Background: Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results. Patients and Methods: In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1st, 2nd and 3rd week follow up. Results: Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3rd week postoperative follow up. There were no procedure-related complications. Conclusion: Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.

Objective: to determine the frequency of hypomagnesaemia in severe acute malnutrition, aged 6 – 59 months. Methodology: Patients admitted in Pediatric Medical Unit of Children Hospital, Lahore fulfilling the inclusion criteria were enrolled in the study. Their MUAC along with weight for height/length was taken and also examined for bilateral pitting edema. Venous sample was taken for serum magnesium level and studied in labs of CHL. Hypomagnesaemia was labeled as per operational definition. Treatment given in form of magnesium sulfate after confirming hypomagnesaemia. Results: Of 200 cases, 58%(n=116) were between 6-36 months of age whereas 42%(n=84) were between 37-59 months. mean +sd was calculated as 34.9+11.36 months. 50.5%(n=101) were male while 49.5%(n=99) were female, mean magnesium level was calculated as 1.94+0.30 mg/dL. Frequency of hypomagnesemia in severe acute malnutrition, aged 6 – 59 months was recorded in 31.5%(n=63) of the cases. Conclusion: frequency of hypomagnesemia is significantly higher in cases with malnutrition, however, a larger study is required to record the rate of this morbidity in our region. Keywords: Malnutrition, hypomagnesemia, 6-59 months of age

Objective: To study frequency of contributing factors of lumbar puncture refusal in children presented with suspected meningitis. Methodology: In this descriptive cross-sectional study during 2019 to 2020 at Pediatric Department Ghurki Trust Teaching Hospital, Lahore a total of 155 cases of 2 months to 12 years of age who presented with suspected meningitis and refused the procedure were included. They were asked about various contributing factors like fear of side effects, little knowledge of the disease, unsuccessful experience and lack of medical facility. Results: In this study there were total 155 cases. Out of these 84 (54.19%) were males and 71 (45.81%) females. The mean age of the participants was 3.81±2.03 years. Among contributing factors for refusal, most common factor was fear of side effect which was observed in 39 (25.16%), followed by unsuccessful experience seen in 18 (11.61%), lack of medical facility seen in 16 (10.3%) and little knowledge of the disease in 13 (8.39%) of the cases. There was no significant association with any of the contributing factor with variable of this study. CONCLUSION: There are number of factors for refusal of LP and fear of side effect was the most common. There was near significant association of high socioeconomic class with lack of medical facility. Keywords: Lumber puncture, CSF, Medical Facility, Fear