Study aim: To compare effectiveness of JANDAS Approach versus McKenzie Retraction exercises on pain, disability and quality of life among Chronic Neck Pain Patients. Design: Randomized clinical trial Settings and conduct: This study will be conducted at Arif Memorial Teaching Hospital, Lahore Participants/Inclusion and exclusion criteria: Inclusion criteria: Patients, 25-40 years of age suffering from neck pain duration more than 6 months will be include in this study. Exclusion criteria: Subjects with a history of severe trauma such as fracture, congenital disorder of cervical spine, spondylolisthesis, any neck tumor, myelopathy, tendinopathy, rheumatoid arthritis or having ankylosing spondylosis will be exclude from this study Intervention groups: There will be two intervention groups. Group A will be treated with JANDA,s approach and group B will be treated with McKenzie retraction exercises. Main outcome variables: NPRS questionnaire will be used to check pain severity level, while NDI will be used for neck disability and SF36 questionnaire will be used for quality of life

Study aim: To determine the effects of progressive resistance exercise training on inflammatory markers, cardiorespiratory fitness, pulmonary function in patients with RA. Design: Two parallel group , single blinded, randomized control trial with pre and post assessment Settings and conduct: Will be conducted in private hospital Ittefaq hospital Lahore Participants/Inclusion and exclusion criteria: Inclusion criteria • Patient with RA • Patients with sedentary lifestyle (no participation in structural exercise for the preceding 6 months) • RA factor positive • Both males and females • Age between 40-65 years • Stable disease • No change in DMARDS (Methotrexate, sulfasalazine, hydroxychloroquine) Exclusion criteria. • Joint surgery (in the preceding 6 months) • Cognitive disability • Other joint diseases such as Osteoporosis and Osteoarthritis • Previous history of fracture • Primary neurological disease • Comorbidity incompatible with exercise Intervention groups: ⚫ Patients will ask to perform four exercises utilising large muscle groups (eg, leg press, shoulder press, chest press and pull ups). Intensity will determine during their first resistance exercise session using an established protocol.20 They will required to complete three sets of 12–15 repetitions during each exercise session. Mode and intensity of exercise will adjust monthly. Main outcome variables: 6 minutes walk test Spirometry Blood test

Study aim: To evaluate the effects of Hand arm bimanual intensive therapy including lower extremities (HABIT-ILE), in pre-school children with CP on functional parameters Design: Randomized controlled trial Settings and conduct: Hospitals of Faisalabad Participants/Inclusion and exclusion criteria: Inclusion Both male and female Children will be considered Diagnosed children of Spastic Cerebral Palsy CP Child of Grade 3 and 4 aged between 3 to 6 years (corrected age if preterm birth), capable of following instructions and completing all necessary tests according to their Exclusion Limb fracture Uncontrolled epilepsy With any other congenital disease (e.g. Diabetes, Hyperthyroidism, Hypothyroidism etc.) Botulinum toxin injections or orthopedic surgery within the past 6 months. Have severe visual or cognitive impairments that could interfere with treatment/testing. Parents are unable/unwilling to provide consent for their child’s participation Intervention groups: Group A Interventional group consist of 25 participants will receive Early Hand arm Bimanual Intensive Therapy Including Lower Extremities (E-HABIT-ILE), while Group B will receive treatment through a Conventional Physical therapy. Both interventions will be given for 3 hours per day in hospital by dividing the both groups into sub groups Main outcome variables: 1. Five classification levels of the Gross Motor Functional Classification System (GMFCS) 2. Modified ACTIVLIM-CP Questionnaire 3. Pediatric Evaluation of Disability Inventory Questionnaire (PEDI-CAT)

