Study aim: To assess the efficacy of short-term, pulsed itraconazole regimen compared to placebo in preventing the recurrence of PV following successful initial treatment over a 4 month period. Design: Community based, parallel group, double blind, randomized controlled trial. Settings and conduct: All participants will receive initial treatment with itraconazole (Cap Itraconazole 100mg twice daily for 7 DAYS).Following successful initial treatment after 1 week, cured participants will be randomly assigned to either the itraconazole group (Group A) or the placebo group (Group B).Group A will receive Cap Itraconazole 200mg twice a day in a month for 4 consecutive months and Group B will receive placebo. Participants will be assessed with scheduled follow-up visits on monthly intervals for 4 months and then after further 2 months to see sustained response Study will be conducted in Cmh quetta Participants/Inclusion and exclusion criteria: Inclusion criteria ● Confirmed diagnosis of PV by clinical examination supported by Wood’s lamp examination ● Age range:13 to 50 years ● Not taken antifungal medication in previous 1 month ● Ability to adhere to treatment and follow-up visits Exclusion criteria ● Known hypersensitivity to itraconazole or other triazole antifungals ● Liver disease or abnormal liver function tests ● Pregnancy or Nursing mother ● Concurrent use of medications known to interact with itraconazole ● Active fungal infections other than PV ● Immunodeficiency or immunosuppressive therapy ● Any other medical condition deemed a safety risk Intervention groups: After initial treatment,Group A will receive Cap Itraconazole 200mg twice a day in a month for 4 consecutive months and Group B will receive placebo. Main outcome variables: Treatment of Pityriasis versicolor based on clinical response and negative wood's lamp examination.

Study aim: To find the KDIGO guidelines effects in Cardiac surgery patients, prone to Acute Kidney Injury. Design: Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site Settings and conduct: Study was conducted at Afridi medical complex, Peshawar. The outcome assessor was blinded in the study. Participants/Inclusion and exclusion criteria: Inclusion: Age 50-80 years with both gender. Participants who maintain central venous pressure (CVP) between 8 and 10 mmHg and mean arterial pressure (MAP) >65 mmHg. Exclusion: Patients with end-stage renal disease on dialysis, recent kidney transplantation and contraindications for participation (e.g., pregnancy, severe comorbidities). Intervention groups: Experimental group: Patients in the intervention group underwent a rigorously controlled administration of the KDIGO recommendations (the "KDIGO CT surgery bundle"), which included the consequent actions: avoiding nephrotoxic substances, stopping angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEi) for the first fourty eight hours following operation. Control Group: The standard of treatment for persons in the control group included instructions to maintain central venous pressure (CVP) between 8 and 10 mmHg and mean arterial pressure (MAP) >65 mmHg. As soon as the hemodynamic status stabilized and hypertension appeared, patients were given angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs). Main outcome variables: The incidence of AKI within the first 72 hours following heart surgery served as the main variable.

Study aim: This study aims to compare the efficacy of topical Anagain 4% versus topical Minoxidil 5% in the treatment of androgenetic alopecia. Design: Community based, parallel group, single blinded, RCT Settings and conduct: In this study 38 patient with moderate to severe AGA are enrolled after explaining thoroughly the course and purpose of study. Patients are randomly assigned one of the two groups, one receiving topical Anagain 4% and the other receiving topical Minoxidil 5% solution twice daily for 6 months. Participants/Inclusion and exclusion criteria: Inclusion criteria A. Clinical diagnosis of AGA B. Age range of 18 - 55 years, C. Patients who haven’t received topical or systemic treatments for AGA within 3 months prior to the study. D. Patient who gave consent for the study Exclusion criteria A. Those with other causes of hair loss such as fungal infection such as taenia capitis, inflammatory or scarring alopecia, hyper-androgenism or other hormonal disorders B. Hypersensitive to the medications C. A history of severe systemic disease (renal, cardiovascular hepatic and lungs). D. Pregnant or breastfeeding patients Intervention groups: Intervention group 1: Patients in the first group will be treated with Topical Anagain 4% (1 cc twice daily). Intervention group 2: Patients in the second group will receive topical Minoxidil 5% (1 cc twice daily) for 6 months. Main outcome variables: Number of hairs, Change in photographic pictures and patient satisfaction score.

