Aim: To study that narcotic analgesia administration in patients of acute appendicitis does not delay the diagnosis and does not interfere with the decision to operate in these patients. Study design: A randomized cross-over study. Setting and duration of study: Study was done at surgery department of Combined military hospital Lahore over a period of two years from March 2019-2021. Methodology: It was a double-blind randomized crossover study. A total of 100 patients, who were confirmed as acute appendicitis by clinical examination, were included. All the male and female patients of age 16 years and above were included in the study. The patients were divided in two groups each having 50 patients. The drugs were labelled as drug A and drug B. Drug A was morphine and drug B was placebo. Each drug was given to both the groups by crossover with an interval of 30 minutes and the components of physical examination were analyzed for both groups. The pain score was calculated by the visual analogue scale (VAS) for both the groups at both intervals. The p-value was calculated by using student’s t-test. The frequency and percentages of the decision to operate were calculated. The data was tabulated and then analyzed on SPSS version 23. Results: The pain score was calculated for both groups of male and females. The pain score difference was calculated in both groups and then p-value was calculated which came out to be significant. The frequencies of the decision to be operated were also calculated in both the groups and the results showed that there was no effect of narcotic analgesia on the decision to operate in patients with clinically diagnosed acute appendicitis Conclusion: The use of morphine analgesia in the patients of acute appendicitis does not alter the diagnostic efficacy of the patients of acute appendicitis. Keywords: Acute abdominal pain, acute appendicitis, Narcotic analgesia, Visual analog scale (VAS)

Background: The use of medicinal plants in herbalism has been documented for thousands of years, with evidence dating back to ancient civilizations such as the, Chinese, Greeks and Egyptians1. Extensive clinical studies have demonstrated that Althaeaofficinalis has properties that promote healing of ulcers2. Aim: To evaluate effectiveness of Althaeaofficinalis seed extract compared to Daflon (diosmin plus hesperidin) in treating hemorrhoids. Methods: A double-blind, randomized clinical trial was carried out in Lahore's urban community. Patients with acute hemorrhoids were randomly divided into two parallel groups, each with 60 participants, for a one-week period. The selection of family physicians for the study was done randomly.6,7,8 Interventions: In the beginning, the participants were given either two capsules of 500mg Althaea seed extract or two tablets of Daflonin morning and evening for four days, followed by two capsules/tablets daily for the next three days. The primary measure of effectiveness was the alleviation of symptoms and signs.9,10 Results: Both groups demonstrated similar improvement from first day tolast day. The intensity of symptoms such as itching, tenesmus, and bleeding ,swelling, painetc reduced markedly in both groups, but the reduction was fast in the Althaeaofficinalis seed extract group observed initial days of the trial. Practical Implications: Estimated prevalence of haemorrhoids ranges from 2.9% to 27.9% worldwide.11,12.13 However, due to cultural practices, it is often ignored and left untreated, It is therefore essential to design preventive measures and control strategies for hemorrhoids. Conclusion: Both Althaea and Daflon were found relieving haemorrhoidal signs and symptoms of hemorrhoids. However, the use of Althaea seed extract resulted in quicker relief and it may be used as good alternative to Daflon. Keywords: Haemorrhoids ,Altthaea seed extract, Althaeaofficinalis, double blind, tenesmus, bleeding,

No abstract

Background: The increasing burden of preventable cancers among women in low-middle income countries call for urgent development of constructive health strategies. The aim of this study was to determine the effect of health education on knowledge, attitude and practices of reproductive age women about preventable cancers in two peri-urban communities of Lahore. Material and Methods: The study was a Randomized field trial and the data was collected from women of reproductive age from areas of Lahore Shadewal (SC) and Satokatla (SI). SC stands for control group and SI for interventional group. Number of participants was 235 in each group. A validated questionnaire was administered to evaluate knowledge, attitude and practices for prevention of reproductive cancers from both groups. Then during next visit to intervention group, a health education program in form of group discussion, role play and demonstration related to preventable cancers was arranged. After 2 weeks of previous visit, questionnaires were again filled. Same questionnaire was filled by the comparison group without giving any intervention. Results: Before intervention mean total score for knowledge was 4.24 ± 2.30 in SC group and 4.68 ± 2.99 in SI group. After educating, mean total score of SC group the score came out to be 5.91 ± 3.014 whereas in SI group it was improved to 20.57 ± 2.755. The mean change in total score of knowledge of SC group was 1.67 ± 2.62 and 15.89 ± 3.35 in SI group. The mean change was found to be highly significant in SI group when compared with SC group, (p<0.001). The attitude and self-practice was also improved in SI group while females of SC showed no improvement, (p>0.05). Conclutions: The study highlighted the need for educational programs to create awareness regarding regular screening of gynecological preventable cancers. Keywords: Females, Reproductive Age, Health education, Awareness, Cancers.

Aim: To evaluate the efficacy of antibiotic treatment as the primary option for non-complicated acute appendicitis in pandemic situation. Study Design: Prospective interventional study. Setting & Duration of Study: CMH Lahore, a 700 bedded tertiary care hospital, for 4 months from 15th April 2020 to 15th august 2020. Methodology: A total of 110 cases meeting inclusion criteria, aged 13-65 years of both genders with suspicion of non-complicated appendicitis were included in the study, using probability sampling. They were divided in two groups on randomization basis. Group A for antibiotic therapy and Group B for appendectomy. Group A patients admitted in the ward 48 hours for IV antibiotics, were re-evaluated after 24 hours. If condition improves, the patient was discharged on oral antibiotics for next 10 days & if condition does not improve, antibiotics were prolonged for 48 hours. If deteriorating or patient. .chooses to change group, they underwent appendectomy. If condition improved, they were discharged on oral antibiotics for next 10 days. Group B patient were discharged after 2 post-operative doses of I/V antibiotics. Post-operative I/V antibiotics for 48 hours & 3 days oral antibiotics were given when appendix was gangrenous or perforated. Results: In a population of 110 patients, we studied the comparison of the groups having antibiotics and appendectomy as treatment for acute appendicitis. There is no significant difference in outcomes on basis of mean pain score and mean duration of hospital stay. Both ways of treatment can be adapted accordingly. Conclusion: Non-complicated acute appendicitis can be managed non-operatively in crisis situations like COVID-19 pandemic causing overburdening of hospitals. Keywords: Acute appendicitis, antibiotic therapy, appendectomy, pandemic.