Study aim: To compare the effects of Spencer muscle energy techniques and Bowen therapy on pain, Range of motion and disability in patients with Adhesive capsulitis. Design: Single blinded randomized clinical trial with parallel assignment of 32 participants to two groups equally. Settings and conduct: The study will be conducted at Arif memorial teaching hospital. Outcome assessor will be kept blind in it. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Both male and female patients between age of 40 - 60 years. Patients with positive capsular pattern. Patients experiencing pain, stiffness, and limited range of motion in the affected shoulder. Patients who have not undergone shoulder surgery or received corticosteroid injections in the past three months. Exclusion Criteria: Patients with a history of shoulder fractures, dislocations, or other significant shoulder injuries. Patients with fracture in and around shoulder. Patients with any neurological disorder Intervention groups: Group A: Spencer muscle energy technique Group B: Bowen Therapy Main outcome variables: Pain measured by numeric pain rating scale ROM measured by universal goniometer Disability measured by shoulder pain and disability index Questionnaire

Study aim: To compare the effect of conventional physiotherapy with and without hold- relax PNF Exercises on knee torque and motor function in children with spastic cerebral palsy. Design: single-blind randomized controlled trial Settings and conduct: Ambulatory patients of cerebral palsy having GMFC of 1 and 2 in the rehabilitation department of Rehab Care School for Special Children Lahore fulfill the inclusion criteria of the study. The assessor was not aware of the treatment given to either group. Participants/Inclusion and exclusion criteria: 8-16 years old cognitive children with spastic cerebral palsy having Knee flexor and extensors grade 3 and above according to manual muscle testing. Intervention groups: hold- relax peripheral neuromuscular facilitation technique along with conventional physical therapy. The exercise program included: o Dynamic stretching utilizing the principles of hold relax peripheral neuromuscular facilitation. Keeping the knee straight, the patient was asked to lift the leg for 7 seconds while the therapist held the leg from moving. The muscles were relaxed for 2 seconds while holding the new position. The process was repeated five times and the whole set was done 66 times with a 2-minute rest between each set. o Conventional static stretching was done at the start of the protocol for 5 minutes. Main outcome variables: • knee torque. • motor function • functional capability • spasticity

Study aim: To determine significant effectiveness of teach back training intervention with breathing exercises including diaphragmatic breathing , pursed lip breathing and effective cough to improve the pulmonary functions in COPD patients. Design: Randomized Control Trial with parallel groups , Single blinded with pre and post treatment readings Settings and conduct: Fatima Memorial Hospital, Jinnah Hospital And Services Hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age from 18 to 75 years old ,Male and Female, Diagnosed COPD with FEV1/FVC ratio <70% ,Lack of cognitive impairment ,Ability to attend training session, Clinical diagnosis of COPD confirmed by smoking history Exclusion Criteria: Long Term Bed Rest, Inability To Perform 6-minute Walk Test, Malignancy, Cardiovascular disease (Angina, MI),Stroke, Immunocompromised conditions, Cardiac and pulmonary surgical History Intervention groups: Interventional Group(A):Teach Back training with breathing exercises along with Conventional treatment and educational session protocols among COPD patients. Control Group(B):Breathing Exercises with Conventional Training among COPD patients Main outcome variables: Pulmonary Function Assessment using Digital Spirometry and Borg Dyspnea Scale

Study aim: To evaluate if pilates exercises have significant effects than neck-stabilization exercises in treating chronic neck pain, sleep disturbance as well as decreasing kinesiophobia in non-specific chronic neck pain patients Design: Sixty participants will be randomly allocated into 2 groups , thirty in each group via computerized random number generator. Group 1 will receive neck stabilization exercises and Group 2 will receive Pilates exercises . The interventions will be given for 8 weeks Settings and conduct: Sample will be selected through Convenient sampling technique from physiotherapy department of Allied Hospital, Faisalabad, Physical therapy department of DHQ Faisalabad Participants/Inclusion and exclusion criteria: Inclusion criteria: • Both gender • Age 18-45 years . • Recurrent history of neck pain from 3 months. • Intensity of pain greater than or equal to 5/10 on numerical pain rating scale. Exclusion criteria: • History of cervical spine injury or surgery • History of neck trauma , spinal deformity . • History of specific neck pain such as fibromyalgia , Rheumatological diseases • History of neck-pain secondary to other conditions including neoplasm, any neurological or vascular disease • History of radiculopathy • History of Degenerative arthritis of cervical spine • History of osteoporosis • History of low back pain Intervention groups: Sixty participants will be randomly allocated into 2 groups , thirty in each group via computerized random number generator. Group 1 will receive neck stabilization exercises and Group 2 will receive Pilates exercises . The interventions will be given for 8 weeks Main outcome variables: Numerical pain rating scale, Insomnia severity index and Tampas scale of kinesiophobia will be used for pre and post assessment