Study aim: The objective of this study is to compare the post-operative analgesic efficacy of ultrasound guided transversus abdominis plane (TAP) block versus intra-thoracic epidural catheter in patients undergoing abdominal laparotomy. Design: A non blinded, Quasi experimental interventional, single center study with two intervention groups carried out from march 2023 to September 2023. Settings and conduct: The study was conducted in Anesthesia Department of Combined Military Hospital, Rawalpindi. Participants/Inclusion and exclusion criteria: Inclusion criteria included all ASA-I and II male and female patients between ages 20-60 years presenting for elective or emergency abdominal laparotomy. Exclusion criteria included patients with cancer, tumors or metastatic disease, low ejection fraction, respiratory compromise, post chemotherapy, allergic to bupivacaine or lignocaine or unwilling to be included in the study, infection at site of block, coagulation disorders, patchy or failed epidural insertion and failure to perform TAP block after three unsuccessful attempts. Intervention groups: The patients were divided into the TAP block group (Group TAP) (n=60) and the epidural group (Group Epidural) (n=60). Main outcome variables: Primary variable observed was mean time to first rescue analgesia and objective patient satisfaction in both groups.

Study aim: The objective was study the effects of routine physical therapy with and without Action observation on freezing of the gait andfunctional mobility in patients with Parkinson’s disease. Design: Randomized, parallel group design of 21 patients, single blinded randomized control trial. Settings and conduct: Study was conducted at THQ Civil Hospital Daska. The study population was consisted of Parkinson's Disease, The study was single blinded. The outcome assessors did not know while they were receiving experimental or conventional treatment Participants/Inclusion and exclusion criteria: Inclusion 1. The participants with set diagnostic criteria of UK society for Parkinson’s Disease Bank Criteria based on clinical findings. 2. Age between 50 to 80 3. The patients were selected on the condition of severely affected gait and enrolled if there was freeing of their gait minimum once in a week (having a score of 1 on FOG outcome tool in item No.2) and having a larger episode of greater than 2 seconds (and if have 2 scores on the FOG item No. 4) 4. Hoehn & Yahr criteria with labeled as stage ≤ 3 Exclusion Criteria: 1. Any of the substance abuse ,illness systematic disease and neurological issues that can affect the outcomes including cognition level 2. Implantation for deep brain stimulation 3. Cognitive impairment, in particular patients with a Mini mental State Examination (MMSE) score < 24 4. Visual or acoustic limitations. Intervention groups: Group A-(Routine Physical Therapy) Group (B) (RPT+ AOT) In this group patient were treated with action observation therapy (AOT) as well as with routine physicaltherapy (RPT). Main outcome variables: Freezing of Gait and functional mobility.

Study aim: the aim of the study is to compare the effectiveness of spencer technique and isotonic stretching in patients with stage-II adhesive capsulitis Design: Pragmatic, parallel-group, single-blind, randomized clinical trial Settings and conduct: The trial is conducted in Allied Hospital Faisalabad. Subjects are chosen according to inclusion criteria. Subjects are blinded as they don't know their treatment protocol and group. Participants/Inclusion and exclusion criteria: Inclusion Criteria • Patients aged between 40-60 years • Gender included both male and female. • Patients having frozen shoulder of stage 2. • Patient having restricted ROM. Exclusion Criteria • Patient with recent history of surgery. • Patient with Rheumatoid arthritis • Patient with history of any trauma/fracture of shoulder region. • Subject with neurological deficit Intervention groups: Both groups will receive baseline treatment protocol capsular stretching of shoulder joint and isometric strengthening exercise of flexor, extensor, abductors, adductors, external rotators, internal rotators. Group A will be given Spenser Technique for 1 set of 10 repetitions. Group B will be given isotonic stretching for 1 set with 5 repetitions. Main outcome variables: Pain, Range of Motion, Shoulder Disability

Study aim: The objective of this study is to compare the block quality along with sensory and motor characteristics when comparing the pericapsular nerve block (PENG) with the fascia iliaca block in patients undergoing total hip arthroplasty. Design: Single blind, randomized by non-probability consecutive sampling via lottery method assessing post-operative pains scores after the two techniques in a single center study Settings and conduct: Will be done according to the inclusion criteria given. Patients undergoing total hip arthroplasty will be undergoing one of the two blocks (PENG or FIB) pre-operatively according to standard methods of NYSORA Patients will be blinded to the block performed by the consultant anesthetist Post-operative pain scores and time to patient mobilization will be the primary variables studied Participants/Inclusion and exclusion criteria: Inclusion criteria included all ASA-II male and female patients above the age of fifty years requiring total hip arthroplasty (THA) due to advanced osteoarthritis of the hip joint. Exclusion criteria included patients with major cardiac or respiratory debility, metastatic bone disease, allergy to drugs used for the block, bleeding diathesis, coagulation defects, patients with patchy or failed block after administration and patients not willing to be included in the study. Intervention groups: Group F (receiving fascia iliac block) Group P (receiving PENG block) Main outcome variables: Mean time for first dose of rescue analgesia, Mean time to patient mobilization

