Background: Premature Rupture of Membranes (PROM) is common in obstetrics and management of such patients depends on whether the rupture has occurred or not. With membranes ruptured the fetus is deprived of protection provided within the amniotic cavity. Beta-Human chorionic gonadotrophin (β-HCG) is a hormone and is present in high concentration in amniotic fluid as well as in the blood and urine of the mother and is studied as possible predictor of preterm labour and as marker of PROM. Objective: To compare the diagnostic accuracy of B-hCG & nitrazine paper test in vaginal washings taking amniotic fluid pooling as gold standard for diagnosing premature rupture of membranes. Material & Methods: It was a comparative cross-sectional study conducted at Unit Department, of Obstetrics & Gynecology, Lahore General Hospital, Lahore. After that vaginal washings were taken for β-hCG testing. A pregnancy test kit (Accu Check) was used for detection of β-hCG in vaginal fluid washings. According to amount of µ-hCG in the washings the result has been positive as early as 40 Seconds but for labeling the result negative 5 minutes complete reaction time has been observed. On netrizine kit, the positive test is indicated by distinct colour band on both; control and test side. Results: Mean age of women was 27.17+4.55 years. Mean age of gestation was 36.16 + 3.30 weeks. Sensitivity & specificity of Nitrazine Paper Test were 92.17% & 66.67%. However the PPV & NPV for Nitrazine Paper Test was 98.15% & 30.77% respectively. Sensitivity & specificity of β-hCG Test was 94.35% & 75%. However the PPV & NPV for β-hCG test was 98.64% & 40.91% respectively. Conclusion: Results of this stud y showed that B-subunit of hCG measured by over-the-counter available pregnancy test kit is a dependable quick and easy test for detection of premature rupture of membranes. This test can be performed on the bed side of the patient without Lab involvement. This test can be promoted as an additional help for the diagnosis of doubtful and ambiguous cases of premature rupture of membranes.

Waste recycling is an option to mitigate the environmental impact resulting from the significant amount of debris generated by the productive activities of the construction. Thus, the aim of the research work to evaluate the use of Recycled Coarse aggregates (RCA) instead of natural coarse aggregate (NCA) in concrete ingredients with 30 MPa compressive strength. The experimental program began with the physical and particle size characterization of the Recycled Coarse aggregates (RCA), and subsequent comparison with the properties of the natural coarse aggregate (NCA). Based on the knowledge of these properties, the production stage began of concretes. Different procedures and literature have been studied in order to achieve the strength of concrete up to 30Mpa by incorporated glass fiber (2 % by addition of cement). It was also the influence of the use of different contents (0, 10%, 20%, 50%, and 100%) of Substitution of natural coarse aggregate by the recycled coarse concrete aggregate in the properties of the fresh and hardened state of concrete. Regarding the strength, parameters increased gradually proportional to the amount of RCA in the concrete from 10 to 20% and decrease strength to the amount of RCA in the concrete from 50 to 100% Substitution of natural coarse aggregate (NCA) in concrete

Objectives: To compare the mean of constant score between conservative and surgical treatment in patients with Grade-III acromio-clavicular dislocation. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from July 2020 to June 2021. Study Procedure: This study involved 94 both male and female patients aged between 18-60 years presenting in orthopedic emergency with Grade-III AC dislocation. These patients were assigned into two treatment groups randomly. Patients in Group-A were managed conservatively while those in Group-B were managed surgically with hook plate. Outcome variable was functional shoulder outcome which was assessed after 6 weeks of treatment using constant score. An informed written consent was gained from every patient. Results: The mean age of the patients was 29.9±9.5 years. Majority (n=44, 46.8%) of the patients were young and were aged between 18-30 years followed by 31-40 years (36.2%) and 41-50 years (17.0%). There were 89 (94.7%) male and 5 (5.3%) female patients in the study group with a male to female ratio of 17.8:1. The mean BMI of these patients was 25.2±2.2 Kg/m2. Right side was more frequently involved (54.3%) as compared to the left side (45.7%). Upon follow-up, the mean constant score was significantly higher in patients treated surgically as compared to conservative treatment (86.72±6.75 vs. 67.43±8.93; p-value<0.001). Similar substantial difference was observed through different subgroups based on patient’s age, gender, BMI and side involved. Conclusion: Surgical treatment of patients with Grade-III acromioclavicular dislocation was associated with better functional shoulder outcome as compared to conservative treatment and should be preferred in future practice if there is no contraindication to surgery. Keywords: Grade-III AC Dislocation, Conservative Treatment, Surgical Treatment, Shoulder Function