Study aim: The comparative effects of progressive resistance exercise and task-specific training in Ischemic stroke patients. Design: Randomized control trial with participants divided into two group progressive resistance exercises and task specific training with 52 sample size. Settings and conduct: Trial is conducted in the University of Lahore Teaching Hospital with assesser is blinded and physiotherapist is not blinded Participants/Inclusion and exclusion criteria: Inclusion Criteria: • Both male and female • Age between 40 and 70 years • First event of ischemic stroke • A Mini- Mental Status Examination score more than and equal to 24 • No facial palsy and receptive aphasia • No prior thoracic or abdominal surgery • Subjects able to sit for 30 secs without using upper extremities for support • Stable patients Exclusion Criteria: • Other disorders such as blindness, deafness, amputation of lower or upper limb, cerebellar stroke • Impaired cognition or other severe medical condition • Patients with abdominal aortic aneurysms; unstable chronic disease; life-incapacitating cardiac disease, severe balance impairment; psychiatric illness. • Musculoskeletal problems in the pelvis or spine • Sensory involvement Intervention groups: Both groups will receive interventions for 12 weeks, 2 times/week with routine physical therapy for 20 mins before every session. The first intervention group received Progressive Resistance Training for 12 weeks with increased repetitions after every two weeks. The second intervention group received Task Specific Training for 12 weeks with different task after every two weeks Main outcome variables: Reflex activity, Volitional Movement Within Synergies, Volitional Movement Mixing Synergies, Volitional Movement With little or no Synergies, Normal Reflex Activity, Coordination/speed, Sensation, Passive joint motion, Joint Pain

Study aim: To compare the effectiveness of muscle energy technique versus kinesiotaping on mobility, pain kinesiophobia in information technology professionals with ergonomic related low back pain. Design: A concealed, randomized, blinded, sham controlled clinical trial with a parallel group design of 30 patients enrolled. Settings and conduct: • The University of Faisalabad • Superior University Faisalabad Campus Participants/Inclusion and exclusion criteria: Both male and female patients of low back pain with the age of 20-40 years was selected after meeting the inclusion and exclusion criteria Intervention groups: 1: muscle energy technique 2: kinesiotaping Main outcome variables: Pain Mobility Kinesiophobia

Study aim: Objectives of current study are to compare effects by Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation on Non-specific Low Back Pain to reduce pain, gain range and overcome disability in female with iliopsoas tightness. Design: Randomised, Parallel, single blinded, Randomised Control Trial. Settings and conduct: Out patient Department of Physical therapy unit in Allied Hospital Faisalabad. Patient was blinded of two different treatment protocols given in separate groups. Participants/Inclusion and exclusion criteria: Female, Aged 20-50, having, Non-specific low back pain for past one month with Thomas test positive having Numeric Pain Rating Scale > 3, Hip Extension Range of Motion >10, Oswestry Disability Index Mild disability (5-34) will be included in study. Patients having carcinomas/tumors, spinal trauma history, anatomical deformities, Open wounds, Severe Osteoporosis, Numeric Pain Rating Scale > 8, Hip Extension Range of Motion > 40 (Hypermobility), Oswestry Disability Index score > 34, Past surgical history of thoracic or lower spine, Infections, Acute Inflammations, Unbearable sharp pain at joints, Wear and tear to soft tissues were excluded from the study Intervention groups: two intervention groups, Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation receiving a baseline treatment of Hot pack and Transcutaneous Electrical Nerve Stimulation to Low Back along with their assigned treatment protocol. Muscle Energy Technique group was treated with Post isometric Relaxation technique on iliopsoas muscle to treat tightness of this muscle, bilaterally. Proprioceptive Neuromuscular Facilitation group received Hold-Relax D1 Flexion-Extension pattern on Iliopsoas muscle bilaterally. Main outcome variables: Pain, Hip extension Range of Motion bilaterally and Oswestry Disability Index