Study aim: To compare the effectivity of negative pressure wound therapy (NPWT) versus standard modern wound care with moist dressings for treatment of diabetic ulcers in patients with type-II diabetes presenting to a tertiary care hospital. Design: Two arm parallel group, randomized controlled trial with blinded outcome assessment of 190 total patients assessed for 12 weeks post treatment Settings and conduct: Since procedural limitations did not allow blinding during the study, the endpoint of wound healing and size regression was assessed by an independent team of 3 consultants who were given the final results of the wounds in pictorial form to give their opinion of the changes before and after treatment and debridement. Both the assessors and the final analysis consultant was unaware of this double blinded study protocol Participants/Inclusion and exclusion criteria: We made two groups of 95 patients each, one to receive standard dressing care and one to receive NPWT Inclusion criteria included all patients >18 years diagnosed clinically and blood sugar fasting and 2-hour-post prandial investigations in the diabetic range according to the (World Health Organization) WHO criteria presenting with a diabetic foot wound of more than 4 weeks duration corresponding to Wagner grade 2 for debridement. Exclusion criteria included patients with pregnancy, non-compliant to follow-up, necrotic tissue on ulcer with eschar that could not be debrided, malignancy, advanced cardiac and respiratory disease, exposed nerve and vessels beneath the ulcer Intervention groups: Patients in Group N received NPWT (negative pressure wound therapy). Patients in Group S received standard modern moist wound dressing after debridement Main outcome variables: Wound closure frequency, wound closure mean time, incidence of infection and amputation

Study aim: To compare the sensory, motor, block duration and added analgesia requirements between ultrasound guided femoropopliteal block and spinal anesthesia in patients with malleolar fractures of the ankle. Design: A randomized control trial was carried out at the Department of anesthesiology. A pilot study was carried out before the start of the trial with 15 participants in each group, one to receive spinal anesthesia and the other to be administered femoropopliteal block under ultrasound guidance for malleolar fracture of the ankle. Settings and conduct: The method of randomization was non-probability consecutive sampling by lottery method. Participants/Inclusion and exclusion criteria: Included all ASA-I and II male and female patients between ages 25-55 years. Excluded patients with major cardiac or respiratory disease, patients with failed spinal or femoropopliteal block after three unsuccessful attempts, patients allergic to local anesthetic including bupivacaine, lignocaine and steroids including dexamethasone, patients with malignancy or malignant disease, pregnant females and patients unwilling to be included in the study. Intervention groups: The trial randomized all patients as per the inclusion criteria furnished. The patients were divided into the spinal group and the femoropopliteal block group. Once the patients were divided into the two groups, an informed written consent was taken, and patients in both groups were explained in detail about the procedure and possible complications. Standard monitoring including non-invasive blood pressure, heart rate, capnography and ECG were attached to participants in both groups. Main outcome variables: Duration of surgery. Mean time to onset of sensory block. Mean time to onset of motor block. Mean time to first dose rescue analgesia. Mean time of analgesia given in HDU. Mean HDU stay. Mean patient satisfaction score for pain releif.

Study aim: To compare the functional outcomes and adverse effects when using general anesthesia versus consious sedation in patients undergoing endovascular treatment for posterior circulation stroke. Design: The randomized controlled trial was carried out at Anesthesia Department of Combined Military Hospital Rawalpindi, PAK Emirates Military Hospital Rawalpindi Settings and conduct: The study was conducted in Anesthesia Department of Combined Military Hospital Rawalpindi, PAK Emirates Military Hospital Rawalpindi Participants/Inclusion and exclusion criteria: Included patients over the age of 18 years with a confirmed diagnosis of posterior circulation stroke ( PCS) by CTscan or MRA with a modified Rankin score of 2 or less than 2 at the time of stroke and considered a suitable candidate for re-canalization within 24 hours of stroke onset. Included patients with massive intracranial hemorrhage, anterior circulation stroke, unclear radiological findings not consistent with acute posterior circulation stroke, a modified Rankin scale of more than 2 stroke onset, at pons midbrain index 3 or greater, patients with aspiration, fits, and intubation before EVT commencement and patient unwilling to be in the study or refusing follow up for the study protocol. Intervention groups: The patients were divided into two groups, one to receive general anesthesia (GA) and other to receive conscious sedation (CS). Main outcome variables: Functional outcome and disability in quality of life was assessed using the mRS(modified Rankin score), NIHSS(National Institute of Health Stroke Scale), GCS(Glasgow Coma Scale).

