Background: Pain in right Iliac fossa is one of the most common presenting symptom in the surgical emergency in which acute appendicitis is the most probable amongst the differentials. Patients with equivocal signs and symptoms pose a significant diagnostic dilemma for which they are admitted for observation. Aim: To compare the efficacy of modified Alvarado scoring system with the routine clinical diagnosis. Study design: A randomized controlled trial was set up to compare clinical diagnosis (control group) with a diagnostic protocol using modified Alvarado scoring system (intervention group). Setting: This study was conducted in a government administered tertiary care referral center (Mayo Hospital Lahore), Pakistan, from Septembers 15, 2019 to September 14, 2020. Method: A total of 256 patients referred to surgical department with suspected appendicitis were included in the study. Patients above the age of 12 years were included in the study. Patients were randomly divided into two groups. Group A included 128 patients who were assessed on the basis of the Modified Alvarado score while the Group B also included 128 patients which were assessed on routine clinical evaluation. Histopathology was the Gold Standard which determined the Diagnostic Accuracy (DA) and Negative Appendectomy Rate (NAR), which were duly recorded. Results: The Diagnostic Accuracy (DA) of the Group A evaluated on the Modified Alvarado Scoring System was 88% in which 113 out of 128 patients were positive for acute appendicitis on histopathology while Negative Appendectomy Rate(NAR) was 12%.Only 15 out of 128 were negative on histopathology . However the Group B had a (DA) of 79% in which 101 patients out of 128 were proven positive through the histopathology while (NAR) was 21%. The mean age of the was found to be 25.34 years with a male to female preponderance ratio of 1.22:1 Conclusion: we have found the Alvarado scoring system to be an effective and a convenient scoring tool. We recommend its regular application in the emergency for the diagnosis of Acute Appendicitis. Keywords: Alvarado score, Acute appendicitis, Histopathology, Clinical diagnosis.

Background: Caustic ingestion is associated with long-term sequelae in the form of esophageal and/ or gastric stricture; is a source of considerable morbidity requiring endoscopic or surgical intervention. The spectrum of gastric injury may vary from acute to varying types of chronic involvement. This study was done on patient Materials & Methods: s with a history of acute corrosive injury by the Department of Medical Gastroenterology, Tirunelveli Medical College from 2021 to 2022. A detailed history was recorded & endoscopy was also done within 24 to 72 hours of admission. The grade 2B & 3 injury patients were followed up and subjected to repeat endoscopy after 6 weeks and the results were analyzed. Based on this s Result: tudy, the incidence of corrosive poisoning was higher in females 64.36% (n=56). The intention of corrosive ingestion was suicidal in 98.86% (n=86). Acid ingestion was more common than alkali ingestion. Out of 87, 24 patients had Grade 2B & 3 Zargar injuries and were managed with Ryle's tube feeding for 6 weeks. 10 out of 24 developed strictures at 6 weeks. 8 patients had an esophageal stricture and were subjected to esophageal dilatation. One patient had refractory stricture for which she had undergone esophagectomy with colonic interposition. 2 patients were subjected to antrectomy for antral stricture. Conclusion: The concentration and quantity of substance consumed are the most important determinant of the outcome. The management of corrosive injury depends on the site of the lesion and severity of the injury, the presence of co-existent esophageal or gastric stricture, and the patient's general condition.

