Cracked nipple is a painful condition for lactating mothers and if untreated leads to lactational mastitis, breast abscesses Objectives: T o compare the efficacy of dexpanthenol, olive oil and breast milk for nipple cracks treatment in lactating mothers Outcome Measures: We measured the Severity of pain (the primary outcome) by using visual analogue scale (VAS) and healing of cracked nipple (Secondary outcome) was assess by Nipple trauma score (NTS) before treatment and after7days, 14 days of treatment Material And Methods: We conducted a quasi experimental study from march 2022 to end of august 2022 in sheikh zayed hospital, Rahim Yar Khan after ethical approval from institutional review board. The total numbers of 120patient were equally divided into three groups using Breast milk, Olive oil or Dexpanthenol respectively for their cracked nipples. The data was collected on predesigned Performa.Data Analysis Procedure: We measured the percentages ,means and standard deviations with the help of statistical package for social sciences version (SPSS) version 28. ANOVA test and Non-parametric test were also used to test the difference between study groups Results: At day0 baseline mean nipple pain score and nipple trauma score was same in all groups.At day 7 breast milk and olive oil show better reduction in pain as compared to Dexpanthenol.At day 14 olive oil showed statistically significant reduction in pain as compared to breast milk and dexpanthenol t. At day 7 and day 14 olive oil show statistically significant better healing of cracked nipples as compared to Breast milk and Dexpanthenol. Practical implication Conclusion: Our study is proving that olive oil is better than Breast milk and Dexpanthenol in term of pain relief and healing of cracked nipples proving hypothesis: H2 Keywords: Cracked nipple, olive oil, Breast milk, Dexpanthenol.

Background: An emergency department is a medical treatment facility which is specialized emergency medicine, the acute care of patients who present without any prior appointment either by their own means or by that of an ambulance. Objective: To determine the efficiency of emergency services in a tertiary care hospital. Methodology: It was a cross sectional study, conducted at Emergency Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from August to October, 2019. A total of 139 subjects who were patients attending emergency department were involved in the study by using random sampling technique. Data was collected by a predesigned proforma. Variables included were age, sex, occupation, door to treatment time, presenting complaints of patient, designation of health care provider, further investigation advised, given treatment, referral to OPD or ward. Results: Mean age of patients was 33±19 years. Out of 139 patients, 59.7% were males and from urban area each, 44.6% were illiterate, 75% of the study subjects were treated by a doctor, and 25.9% came with GIT complaints. It was noted that 48.2 % of the patients had the first contact within 4 minutes, and treatment of 49.7% patients was started within 10 minutes, and 3.5% of the patients it took more than 25 minutes. Conclusion: This study showed that almost half of the patients received treatment within four minutes while few of the patients have to wait for upto twenty five minutes to get healthcare, which is quite a long time as for as emergency healthcare services is concerned., additionally only half of the patients were received by doctors.

Background: Laparoscopic cholecystectomy has replaced open surgery in the treatment of symptomatic cholecystolithiasis. Objective: To evaluate the clinical practices and outcome of laparoscopic cholecystectomy at our institute. Methodology: This was a cross sectional study, conducted at Surgical Unit II, Sheikh Zayed Hospital, Rahim yar khan, from November 2018 to October 2019. Sample size: 100 patients undergoing standard laparoscopic cholecystectomy selected by non probability sampling. All the patients of laparoscopic cholecystectomy during the study period having a clinical diagnosis of acute and chronic cholecystitis were included, whereas patients who had previously undergone midline abdominal operations, ventral hernias, with evidence of common bile duct pathology, having bleeding disorders and hepatitis were excluded. Study variables were operating time, duration of hospital stay, frequency of operative and post-operative complications. Results: There were 85 females and 15 males. Mean age was 40 ± 1.2 years. In this study, 68% patients were having chronic cholecystitis due to cholelithiasis whereas 32% were having acute cholecystitis. Abdominal ultrasound showed multiple stones in 82% and single stone in 18% patients. Adhesions in 30%, Mucocele in 1% and empyema in 2% patients was reported. Gall bladder was perforated in 12% patients and 8% patients converted to open procedure. The mean operative time for laparoscopic cholecystectomy was 71.2+ 2.6 minute. The post operative complications were; wound infection in 4%, shoulder pain 1% and surgical emphysema 1%. The mean hospital stay was 1.38 days. Conclusion: Laparoscopic Cholecystectomy proved a safe procedure in term of operative and post operative complications in our setup.