Study aim: The objective of the study is to compare the incidence of airway related complications when using nasal packing versus septal stitch post-operatively in patients presenting for elective septoplasty for deviated nasal septum (DNS) Design: A randomised controlled trial ; single study center with two interventional groups carried out from June 23 to Dec 23 , with sample size of 110 individuals in each group. Settings and conduct: The study was conducted in Anesthesia department of combined military hospital rawalpindi, with randomized controlled method, non blind. The sampling was done by non probability consecutive sampling via lottery method and resident o duty marked the groups with X and Y chits. Patients of group marked with X chits were allocated septal stich group and patients with group marked Y chit were allocated nasal packing group. Participants/Inclusion and exclusion criteria: The inclusion criteria included all patients >18 years presenting for pre-anesthesia assessment for elective nasal surgeries requiring nasal packing/septal stitch post-operatively. The exclusion criteria included patients < 18 years, pregnancy, previous history of septoplasty, patients with coagulation disorders, patients with advanced cardiac, respiratory, or metastatic disease, patients with concomitant nasal surgery including turbinectomy etc. and patients unwilling to be included in the study or lost to follow-up. Intervention groups: The patients were randomized into two groups of 110 patients each. Group N (n=110) to receive nasal packing and Group S (n=110) to receive septal sutures. Main outcome variables: Main variables were followings 1. Time from recovery room to discharge 2. Median pain scores in recovery 3. Mean dose of analgesia post procedure in recovery room before discharge 4. Laryngospam 5. Hypoxia 6. Bleeding 7. Headache 8. Sleep disturbances

Study aim: To compare the treatment efficacy of medical therapy using glyceryl trinitrate versus surgical lateral sphincterotomy in patients with chronic anal fissure Design: Parallel group, double blinded randomized controlled trial Settings and conduct: The study was carried out at CMH Peshawar, the population under study were patients with chronic anal fissure requiring treatment, since the procedural limitation did not allow patients blinding, the surgical specialists conducting the surgical procedure and the resident surgeon advising and applying the medical treatment (glyceryl trinitrate) were blinded to the study protocol using proformas marked X and Y for endorsing study outcomes in both groups respectively. The final analysis was carried out by an independent team unaware of the treatment modality given in patients and only outcomes variables were given to them for analysis Participants/Inclusion and exclusion criteria: Inclusion criteria: all patients more than 18 years of age; with a chronic non-healing anal fissure more than 8 weeks duration; presenting to the surgical out-patient department for treatment. Exclusion criteria: pregnancy, non-compliant to follow-up, history of recurrent anal fissures; surgical or medical intervention in the last 6 months; patients with major cardiac or respiratory disease; patients unwilling to be included in the study. Intervention groups: Intervention Group 1: Group S (n=120) to receive surgical lateral sphincterotomy. Lateral sphincterotomy was done by dissecting part of the internal anal sphincter to relieve fissure induced spasm. Intervention Group 2: Group M (n=95) to receive glyceryl trinitrate. glyceryl trinitrate 0.2% (1-2ml) was used as local applicant not the fissure area to relieve spasm Main outcome variables: Mean time for complete healing of the fissure, frequency of ulcer healing; median pain scores as assessed on the NRS (numerical rating scale); frequency of bleeding

Study aim: To determine the effects of diaphragmatic and paced breathing on pulmonary function , hot flashes and postmenopausal syndrome in women. Design: 44 participants will be recruited. Two parallel groups, double blinded, randomized clinical trial with pre and post assessment. Settings and conduct: This study will be conducted in gynecology department at Mussarat Razzaque hospital 196 G.T road baghbanpura Lahore. Participants and outcome assessor will be blinded. Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA Menopausal women having symptoms Hot Flashes during menopause Not currently taking hormonal replacement therapy, a psychoactive medication, and not using complementary therapy for menopausal symptoms. EXCLUSION CRITERIA  Had hormonal replacement therapy Having any cardiac and lung diseases will be excluded If they had history of breast cancer , mayocardial infarction and pulmonary embolism. Intervention groups: Group A: will be treated by Diaphragmatic Breathing Group B: will be treated by Paced Breathing Main outcome variables: Menopause rating scale (MRS), Hot flash-related daily interference scale, Pulmonary function changes by using a portable spirometer.