Study aim: The aim of the study was to compare the effect of myofascial release therapy (MFR), and the post-isometric relaxation (PIR) in pain reduction, improving the elbow range of motion (ROM), and strengthening the muscles in the individuals with post-traumatic elbow stiffness. Design: A Randomized clinical trial, blinded with a parallel group design of 34 patients enrolled between March 2024 and May 2024 at Allied Hospital Faisalabad. Settings and conduct: Allied Hospital Faisalabad. Participants/Inclusion and exclusion criteria: Inclusion criteria Age ranging from 15 to 50 years old . • Pain (NPRS score from 3-7). • Stiff elbow . • After 6 weeks of surgery(9). • Restricted ROM: subjects with limited active range of motion A(ROM) . • Both male & female patients. • Participants willing for the enrollment in the study. Exclusion Criteria • Open wound . • ROM not improved after 2nd session . • Acute infection to the elbow region. • Cervical radiculopathy & any other upper limb dysfunction. • Neurological impairments. • Pregnant females . Intervention groups: In Group A, the treatment includes Maitland Mobilization to enhance joint movement, Myofascial Release Therapy to relieve muscle tension and the application of ice to reduce inflammation and pain. In contrast, Group B's approach incorporates Maitland Mobilization as well, but instead of Myofascial Release Therapy, it utilizes Post-Isometric Relaxation to reduce muscle spasms and improve flexibility, followed by ice application. Main outcome variables: Numeric Pain Rating Scale to assess pain, Goniometer for the measurement of range of elbow and Liverpool Elbow Score for functional assessment will be used to collect the data

Study aim: To determine the effect of dialysate temperature on adequacy of hemodialysis Design: A two arm, parallel group, randomized trial to be carried out on minimum 50 patients at a single center. Randomization will be computerized with concealment using opaque envelopes. Settings and conduct: This trial would be conducted at Dialysis Unit of Pak Emirates Military Hospital. Patients would be selected by non-probability convenience sampling. Randomization would be through computer generated sequences and would be concealed in opaque envelopes. Patients would undergo haemodialysis with dialysate temperature at 37.0 or 36.0 degree Celsius. They would be blinded to the treatment strategy. Participants/Inclusion and exclusion criteria: Inclusion criteria: Patients on maintenance haemodialysis for at least 3 months; Use of arteriovenous fistula Exclusion criteria: Acute kidney injury; History of intradialytic hypotension during last one month; Shortening of haemodialysis session for any reason; Interruption in haemodialysis session for more than 5 minutes; Patients known to have central venous stenosis; Uncooperative patients; Lack of consent Intervention groups: Intervention group 1: Dialysate Temperature 37.0 degree Celsius. Patients in this group would have the dialysate temperature set at 37.0 degree Celsius when the machine is being setup for a dialysis session and maintained throughout the 4 hours session. Intervention group 2: Dialysate Temperature 36.0 degree Celsius. Patients in this group would have the dialysate temperature set at 36.0 degree Celsius when the machine is being setup for a dialysis session and maintained throughout the 4 hours session. Ultrafiltration would be done to the usual dry weight. All sessions would be carried out on Fresenius F4008 haemodialysis machines. Main outcome variables: Urea reduction ratios; online Kt/V (as measured by Online Clearance Monitoring)

