Objective: To evaluate the sequence of performing adenoidectomy or myringotomy first in a single stage procedure has any bearing on the per- operative outcome on middle ear effusion and subsequent grommet insertion in a patient of otitis media with effusion (OME). The hypothesis was that initially performed adenoidectomy allowed the middle ear fluid to drain passively and precluded grommet insertion. Study Design and Setting: Comparative study conducted at Department of ENT, Combined Military Hospital Sialkot and PNS Shifa Hospital Karachi, from Jun 2016 to Jun 2017. Methodology: One hundred and twenty patients (218 ears) with OME and adenoid hypertrophy, meeting the inclusion criteria, were inducted in this study and divided into 2 groups. Group A (60 patients with 110 ears) had adenoidectomy first followed by myringotomy and or grommet insertion, while Group B (60 patients with 108 ears) had myringotomy with or without grommet insertion first and followed by adenoidectomy. Result: There were 76 males and 44 female patients with a ratio of 1.7:1 and the age range was 3 to 14 years with a mean age of 4.81 ± 0.77 years. There was a significant difference between the two groups. Out of a total of 110 ears in group A, 74 ears (67.2%) had no mucoid fluid or dry tap on myringotomy in contrast with group B where out of total 108 ears, only 26 ears (24.1%) had dry tap or no mucoid fluid (p = 0.001). Conclusion: Adenoidectomy performed before myringotomy significantly reduced the need for grommet insertion. Larger studies however are needed to corroborate these findings.

Objective: To compare efficacy of Peritonsillar Dexamethasone with Peritonsillar Bupivacaine in managing post-tonsillectomy pain in children. Study design: Randomized Controlled Trial Setting & Period: ENT Department Fauji Foundation Hospital (FFH) Rawalpindi from 01-06-2019 to 31-11-2020. Material &Methods: A total of sixty patients of both genders between ages of 5-15 years fulfilling the recognized criteria for tonsillectomy were selected. They were equally divided into two groups; Group A received peritonsillar Bupivacaine while Group B received peritonsillar Dexamethasone. Mean post-tonsillectomy Visual Analogue Score (VAS) at 1st, 2nd and 7th day were recorded in both groups and compared using independent sample ‘t’ test. Results: In group A Mean post-tonsillectomy VAS at 24 hours was 6.73±1.44 SD while in group B it was 5.93±1.26 SD (p-value 0.025). Mean post-tonsillectomy VAS at 48 hours was 5.60±1.25 SD and 4.37±1.03 SD (p-value 0.000) respectively in groups A and B. At 7th post operative day, Mean VAS was noted as 3.27±0.74 SD and 2.30±0.79 SD (p-value 0.000) respectively in group A and B.  Conclusion: Peritonsillar Dexamethasone is more effective than peritonsillar Bupivacaine in controlling post-tonsillectomy pain in children. Statistically significant difference was noted for mean post-tonsillectomy VAS at 1st, 2nd and 7th day. Key Words: Tonsillectomy, visual analogue score, postoperative pain, dexamethasone, bupivacaine.

There has been no molecular studies of melanocyte (MC) precursors activation in the hair follicle (HF) bulge by NBUVB treatment in vitiligo. To better understand repigmentation process, we collected biopsies from untreated and NBUVB-treated vitiligo patients (n¼6 unpaired samples). We performed laser capture microdissection of HF bulge MCs from both groups, isolated the RNA, and performed Whole Transcriptome RNA Sequencing followed by gene expression analysis. Using the Ingenuity Pathway Analysis tool and our list of differentially expressed genes (P<0.05), we identified the RHO-GTPase (RHO) pathway as the top canonical pathway modulated by NBUVB in the bulge MCs (P¼1.2E-02; Activation Z-Score¼2.4), and RHOJ (with role in melanoma migration) as the top RHO component (P¼4.4E-03; fold change (FC)¼12.7). Using qRT-PCR and new patient samples, we validated induction of RHOJ and VIM (P<0.05; FC2) by NBUVB, and found a similar expression trend for RELA, CDH3 and CDH11. To study functional phenotypes associated with RHOJ depletion, we used the PIG1 immortalized MC cell line, which we identified as good functional model for human bulge MCs. RHOJ knockdown by siRNA transient transfection caused: a. decreased PIG1 cell number and an abnormal, senescent phenotype; b. decreased PIG1 cell migration (45%; P3.6E-03) during the first 48h, as assessed by a scratch wound assay; c. decreased expression of cytoskeletal proteins (focal adhesions and actin stress fibers) (P5.0E-04), as analyzed by immunostaining. Our data suggest that RHOJ signaling impacts proliferation and migration of immature MCs, and is an important activator of these cells during NBUVB treatment.