Study aim: To find the combined effects of pelvic floor Hold relax and Buteyko technique on urinary incontinence, pulmonary functions and exercise tolerance in COPD patients Design: Randomized Controlled Trial Settings and conduct: This Study will be conducted at Gulab Devi Chest Hospital, Lahore. Participants/Inclusion and exclusion criteria: • Patients complaining incontinence link with cough and exercise. • Age criteria 25-45 years • Patients having ability to perform voluntary pelvic floor muscle contraction and cooperative. • Self-reported urinary incontinence. • Stable COPD Exclusion Criteria: • Subjects having unstable COPD. • Also, the subjects with >4 hospital admissions due to COPD during last 1 year. • Patient ‘s having Neurological conditions and non-cooperative. • Subjects having spinal cord injuries. • Patients having history of Hysterectomy and other gynecological surgeries • Patients having Malignancy. Intervention groups: Group A: will be treated by Behavioral Therapy along with Pelvic floor hold relax and Buteyko technique. Group B: will be treated by Behavioral Therapy Main outcome variables: Urinary Incontinence, Pulmonary functions, Exercise tolerance

Study aim: The objective of this study is to compare methods of forced air warming combined with warm intravenous fluid administration versus forced air warming alone in preventing hypothermia and shivering associated with spinal anesthesia for elective caesarian section. Design: A preventive, double blinded, randomized controlled clinical trial with a parallel group design of 390 patients, enrolled between January 2023 and July 2023 and a single center study. Settings and conduct: Core temperature in both groups was recorded using a standard Braun Infrared Thermoscan5 thermometer (IRT 6500) by a resident anesthetist in the operating room unaware of the study protocol being double blind. Participants/Inclusion and exclusion criteria: included all ASA-I and II female patients presenting for elective caesarian with a gestational age of 37 or more weeks under spinal anesthesia. Excluded patients with pre-maturity, caesarian converted to general anesthesia following spinal administration, patients with fever, cardiac or respiratory disease, patients with PIH (pregnancy induced hypertension) or gestational diabetes mellites and patients unwilling to be included in the study. Intervention groups: The patients were randomized into Group FWI (forced warming with warm IV fluid) and FWA (forced warming alone). Main outcome variables: Core body temperature measured in degrees Celsius between Group FWI and Group FWA was 37.34±0.17 degrees Celsius versus 37.34±0.16 degrees Celsius measured pre-spinal administration (p=0.922). It was 36.85±0.09 degrees Celsius versus 36.12±0.10 degrees Celsius 30 minutes after spinal during the procedure between both groups (p<0.001) and was36.84±0.09 degrees Celsius versus 36.11±0.10 degrees Celsius measured 60 minutes in the procedure between both groups (p<0.001)

Study aim: In instances of 1st and 2nd grade degenerative lumbar spondylolisthesis treated with transpedicular fixation with or without interbody fusion via lumbar cage, the goal of this study is to assess the short-term clinical and outcome outcomes of two surgical procedures. Design: Randomized, superiority, parallel group trial with blinded outcome assessment. Randomization was centralized and computerized with concealed randomization sequence carried out at an external site, sample size 28. Settings and conduct: A trial was conducted at Afridi medical complex, Peshawar. In the Randomized Controlled Trial (RCT), outcome assessors were blinded through a meticulous process where they were kept unaware of participants' assigned interventions. Participants/Inclusion and exclusion criteria: Inclusion criteria: 1st and 2nd grade degenerative lumbar spondylolisthesis patients and patients who would consent to participate under ethical conditions Exclusion criteria: 1) Patients with additional lumbar spondylolisthesis types; 2) Patients with additional lumbar degenerative spondylolisthesis grades (3rd and 4th grades); 3) Patients with additional spine pathology (lumbar fracture, disc prolapse) Intervention groups: Group A: Participants randomized to group, undergoing transpedicular fixation with Fusion, will receive bilateral transpedicular fixation using pedicle screws, coupled with interbody fusion employing autograft or suitable bone substitute. This will be complemented by posterior stabilization using rods and cross-links. Group B: Group B, designated for Transpedicular Fixation Alone, will involve bilateral transpedicular fixation with pedicle screws without interbody fusion, followed by posterior stabilization using rods and cross-links. Main outcome variables: The Oswestry Disability Index (ODI) and Visual Analogue Score (VAS)