Study aim: The aim of this study was to investigate the impact of nutritional counselling on the quality of life of patients who have undergone Sleeve Gastrectomy. Design: Randomized Control Trial (RCT) was performed utilized a simple random sampling using lottery method. The study compared the quality of life of post-op patients that have undergone sleeve gastrectomy and who received nutritional counselling with those who did not receive any counselling. Settings and conduct: The study was conducted in the General Surgery Department at Ammar Medical Complex Lahore and had a duration of 6 months. Participants/Inclusion and exclusion criteria: Inclusion criteria: The study's inclusion criteria included male and female patients aged between 18 to 60 years who have undergone bariatric surgery within 6 months, with no prior bariatric surgery, fractures or limb issues, and no coexisting diseases that affect limb function. This criteria helped in reducing confounding variables Exclusion criteria: Patients under the age of 18 or older than 60, those with a history of bariatric surgery that lasted longer than six months, those with limb fractures, pregnant women with a history of bariatric surgery, those taking antidepressants, and those who refused to adhere to the study's protocol were all excluded from the study. These requirements helped to accurately represent the study's target group and to reduce any potential confounding variables that might have had a detrimental impact on the study's findings. Intervention groups: A crucial component of sleeve gastrectomy is nutritional counselling, which assists patients in adjusting to dietary changes and achieving the best possible results in terms of weight loss and health Main outcome variables: effectiveness of nutritional counselling

Study aim: To compare the effects of post isometric relaxation and bruegger’s exercises on pain, Range of motion and disability in patients with mechanical neck pain . Design: It will Single blinded randomized clinical trial with parallel group design. 24 Participants will be allocated to two groups equally by random computer number generator Settings and conduct: It will be conducted at Arif memorial teaching hospital. Outcome assessor will be kept blind. Participants/Inclusion and exclusion criteria: Inclusion criteria: Both male and female patients age ranged from 20-40 years and suffering from Mechanical neck pain for at least three months Exclusion criteria: any orthopedic or neurological condition surgery in the cervical spine or shoulder Patients having Inflammation, malignancy and metabolic disorder will be excluded Patients with neck pain radiating into arms and upper extremity will be excluded from this study Neck pain associated with headache and facial pain, recent surgery, Vertebrobasiliar insufficiency (VBI) positive will be exclusion criteria: History of recent trauma and fractures of cervical spine will be excluded Intervention groups: Group A: Post isometric relaxation: Total 20 sessions will be given to each patient in 4 weeks with 3 sessions per week Group B: Bruegger’s exercise: Total 20 sessions will be given to each patient in 4 weeks with 3 sessions per week Baseline Treatment: Baseline treatment will be given as common treatment to both groups. It include Hot pack for 10-15 minutes Main outcome variables: Pain: Numeric Pain Rating Scale (NPRS) ROM: Universal Goniometer Disability: Neck Disability Index (NDI)

Study aim: To Compare the effects of post isometric relaxation and strain-counterstrain technique on pain, Range of motion and functional activities among individuals with gastrocnemius tightness. Design: Single blinded randomized clinical trial with parallel assignment of 44 participants to two groups equally. Settings and conduct: The study will be conducted at Arif Memorial Teaching Hospital. Outcome assessor will be kept blind. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Participants from age group of 18-40 who present with gastrocnemius tightness. Patients with positive silfverskiold test. Exclusion Criteria: Systemic disease causing musculoskeletal issue. Any other type of connection tissue disorder. With history of neurological disorder. Having recent lower limb or spine fracture causing change in gait pattern. Intervention groups: Group A: Participants of group A received exercise post isometric relaxation exercise, 3 times a week for 4 weeks. Group B: Participants of group B received strain-counterstain technique, 3 times a week for 4 weeks. Main outcome variables: Pain: The intensity of pain will be measured by the numeric pain rating scale [NPRS]. Range of motion: ROM will be measured using a Universal Goniometer. Functional activities: Functional activities will be examined by foot functional index.

