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Objectives: To evaluate the role of RIPASA scoring system for diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Prospective Study. Setting: Department of General Surgery, Nishter Hospital Multan. Period: February 2016 to February 2017. Material & Methods: One hundred and sixty 160 patients were included in this study. Study was started after ethical approval from ethical board of institution and informed consent from patients was taken. Non probability consecutive sampling was used. Main outcome variables were sensitivity, specificity and diagnostic accuracy of RIPASA score. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: Estimated sensitivity was 97.9%, which means that of the patients with acute appendicitis, 97.9% were diagnosed correctly. The estimated specificity was 76.9%, which means that of the patients not having acute appendicitis, 76.9% were diagnosed correctly. Positive predictive value was 86.1% and negative predictive value was 96.2%. The overall accuracy was 89.4% for diagnosing acute appendicitis. Conclusion: RIPASA scoring system is efficient, reliable and more diagnostic in cases of acute appendicitis. Abdominal ultrasonography is not suitable diagnostic tool to rule out negative appendectomy.

Aim: To evaluate patient satisfaction undergoing inguinal hernia surgery under local anesthesia. Methods: The study was conducted in Jinnah hospital, Lahore from 2014 to 2019 including 650 clinically diagnosed patients with direct or indirect inguinal hernia with age ranging 20 to 60 years. All of these patients were operated in dedicated day care operation-theater of surgical department, where hernia surgeries under local anesthesia were done on daily basis 6 days a week. We assessed satisfaction in all patients undergoing inguinal hernia surgery with monitoring during anesthesia care known as iowa satisfaction with small anesthesia scale. Results: 80% of patients were between 20 to 45 years of age with male to female ratio 99: Right inguinal hernia patients were 55% and 45% with left inguinal hernia. In the proforma of 11 questionnaire, 96 % patients were found satisfied with the quality of anesthesia care with varying satisfactions ranging above 90 % regarding pain, feeling like throwing up, feeling relaxed as well as feeling hurt. Conclusion: Inguinal hernia surgery under local anesthesia is found profoundly satisfactory with regard to anesthetic care. Local anesthesia hernial surgery has satisfactory patient acceptability similar to those observed in a conventional regional/general anesthesia in tertiary care setup. Keywords: Inguinal hernia, local anaesthesia, satisfaction

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,