Study aim: To assess the influence of muscle energy technique with and without the application of a sacroiliac belt on pain levels, muscle strength, and the overall quality of life in individuals with sacroiliac joint dysfunction. Design: In an upcoming nine-month randomized control trial at Begum Akhtar Rukhsana Memorial Welfare Trust Hospital in Lahore, 48 participants will be conveniently sampled. Settings and conduct: Setting: Begum Akhtar Rukhsana Memorial trust Hospital, Lahore. Participants in the trial will be blinded, unaware of their group assignments or the nature of interventions, to minimize potential biases in behavior and reporting. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Participants aged 30 to 50 years of both genders; Individuals with persistent pain in the lower back, gluteal, and groin regions, and lower extremity pain lasting between four weeks and one year; Participants testing positive on pain provocation tests. Exclusion Criteria: Pregnant females; Individuals with health issues hindering exercise, such as SLE, Multiple Sclerosis, and Chronic Fatigue Syndrome; Those with osteoporosis affecting the pelvic and spine region, inflammatory pathologies (Ankylosing Spondylitis, Osteoarthritis Hip, Degenerative Arthritis), a history of hip fracture, or any spinal surgery. Intervention groups: The study will allocate participants into experimental (MET with SI Belt) and control (MET only) groups, Main outcome variables: SF-36, NPRS, and MMT to assess quality of life, pain, and muscle strength, respectively.

Study aim: This study aimed to compare the efficacy of probiotic and antibiotic combination therapy with antibiotic therapy alone to prevent the recurrence of bacterial vaginosis. Design: Parallel-arm, Randomized controlled trial Settings and conduct: Gynecological Department of Nishtar Hospital, Multan, Participants/Inclusion and exclusion criteria: Women 18-45 years old having bacterial vaginosis diagnosed according to Amsel's criteria (at least three of the following BV symptoms: Greyish white, thin, homogenous vaginal discharge, vaginal pH >4.5, positive amine test findings, and presence of clue cells (>20%) in a wet smear observed under microscopy, all cured with metronidazole, were enrolled. Patients with a history of allergy against the study drug, pregnant, lactating, menopausal women, history of bleeding from the genital tract of unknown aetiology, women with malignancy of the reproductive tract or any co-morbid condition like AIDS, diabetes, psychiatric illness, or currently using any contraceptive method, and patients using another oral or vaginal probiotic at the time of assessment or receiving antibiotic therapy for another reason were excluded. Intervention groups: In Group A, probiotics (Lactobacillus plantarum PBS067, Lactobacillus rhamnosus LRH020, and Bifidobacterium animalis lactis BL050) were administered once a day for 14 days following antibiotic treatment (Tab Metronidazole 400mg TDS for seven days). A post-antibiotic therapy placebo (dextrose-filled pill) was administered to Group B (n = 52). Main outcome variables: Recurrence of bacterial vaginosis

Study aim: To evaluate the therapeutic outcomes of dry needling coupled with intramuscular stimulation in patients with fibromyalgia syndrome. Design: A concealed, randomized, blinded, controlled trial with a parallel group design of 78 patients Settings and conduct: Physical Therapy Department, University of Lahore Teaching Hospital, Lahore Participants/Inclusion and exclusion criteria: Inclusion Criteria Both male and female patients; Age over 18 years and under 60 years; Pre diagnosed patients with FMS referred through consultant; Manifesting chronic widespread musculoskeletal pain symptoms; Presence of active trigger points, as confirmed by physical examination; No contraindications to dry needling or IMS. Exclusion Criteria Pregnancy or breastfeeding; Use of any medications that could interfere with the study results e.g. muscle relaxants, opioids within the past 48 hours; Previous treatment with dry needling or IMS within the past 6 months; Presence of any other conditions that could interfere with the study results e.g. cancer, infection; Intervention groups: Group A: This group will be given dry needling and conventional treatment. The sterile stainless steel 0.25*25mm to 0.25*50mm (Hua long) acupuncture needle will be inserted. CPT will consist of Application of hot pack for 10 minutes, TENS(typical, 100 Hz) for 20 mins at the affected region. Isometric exercise, Range of Motion, Stretching and strengthening exercise of affected region. Therapy will be provided for one session per week for four weeks. Group B: This group will be given dry needling and IMS will be applied for 15 minutes (low frequency parameters (2 Hz) and a pulse width of 120 μs).Conventional physical therapy will be given as of Group A. Main outcome variables: Numeric Pain Rating Scale; Pain pressure threshold; algometer; Quality of sleep; Anxiety depression; Fatigue scale

