Abstract Background: Dengue fever is the world’s fastest spreading mosquito borne viral infection. It is prevalent throughout both subtropical and tropical region if the world. The severe form of dengue fever with bleeding manifestations called as dengue hemorrhagic fever. Some of the Dengue fever patients developed capillary leak during critical period of illness. This study aims at determining the frequency of capillary leak syndrome in hospitalized dengue fever patients of tertiary care hospital. Patients and Methods: The study was conducted over a period of one month from 1st October to 30th October 2019 at department of Medicine Federal Government Polyclinic Post Graduate Medical Institute, Islamabad. This cross sectional study comprising 200 consecutive hospitalized (≥14 years of both gender) dengue fever patients. Results: Capillary leak syndrome found in 75 patients of Dengue fever. All of them were Primary Dengue Patients. Both ascites and effusion was present in 31 patients. Ascites only found in 25 patients, Pleural effusion bilateral in 7, Right sided pleural effusion in 11 and Left sided in 1 patient. None of the patient had pericardial effusion. Conclusion: It is concluded that capillary leak syndrome is common in primary dengue fever patients and its early diagnosis helps us in better management during critical phase of illness with better outcome. Key Words: Dengue Fever, Capillary Leak Syndrome, Dengue Shock

Objective: To see the effect of exercise in preventing diastasis recti in pregnant women. Study Design: Prospective comparative study. Place and Duration of Study: Gynecology & Obstetrics, Avicenna Medical College, Lahore Pakistan, from Jan to Dec 2019. Methodology: This study included 93 pregnant women who were randomized in two groups, exercise group and non-exercise group. The measurement for diastasis recti abdomen was taken at 3 locations: at the umbilicus, 5 cm above the umbilicus, and 5 cm below the umbilicus. Measurement for diastasis recti were done at the time of inclusion in study and 6 weeks after the termination of pregnancy. Results: The mean age of the women in our study was 26.5 ± 0.62 years. The frequency of diastasis recti was far less in exercising pregnant women as compared to non-exercising pregnant ladies after 6-weeks postpartum period. No diastasis recti was present at the supra-umbilical level in 34 (36.55%) women of exercise-group as compared to 9 (9.67%) in non-exercise group. At supra umbilical level, there was no diastasis recti present in 43 (46.2%) women of exercise-group as compared to 7 (7.52%) women in non-exercising groups at 6-weeks postpartum period. Similarly, no diastasis recti were present in 43 (46.2%) women of exercise-group as compared to 8 (8.60%) women in non-exercising group at infra umbilical level at 6 weeks postpartum period. Result showed that there was statistically significant improvement in the diastasis recti abdominis in exercise-group (p=0.002). Conclusion: Abdominal exercises help in reducing diastasis recti in pregnant women significantly as compared..............................

Objective: To find the frequency of backache in our pregnant women and factors increasing the risk of low backache in pregnancy. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Gynecology & Obstetrics, Avicenna Medical College, Lahore Pakistan, from Jan 2018 to Dec 2019. Methodology: We included 247 consecutive women between 18 and 45 years of age and between 16 and 35 weeks of a single pregnancy. These were evaluated for low backache. Women with comorbid conditions and multiple fetuses who needed elective caesarian sections were excluded. Results: Mean age of the pregnant women in our study was 27 ± 3.7 years, with an age range of 18 to 45 years. 197 (80.1%) complained about low back pain during their pregnancy, and 75 (30.3%) had a previous history of back pain when not pregnant. Back pain was present in 47 (19.02%) 6 months postpartum. The risk factors present were higher weight gain in 75 (30 %), age >35 years in 62 (25 %), low haemoglobin 38 (15%) and poor socio-economic condition 25 (10.1%). Conclusion: Low back pain is common in pregnancy and is a less addressed issue of pregnant women. Many factors responsible for low backache in pregnant women were identified. Analgesics and increased physical activity are the main treatment and prevention options.

Objective: To study the frequency, clinical presentation, management and outcome of degloving soft-tissue injuries. Study Design: Case series. Place and Duration of Study: Department of Surgery, Federal General Hospital, Islamabad Pakistan, from Jan 2018 to Dec 2019. Methodology: This study included 28 consecutive patients with degloving injuries. Patients with degloving injuries of the soft tissue were included. Initial assessments of all patients were done according to advanced trauma life support. Regular clinical examination for abnormalities such as excessive local pain that was out of line with the intensity of the trauma, extensive ecchymosis or hematomas, and especially, local and regional hypermobility of the skin, capillary refill and perfusion of the area. Results: Out of 28 patients, there were 25 males (9.28%) and three females (10.72%). The mean age was 33.07±9.04 years with a range of 6-50 years. The thigh was the most frequently involved area by degloving injury (25.00%). The back was involved in 17.85% of patients. Leg (10.71%) and foot (10.71%) were involved in 21.42% of patients. From the management point of view, 42.85% of patients had some form of debridement and healing by secondary intention, 17.85% patients were managed conservatively, and 10.71 % of the patients' primary closure was successful. Conclusion: Degloving soft-tissue injury is debilitating and, if not taken care may lead to ischemia necrosis, infection and septicemia of the tissues, which needs extensive debridement, prolonged use of broad-spectrum antibiotics, which result in disability and protracted course of rehabilitation.

Abstract Background: COVID-19 has effected General Surgical Elective list and most of the surgical procedures are postpone. Inguinal hernia surgery can be performed under local anesthesia on day care basis in selected group of patients taking all necessary precautions for COVID-19. Patients & Methods: This prospective study was conducted at department of General Surgery Federal Hospital, Islamabad for a period of three months from 15th March 2020 to 15th June 2020. All patients were included in the study through purposive sampling and preference was given to patients elder than 50 years of age. This study included 59 adult patients with inguinal hernia who under mesh repair under local anaesthesia on day care basis. Results: A total of 59 patients were included in the study. All patients were male. The age range was from 37 to 82 years (SD=± 10.23).  30 (50.84%) patient had inguinal hernia on left side while 26 (44.06%) had hernia on right side. Mean Operative time was 35 min. Pain was chief complaint postoperatively 30 (50.8%) patients had moderate pain while 6 (10.1%) patients had severe pain in first 24 hours after surgery. Fever was present in 15 (25.42%) patients in first 24 hours. All patients were negative for COVID -19 preoperatively and after 2 weeks none of the patients develop any symptoms of COVID-19. 3 (5.08%) patients needed readmission within 24 hours for pain and some haemorrhage. There was no mortality in our study Conclusions: Inguinal Hernia Surgery under local anaesthesia on day care basis in a very good practice at this time of global pandemic of COVID-19. This is a safe and reliable strategy. Key words: Inguinal Hernia, COVID-19, Local Anaesthesia