anesthetist Post-operative pain scores and time to patient mobilization will be the primary variables studied Participants/Inclusion and exclusion criteria: Inclusion criteria included all ASA-II male and female patients above the age of fifty years requiring total hip arthroplasty (THA) due to advanced osteoarthritis of the hip joint. Exclusion criteria included patients with major cardiac or respiratory debility, metastatic bone disease, allergy to drugs used for the block, bleeding diathesis, coagulation defects, patients with patchy or failed block after administration and patients not willing to be included in the study. Intervention groups: Group F (receiving fascia iliac block) Group P (receiving PENG block) Main outcome variables: Mean time for first dose of rescue analgesia, Mean time to patient mobilization

Study aim: To compare the effectivity of negative pressure wound therapy (NPWT) versus standard modern wound care with moist dressings for treatment of diabetic ulcers in patients with type-II diabetes presenting to a tertiary care hospital. Design: Two arm parallel group, randomized controlled trial with blinded outcome assessment of 190 total patients assessed for 12 weeks post treatment Settings and conduct: Since procedural limitations did not allow blinding during the study, the endpoint of wound healing and size regression was assessed by an independent team of 3 consultants who were given the final results of the wounds in pictorial form to give their opinion of the changes before and after treatment and debridement. Both the assessors and the final analysis consultant was unaware of this double blinded study protocol Participants/Inclusion and exclusion criteria: We made two groups of 95 patients each, one to receive standard dressing care and one to receive NPWT Inclusion criteria included all patients >18 years diagnosed clinically and blood sugar fasting and 2-hour-post prandial investigations in the diabetic range according to the (World Health Organization) WHO criteria presenting with a diabetic foot wound of more than 4 weeks duration corresponding to Wagner grade 2 for debridement. Exclusion criteria included patients with pregnancy, non-compliant to follow-up, necrotic tissue on ulcer with eschar that could not be debrided, malignancy, advanced cardiac and respiratory disease, exposed nerve and vessels beneath the ulcer Intervention groups: Patients in Group N received NPWT (negative pressure wound therapy). Patients in Group S received standard modern moist wound dressing after debridement Main outcome variables: Wound closure frequency, wound closure mean time, incidence of infection and amputation

Study aim: To compare the sensory, motor, block duration and added analgesia requirements between ultrasound guided femoropopliteal block and spinal anesthesia in patients with malleolar fractures of the ankle. Design: A randomized control trial was carried out at the Department of anesthesiology. A pilot study was carried out before the start of the trial with 15 participants in each group, one to receive spinal anesthesia and the other to be administered femoropopliteal block under ultrasound guidance for malleolar fracture of the ankle. Settings and conduct: The method of randomization was non-probability consecutive sampling by lottery method. Participants/Inclusion and exclusion criteria: Included all ASA-I and II male and female patients between ages 25-55 years. Excluded patients with major cardiac or respiratory disease, patients with failed spinal or femoropopliteal block after three unsuccessful attempts, patients allergic to local anesthetic including bupivacaine, lignocaine and steroids including dexamethasone, patients with malignancy or malignant disease, pregnant females and patients unwilling to be included in the study. Intervention groups: The trial randomized all patients as per the inclusion criteria furnished. The patients were divided into the spinal group and the femoropopliteal block group. Once the patients were divided into the two groups, an informed written consent was taken, and patients in both groups were explained in detail about the procedure and possible complications. Standard monitoring including non-invasive blood pressure, heart rate, capnography and ECG were attached to participants in both groups. Main outcome variables: Duration of surgery. Mean time to onset of sensory block. Mean time to onset of motor block. Mean time to first dose rescue analgesia. Mean time of analgesia given in HDU. Mean HDU stay. Mean patient satisfaction score for pain releif.

Study aim: To compare the functional outcomes and adverse effects when using general anesthesia versus consious sedation in patients undergoing endovascular treatment for posterior circulation stroke. Design: The randomized controlled trial was carried out at Anesthesia Department of Combined Military Hospital Rawalpindi, PAK Emirates Military Hospital Rawalpindi Settings and conduct: The study was conducted in Anesthesia Department of Combined Military Hospital Rawalpindi, PAK Emirates Military Hospital Rawalpindi Participants/Inclusion and exclusion criteria: Included patients over the age of 18 years with a confirmed diagnosis of posterior circulation stroke ( PCS) by CTscan or MRA with a modified Rankin score of 2 or less than 2 at the time of stroke and considered a suitable candidate for re-canalization within 24 hours of stroke onset. Included patients with massive intracranial hemorrhage, anterior circulation stroke, unclear radiological findings not consistent with acute posterior circulation stroke, a modified Rankin scale of more than 2 stroke onset, at pons midbrain index 3 or greater, patients with aspiration, fits, and intubation before EVT commencement and patient unwilling to be in the study or refusing follow up for the study protocol. Intervention groups: The patients were divided into two groups, one to receive general anesthesia (GA) and other to receive conscious sedation (CS). Main outcome variables: Functional outcome and disability in quality of life was assessed using the mRS(modified Rankin score), NIHSS(National Institute of Health Stroke Scale), GCS(Glasgow Coma Scale).