Objectives: To compare the functional outcome of shoulder in humeral shaft fractures fixed with dynamic compression plate versus locking compression plate. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from March 2018 to February 2019. Study Procedure: This study involved 62 both male and female patients aged between 18-60 years presenting in orthopedic emergency with humeral shaft fracture. These patients were assigned into two treatment groups randomly. Fracture in Group-A was fixed with dynamic compression plate while locking compression plate was used in Group-B. Outcome variable was functional shoulder outcome which was assessed after 12 weeks of treatment using Modified Constant and Murley Score. An informed written consent was gained from every patient. Results: The mean age of the patients was 42.6±12.7 years. There were 45 (72.6%) male and 17 (27.4%) female patients in the study group with a male to female ratio of 2.6:1. The mean BMI of these patients was 27.9±3.4 Kg/m2 and 17 (27.4%) patients were obese. Left side was more frequently involved (53.2%) as compared to the right side (46.8%). Upon follow-up, the Modified Constant and Murley score was significantly higher in patients treated with DCP as compared to LCP (91.3±7.4 vs. 85.8±8.3; p-value=0.008). The frequency of excellent functional shoulder outcome was significantly higher in patients treated with DCP as compared to LCP (87.1% vs. 54.8%; p-value=0.005). When stratified similar difference was observed across various subgroups of patients based on patient’s age, gender, side involved, duration since injury and BMI. Conclusion: Dynamic compression plate was associated with significantly better functional shoulder outcome as compared to locking compression plate in patients with humeral shaft fractures regardless of patient’s age, gender, duration since injury, side involved and BMI which along with cheaper hardware cost advocates its preferred use in future practice. Keywords: Humeral Shaft Fracture, Locking Compression Plate, Dynamic Compression Plate, Functional Shoulder Outcome

Objectives: To compare the frequency of disease progression in patients with osteoarthritis of knee treated with versus without intra-articular injection of corticosteroids. Design: The present study was a randomized single-blind controlled trial. Study Settings: The current study was conducted at Department of Orthopedic Surgery at Sir Ganga Ram Hospital Lahore over 1 year from May 2020 to April 2021. Study Procedure: The present study was conducted over 186 patients of both genders aged between 40-70 years presenting in outpatient department of orthopedic surgery with osteoarthritis of knee joint. The sampled patients were randomly allotted into two treatment arms. Patients from Group-A received intraarticular injection of steroids in addition to conservative management while those in Group-B were taken as controls and were managed conservatively without intraarticular injection of steroids. Outcome variable was frequency of disease progression over KL grading which was noted and compared between the groups. An informed on paper consent was obtained from every participant. Results: The mean age of the patients was 52.5±8.7 years. There was a female predominance with a male to female ratio of 1:1.7. The mean BMI of these patients was 28.3±3.6 Kg/m2 and 60 (32.3%) patients were obese. 103 (55.4%) patients had grade 2 while 83 (44.6%) patients had grade 3 osteoarthritis. Disease progression was noted in 30 (16.1%) patients after 6 months follow-up. The frequency of disease progression was significantly higher in patients receiving intra-articular injection of corticosteroids as compared to controls (26.9% vs. 5.4%; p-value<0.001). When stratified, comparable difference was observed across various subgroups of patients based on patient’s age, gender, BMI and baseline Kellgren-Lawrence Grade. Conclusion: In the present study intraarticular injection of steroids was found to be associated with articular cartilage damage evident from increased frequency of disease progression following intraarticular injection as compared to controls which advocates that intraarticular injection of steroids should be avoided in the management of osteoarthritis and should be reserved only for patients with advanced disease and who are already planned for joint replacement. Keywords: Osteoarthritis, Intraarticular Steroids, Chondrotoxicity