Objectives: To compare the effects of Nalbuphine with Tramadol on cardiovascular response (change in heart rate and blood pressure) to tracheal intubation in patients undergoing emergency appendectomy. Material and methods: This randomized controlled trial was conducted at the Department of Anaesthesiology, CMH Mardan from January 1, 2022, to June 30, 2022. A total of 100 patients who were undergoing emergency appendectomy under general anaesthesia, with ASA grade I, aged between 30-50 years, and weighing between 50-80 kg were selected. Patients were either male or female and had normal blood pressure. They were divided into two groups: the Nalbuphine group and the Tramadol group. The study focused on analyzing the cardiovascular response (changes in heart rate and blood pressure) to tracheal intubation in both groups. Results: Most of the patients in both Group A and Group B were females, with a female to male ratio of 3.54:1 and 2.57:1, respectively. The mean age of patients in Group A was 37.90±5.41, while in Group B it was 40.10±6.39. After laryngoscopy and tracheal intubation, patients in Group A had a significantly less increase in heart rate and blood pressure as compared to those in Group B. Conclusion: The Nalbuphine is better than Tramadol in attenuating the cardiovascular response to laryngoscopy and tracheal intubation. Keywords: Nalbuphine, Tramadol, Cardiovascular Response, Tracheal Intubation, Laryngoscopy, Heart Rate and Blood Pressure.

Mastalgia is a common clinical symptom experienced by up to 70% of women at some stage of their life. A wide varietyof therapeutic agents are available for the treatment of mastalgia. Both evening primrose oil and non steroidal anti-inflammatory drugs havebeen assessed in randomised controlled trials and demonstrated to be effective. The objective of this Quasi experimental study was tocompare the efficacy and safety of topical nonsteroidal anti-inflammatory drugs with evening primrose oil in the treatment of mastalgia. Westudied 90 female patients presenting with breast pain from 25 July 2006 to 25 July 2007 at the surgical outpatient department of CMHKharian. The patients were divided into three groups. Group-1 was given capsule Effamol (evening primrose oil), group-2 topical brufen geland group-3 topical Vaseline for two months. Patients were followed every two weeks for two months. Response was assessed using Cardiffbreast pain score. Side effects of drugs were recorded at each follow up. Out of 30 patients of group-1,14 (46.6%) had clinically significantresponse at the end of 8 weeks treatment as compared to 27 (90%) in group-2.5 (16.6%) patients of group-1 showed mild side effects whilenone in group-2 had any side effect, p- value was < 0.0001 showing highly significant statistical difference between 2 groups. Topicalnonsteroidal anti-inflammatory drugs are safe and effective as compared to evening primrose oil in the treatment of mastalgia.

Objective: Aim of current is to determine the efficacy of darn repair technique in the management of indirect inguinal hernia in terms of complications and recurrence rate among patients. Study Design: Prospective study Place and Duration: The study was conducted at Surgery department of Combined Military Hospital, Sargodha and DHQ Hospital, KharBajaur during the period from January 2021 to June 2021. Methods: There were sixty males who had indirect inguinal hernia included in this study. Included patients had age between 18-80 years. After receiving informed written agreement, the demographics of enrolled patients were recorded, including age, BMI, and side of hernia. All the patients were treated with darning method. Post-operative complications, hospital stay and recurrence rate among patients were assessed. We used the SPSS 24.0 version to analyze all data. Results: Among 60 cases, 10 (16.7%) were aged between 18-30 years, 12 (20%) patients were from age group 31-40 years and most of the patients 38 (63.3%) had age >40 years. We found most of the cases had right side hernia 34 (56.7%), 20 (33.3%) cases had left and bilateral cases were 6 (10%). Majority of the cases had reducible hernia 48 (80%) and emergency treatment was given to irreducible cases 12 (20%). General anesthesia was mostly used among 44 (73.3%) cases. The mean operative time was 55.3±9.43 minutes and mean hospitalization was 30.3±7.33 hours. We found recurrence rate only among 2 (3.3%) cases and frequency of complications were 8 (13.3%). Conclusion: We concluded in this study that darning method for the management of indirect inguinal hernia is effective and useful in terms of less post-operative complications and recurrence rate. Keywords: Inguinal Hernia, Darn Method, Anesthesia, Complications, Recurrence Rate