Study aim: The objective of the study is to compare the incidence of airway related complications when using nasal packing versus septal stitch post-operatively in patients presenting for elective septoplasty for deviated nasal septum (DNS) Design: A randomised controlled trial ; single study center with two interventional groups carried out from June 23 to Dec 23 , with sample size of 110 individuals in each group. Settings and conduct: The study was conducted in Anesthesia department of combined military hospital rawalpindi, with randomized controlled method, non blind. The sampling was done by non probability consecutive sampling via lottery method and resident o duty marked the groups with X and Y chits. Patients of group marked with X chits were allocated septal stich group and patients with group marked Y chit were allocated nasal packing group. Participants/Inclusion and exclusion criteria: The inclusion criteria included all patients >18 years presenting for pre-anesthesia assessment for elective nasal surgeries requiring nasal packing/septal stitch post-operatively. The exclusion criteria included patients < 18 years, pregnancy, previous history of septoplasty, patients with coagulation disorders, patients with advanced cardiac, respiratory, or metastatic disease, patients with concomitant nasal surgery including turbinectomy etc. and patients unwilling to be included in the study or lost to follow-up. Intervention groups: The patients were randomized into two groups of 110 patients each. Group N (n=110) to receive nasal packing and Group S (n=110) to receive septal sutures. Main outcome variables: Main variables were followings 1. Time from recovery room to discharge 2. Median pain scores in recovery 3. Mean dose of analgesia post procedure in recovery room before discharge 4. Laryngospam 5. Hypoxia 6. Bleeding 7. Headache 8. Sleep disturbances

Study aim: To compare the treatment efficacy of medical therapy using glyceryl trinitrate versus surgical lateral sphincterotomy in patients with chronic anal fissure Design: Parallel group, double blinded randomized controlled trial Settings and conduct: The study was carried out at CMH Peshawar, the population under study were patients with chronic anal fissure requiring treatment, since the procedural limitation did not allow patients blinding, the surgical specialists conducting the surgical procedure and the resident surgeon advising and applying the medical treatment (glyceryl trinitrate) were blinded to the study protocol using proformas marked X and Y for endorsing study outcomes in both groups respectively. The final analysis was carried out by an independent team unaware of the treatment modality given in patients and only outcomes variables were given to them for analysis Participants/Inclusion and exclusion criteria: Inclusion criteria: all patients more than 18 years of age; with a chronic non-healing anal fissure more than 8 weeks duration; presenting to the surgical out-patient department for treatment. Exclusion criteria: pregnancy, non-compliant to follow-up, history of recurrent anal fissures; surgical or medical intervention in the last 6 months; patients with major cardiac or respiratory disease; patients unwilling to be included in the study. Intervention groups: Intervention Group 1: Group S (n=120) to receive surgical lateral sphincterotomy. Lateral sphincterotomy was done by dissecting part of the internal anal sphincter to relieve fissure induced spasm. Intervention Group 2: Group M (n=95) to receive glyceryl trinitrate. glyceryl trinitrate 0.2% (1-2ml) was used as local applicant not the fissure area to relieve spasm Main outcome variables: Mean time for complete healing of the fissure, frequency of ulcer healing; median pain scores as assessed on the NRS (numerical rating scale); frequency of bleeding

Study aim: To determine the effects of diaphragmatic and paced breathing on pulmonary function , hot flashes and postmenopausal syndrome in women. Design: 44 participants will be recruited. Two parallel groups, double blinded, randomized clinical trial with pre and post assessment. Settings and conduct: This study will be conducted in gynecology department at Mussarat Razzaque hospital 196 G.T road baghbanpura Lahore. Participants and outcome assessor will be blinded. Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA Menopausal women having symptoms Hot Flashes during menopause Not currently taking hormonal replacement therapy, a psychoactive medication, and not using complementary therapy for menopausal symptoms. EXCLUSION CRITERIA  Had hormonal replacement therapy Having any cardiac and lung diseases will be excluded If they had history of breast cancer , mayocardial infarction and pulmonary embolism. Intervention groups: Group A: will be treated by Diaphragmatic Breathing Group B: will be treated by Paced Breathing Main outcome variables: Menopause rating scale (MRS), Hot flash-related daily interference scale, Pulmonary function changes by using a portable spirometer.

Study aim: To find the combined effects of pelvic floor Hold relax and Buteyko technique on urinary incontinence, pulmonary functions and exercise tolerance in COPD patients Design: Randomized Controlled Trial Settings and conduct: This Study will be conducted at Gulab Devi Chest Hospital, Lahore. Participants/Inclusion and exclusion criteria: • Patients complaining incontinence link with cough and exercise. • Age criteria 25-45 years • Patients having ability to perform voluntary pelvic floor muscle contraction and cooperative. • Self-reported urinary incontinence. • Stable COPD Exclusion Criteria: • Subjects having unstable COPD. • Also, the subjects with >4 hospital admissions due to COPD during last 1 year. • Patient ‘s having Neurological conditions and non-cooperative. • Subjects having spinal cord injuries. • Patients having history of Hysterectomy and other gynecological surgeries • Patients having Malignancy. Intervention groups: Group A: will be treated by Behavioral Therapy along with Pelvic floor hold relax and Buteyko technique. Group B: will be treated by Behavioral Therapy Main outcome variables: Urinary Incontinence, Pulmonary functions, Exercise tolerance