Study aim: The aim of study is to manage psychological distress to improve quality of life, self-efficacy and emotional intelligence of school teachers by using cognitive behavioral therapy Design: This phase of the study will be based on Randomized Control Trial with Pre and Post test design with 187 subjects, enrolled between February 2024 to June 2024. Settings and conduct: The independent variable of the study will be cognitive behavioral therapy while the dependent variable will be psychological distress, quality of life, self-efficacy and emotional intelligence. There will be two groups. One group will be experimental group which will receive treatment and the other will be control group which will not receive any treatment. Nature of the treatment will be brief cognitive behavioral therapy. Participants/Inclusion and exclusion criteria: Inclusion criteria: Female school teachers employed in government and private schools in the Layyah district, employed for at least one year, females who will score high in psychological distress scale. Exclusion criteria: Male school teachers, who will be unwilling to participate in the CBT intervention, females who will score low in psychological distress scale. Intervention groups: Participants in the Experimental group will receive 8 sessions of culturally adapted Cognitive behavioral therapy. Each session will be comprised on 120 minutes once in a week. However Control group will be kept passive and will not receive any treatment during experiment. Main outcome variables: Level of psychological distress.

Study aim: The objective of this study is to compare the effects of modified otago exercises and Action observation therapy on balance and postural stability in sub-acute stroke Design: Randomized Clinical Trial, Single blinded study Settings and conduct: This study will be conducted in Society hospital Lahore single blinded study , Participant will be blinded Participants/Inclusion and exclusion criteria: Inclusion criteria: patients should be diagnosed with stroke; both male and female. Participant’s Age will be between 45 to 60 years patients should be able to walk at least 10 meters. Patients should be able to understand and follow instruction, mini mental status examination (MMSE)>24. Exclusion criteria: If patient has any other neurologic disease other than stroke Any auditory or visual deficit that can affect data collection of this study Patient having any abnormality in the vestibular System. Patients having any other orthopedic conditions Intervention groups: Group A: Experimental group (n=19) Group A will be treated by modified otago exercise program and Conventional physical therapy. A session of 40 minutes for 6 weeks including 3 sessions per week will be given to each patient. 10 minutes of conventional treatment will be given to every participant and then 30 minutes of modified otago exercise program. Experimental group (n=19) Group B will be treated by Action Observation Therapy and Conventional physical therapy 40 minutes session will be given 3 times per week for 6 weeks. Prior to Action observation therapy patient will receive session of conventional physical therapy of 10 minutes. Main outcome variables: Balance Postural stability

Study aim: Comparison of efficacy of intramuscular meglumine antimoniate plus oral allopurinol with intramuscular meglumine antimoniate alone in treatment of cutaneous leishmaniasis Design: Clinical trial which is parallel group, double blind, randomized, phase 3 trial. Settings and conduct: Dermatology Department Combined military hospital Quetta Participants/Inclusion and exclusion criteria: Inclusion criteria:All patients with biopsy proven leishmaniasis plus has lesion(s) located in sites not compatible with local treatment for example on or around eyes lesions in which scaring would be disfiguring like on face lesions that will have difficulting in healing like on lower limb or lesion ≥4 cm lesion with sporotrichoid spread Exclusion criteria:patients allergic to antimonials pregnant and breast feeding women patients having mucosal, mucocutaneous or visceral leishmaniasis Patients with comorbidity (diabetes, hypertension,chronic liver disease,chronic kidney disease) and/or immunosuppression Patients with baseline ECG abnormalities/ Intervention groups: Intervention group A: Patients were given drug via Intramuscular route injection meglumine antimoniate plus oral allopurinol. Intramuscular meglumine antimoniate was given in dose of 15mg/kg intramuscular if volume of injection exceeds 10ml as per body weight then it should be divided into two doses in each buttock nd oral allopurinol was given 15mg/kg in the form of tablets Intervention group B: Patients were given drug via Intramuscular route meglumine antimoniate 15mg/kg if the volume of injection exceeds 10 ml, it should be divided into two doses: one in each buttock or thigh. Main outcome variables: Clinical/treatment response