Study aim: To compare the opioid-sparing effect of intraoperative intravenous ibuprofen versus placebo in patients undergoing laparoscopic cholecystectomy, in terms of postoperative opioid consumption, pain scores, and requirement for rescue analgesia. Design: A single-center, randomized, placebo-controlled, parallel-group trial with blinded outcome assessment involving 60 patients (30 in each group). Settings and conduct: The study will be conducted in the Department of Anesthesia, National Hospital & Medical Center Lahore. Patients will be randomized into two groups by using the closed envelope method: the ibuprofen group (n = 30) and the control group (n = 30). The randomization will be blinded to all assessors Participants/Inclusion and exclusion criteria: Inclusion Criteria Age 18–65 years ASA physical status I–II Patients scheduled for laparoscopic cholecystectomy Exclusion Criteria Chronic use of NSAIDs or opioids Intraoperative discontinuation of study protocol for any reason Known contraindication or hypersensitivity to study drugs (ibuprofen/tramadol) Intervention groups: Intervention Group 1: The ibuprofen group (n = 30) will receive 400 mg (100 ml) of intravenous ibuprofen over 20 minutes, 20 minutes before extubation. Control Group: The control group (n = 30) will receive 100 ml of normal saline intravenously over 20 minutes, 20 minutes before extubation. Main outcome variables: Total postoperative opioid consumption (tramadol dose in mg) within 24 hours after laparoscopic cholecystectomy. Postoperative pain scores using Visual Analogue Scale (VAS) at 2-hour intervals for up to 12 hours. Time to first rescue analgesia. Requirement for rescue analgesia (yes/no). Total dose of rescue analgesia administered.

Study aim: This study was designed to compare the outcomes of SPG block administered via transmucosal and transcoronoid approaches in patients with autonomic cephalalgia Design: prospective quasi-experimental comparative study Settings and conduct: Department of Pain Medicine, CMH Rawalpindi over a period of six months Participants/Inclusion and exclusion criteria: Inclusion Criteria Patients aged 18–65 years with a clinical diagnosis of trigeminal autonomic cephalalgia were included. Eligible participants were those with inadequate response to at least six months of standard oral pharmacotherapy (including amitriptyline, duloxetine, venlafaxine, pregabalin or gabapentin) and who reported moderate to severe pain intensity (defined as a Numeric Rating Scale - NRS score greater than 6). Only patients without evidence of secondary headache disorders or underlying dental or palatal pathology were enrolled. Exclusion Criteria Individuals with identifiable dental or palatal abnormalities contributing to facial pain, patients with secondary headache etiologies such as intracranial tumors or hemorrhage, patients with structural abnormalities including cleft lip/ palate or nasal septal defects, history of trauma or surgical intervention, patients with significant coagulopathy, hepatic or renal dysfunction, as well as those with a history of malignancy, were excluded from the study. Intervention groups: Group A underwent sphenopalatine ganglion (SPG) block via the transmucosal approach, whereas Group B received the block through fluoroscopy guided transcoronoid approach. Main outcome variables: The primary outcome was the mean change in NRS score from baseline to one month.