The 2010 dietary cholesterol recommendations were derived from guidelines established in the 1960s, when little scientific evidence was present, other than the possible association between saturated fat and dietary cholesterol, as well as animal studies, in which cholesterol was fed in amounts that exceeded typical or normal intakes. Aim of this research was to compare individual and combined effects of Ispaghola and Anjeer in primary as well as secondary hyperlipidemia. It was single blind placebo-controlled research work, conducted from January 2017 to April 2017 at General Hospital, Lahore, Pakistan. One hundred male and female hyperlipidemic patients were selected for research, age range from 20 to 65 years. Inclusion criteria were primary, secondary hyperlipidemic patients. Written and explained consent was taken from all participants and approved by research ethics committee of the hospital. Patients were divided in four equal groups, comprising 25 patients in each group. Their baseline systolic/diastolic blood pressure and lipid profile was estimated and kept in individual's folder. Group-I was on Ispaghula 10 grams, group-II was on 10 grams Anjeer, and group-III was advised to take 10 grams Ispaghula and 10 grams Anjeer in combination for 3 months. Group-IV was on placebo therapy. After 3 months when results were compiled and analyzed statistically, it was observed that Ispaghula decreased LDL-c significantly with p-value <0.05, Anjeer decreased LDL-c significantly with p-value <0.01. When both herbs were combinely given, they reduced systolic BP with p-value <0.01, LDL-c reduced highly significantly with p-value <0.001, and HDL-c increased significantly with p-value <0.05. It was concluded from the study that Ispaghula and Anjeer have LDL-c lowering potential if given separately. When used in combination they reduce systolic BP, LDL-c, and increase HDL-c.

Presence of hyperlipidemia directly correlates with the risk of developing coronary heart disease (CHD) and future cardiovascular (CV) events. Less than half of adults with elevated low density lipoprotein cholesterol (LDL-C) levels receive treatment or are adequately treated and as a result, high-risk patients continue to remain at risk for new CV events. Modest reductions in CHD rates by decreases in saturated fat are possible if saturated fat is replaced by a combination of poly-and mono unsaturated fat, and the benefits of polyunsaturated fat appear strongest. However, little or no benefit is likely if saturated fat is replaced by carbohydrate, but this will in part depend on the form of carbohydrate. Because both N-6 and N-3 polyunsaturated fatty acids are essential and reduce risk of heart disease, the ratio of N-6 to N-3 is not useful and can be misleading. In practice, reducing red meat and dairy products in a food supply and increasing intakes of nuts, fish, soy products and nonhydrogenated vegetable oils will improve the mix of fatty acids and have a markedly beneficial effect on rates of CHD. This study was conducted to see hypolipidemic potential of two medicinal herbs. The research work was single blind placebo-controlled, conducted at Jinnah Hospital, Lahore It was conducted from January 2018 to June 2018. Seventy five already diagnosed primary and secondary hyperlipidemic patients were selected with age range from 17 to 65 years. Diabetes mellitus, cigarette smoking/alcohol addictive patients, peptic ulcer disease, hypothyroidism, kidney dysfunction, any heart disease and liver disease. All patients were divided in three groups (group-I, group-II, group-III), 25 in each group. All participant's baseline lipid profile data were taken and filed in specifically designed Performa, at start of taking medicine. Twenty five patients of group-I were advised to take 10 grams of Flaxseeds in three divided doses after meal. Twenty five patients of group-II were advised to take Ajwain seeds 10 grams in three divided doses after each meal for two months. Twenty five patients of group-III were provided placebo capsules, (containing grinded rice), taking one capsule after each meal. All participants were advised to take these medicines for eight weeks. Followup period: All participants were called fortnightly for their query and follow up. Their LDL-cholesterol, and HDLcholesterol was determined at the hospital laboratory. In two months therapy by Flaxseeds decreased LDL-cholesterol from 195.11±2.11 mg/dl to 190.22±3.11 mg/dl, which is significant statistically. HDL was increased from 34.53±1.65 mg/dl to 38.97±2.29 mg/d, which is also significant change. In two months therapy by AJWAIN, LDL-c reduced from 201.51±2.62 mg/dl to 197.11±2.66 mg/dl, which is significant statistically. HDL-cholesterol increased by Ajwain from 36.97±3.32 mg/dl to 37.45±1.87 mg/dl, which is insignificant statistically.It was concluded from this study that Flaxseeds have more effect on HDL-c but Ajwain has lowest effect on this parameter.