Study aim: The objectives are to enhance gaze stability through the application of gaze stabilization exercises and Cawthorne Cooksey exercises also to study and compare the effect of Gaze stabilization exercises and Cawthorne Cooksey exercises on Craniovertebral angle and Vestibular ocular reflex. Design: Simple random sampling is a statistical method used to gather data from a population. In simple random sampling, each member of the population has an equal chance of being selected to be part of the sample. This method ensures that the sample is representative of the entire population and helps reduce bias in the results. Simple random sampling can be conducted using various techniques such as random number generators, random drawing methods, or randomization software. Settings and conduct: The University of Faisalabad. participants were blinded Participants/Inclusion and exclusion criteria: Inclusion criteria • Participants willing to give consent • IT students • Both genders • Age: 19-25 years • Screen time 6-8 hours • VOR(+) • Craniovertebral angle 50° -53° • Thoracic angle 30° -50° Exclusion criteria • Uncooperative participants • No other neurological disorder • History of ear infection • History of migraine • History of dizziness, vertigo • Subjects with history of head injury • Subjects with ADHD Intervention groups: Group A The participants of experimental group A will perform Gaze stabilization exercises as treatment approach for 3 weeks, 3 sessions per week and 3 times a day. Group B The participants of experimental group B will perform Cawthorne Cooksey exercises as a treatment protocol for 1 minute thrice a day (total 3 minutes per day) on alternate days for 3 weeks, 3 sessions per week and 3 times a day. Main outcome variables: Goniometer Inclinometer

Study aim: The objectives are to enhance gaze stability through the application of gaze stabilization exercises and Cawthorne Cooksey exercises also to study and compare the effect of Gaze stabilization exercises and Cawthorne Cooksey exercises on Thoracic angle and Cervical ranges. Design: Simple random sampling. Settings and conduct: The University of Faisalabad. Participants/Inclusion and exclusion criteria: Inclusion criteria • Participants willing to give consent • IT students • Both genders • Age: 19-25 years • Screen time 6-8 hours • VOR(+) • Craniovertebral angle 50° -53° • Thoracic angle 30° -50° Exclusion criteria • Uncooperative participants • No other neurological disorder • History of ear infection • History of migraine • History of dizziness, vertigo • Subjects with history of head injury • Subjects with ADHD Intervention groups: Group A: The participants of experimental group A will perform Gaze stabilization exercises as treatment approach for 3 weeks, 3 sessions per week and 3 times a day. Group B: The participants of experimental group B will perform Cawthorne Cooksey exercises as a treatment protocol for 1 minute thrice a day (total 3 minutes per day) on alternate days for 3 weeks, 3 sessions per week and 3 times a day. Main outcome variables: Goniometer Inclinometer

Study aim: To investigate the effects of ischemic conditioning along with bimanual task training to improve skill learning in children with unilateral cerebral palsy Design: consecutive sampling Settings and conduct: The Children Hospital & institute of child health Faisalabad Participants/Inclusion and exclusion criteria: Children diagnosed with Unilateral Cerebral palsy UCP. Children with age: 8-16 years. Children having Manual Ability Classification System (MACS) levels I – III. Children having ability to complete a stack of three cups in 1 min. Mainstream in school. Children with other developmental disabilities such as Autism, attention deficit hyperactivity disorder, developmental coordination disorders. Children with absent active motor threshold. Children with known cardiorespiratory, vascular and metabolic disorders. Children with neoplasm and hydrocephalus. Children who are currently receiving or received other adjunct therapies such as RTMs and TDs in the past 6 months. Children with active seizures or seizures within last two years and currently on anti-seizures medication. Children with metal implants and incompatible medical devices. Intervention groups: After taking informed consent from participants fulfilling the inclusion criteria, they will be randomized into two groups (Group A and Group B). Group A will receive Ischemic conditioning with 20 mmHg and bimanual task training of 15 repetitions each, for 6 consecutive days. Group B will receive only ischemic conditioning with 25 mmHg for 5 consecutive days. Main outcome variables: Movement Time Measure of bimanual coordination Goal Synchronization Total Task Duration