Study aim: To compare knowledge outcomes following chatbot-facilitated case-based learning and traditional facilitator-led case-based learning among undergraduate dental students. Design: A single-center concealed, randomized, crossover trial conducted among third-year Bachelor of Dental Surgery (BDS) students between December 2025 and January 2026. Because of the nature of the educational intervention, participants and facilitators were not blinded. A total of 32 students participated in Session 1 and 27 students participated in Session 2. Settings and conduct: Foundation University College of Dentistry, Foundation University Islamabad. Participants/Inclusion and exclusion criteria: Participants 3rd Year Bachelor of Dental Surgery (BDS) students. Inclusion Criteria  Third-year BDS students.  Enrolled in the Oral Pathology course.  Able to understand English.  Provided written informed consent.  Willing to participate in both study sessions. Exclusion Criteria  Declined participation.  Withdrew consent.  Absent during either study session or the corresponding assessments. Intervention groups: Intervention Students participated in chatbot-facilitated case-based learning using a customized GPT-based educational chatbot. Participants were stratified based on their most recent Oral Pathology examination scores and randomized in a 1:1 ratio into two sequences:  Sequence 1: Traditional CBL → Chatbot-CBL  Sequence 2: Chatbot-CBL → Traditional CBL. The study followed a crossover design in which students participated in two CBL sessions conducted two weeks apart to minimize potential carryover effects (Session 1: Soft Tissue Pathology; Session 2: Salivary Gland Pathology). Control Group In both sequences, the traditional CBL served as control group. Main outcome variables: Knowledge outcomes of traditional vs chat-bot CBL.

Study aim: To compare the antihypertensive efficacy of valsartan and Telmisartan in young adults with newly diagnosed essential hypertension by assessing changes in systolic and diastolic blood pressure after 12 weeks of treatment. Design: Single-center, two-arm, parallel-group, randomized controlled superiority trial enrolling 126 participants. Participants will be randomly allocated in a 1:1 ratio to receive valsartan or Telmisartan for 12 weeks. Settings and conduct: This study will be conducted at the Department of Medicine, CMH Rawalpindi. Eligible participants will be randomized to receive Valsartan or Telmisartan and followed for 12 weeks with standardized blood pressure assessments. Participants/Inclusion and exclusion criteria: Inclusion criteria: Adults aged 18–40 years with newly diagnosed essential hypertension who provide informed consent. Exclusion criteria: Secondary hypertension, pregnancy or lactation, severe renal or hepatic disease, hypersensitivity to ARBs, or serious comorbid illness. Intervention groups: Participants will receive valsartan 160 mg orally once daily for 12 weeks, along with standard lifestyle modification advice. Blood pressure will be measured at baseline and scheduled follow-up visits. Main outcome variables: Primary outcome: Change in systolic and diastolic blood pressure (mmHg) from baseline to 12 weeks. Secondary outcome: Proportion of participants achieving target blood pressure (<140/90 mmHg) at 12 weeks.

Study aim: The aim of this study is to evaluate the lipid profile level changes assessed by total serum cholesterol (TC), serum low density lipoproteins (LDLs), serum triglycerides (TGs) and serum high density lipoproteins (HDLs) after six months of levothyroxine therapy in patients with presenting with sub-clinical hypothyroidism. Design: Pragmatic research, quasi experimental study, carried out at the Department of Medicine, Combined Military Hospital, Hyderabad from August 2025 – January 2026 Settings and conduct: After approval from the Institutional Ethical Review Committee, CMH Hyderabad, the study was conducted in the institute, ensuring strict confidentiality and data protection according to institutional and international guidelines. Simple random sampling was used to recruit a total of 90 adult patients aged 18–65 years diagnosed with mild SCH (sub-clinical hypothyroidism) (TSH 4.49–10 mIU/L) or moderate SCH (TSH >10 mIU/L) with normal T3 and T4 levels. They were screened through laboratory-verified thyroid profiles. Participants/Inclusion and exclusion criteria: Inclusion criteria: all patients aged 18-65 years of age diagnosed with sub-clinical hypothyroidism (mild and moderate) as per the WHO definition criteria furnished in the methodology and planned for levothyroxine therapy for six months. Exclusion criteria: patients already on thyroid replacement therapy, Overt hypothyroidism or Hyperthyroidism, Pregnancy or lactation, use of medications significantly known to affect thyroid function or lipid metabolism ( e.g amiodarone, statins) Intervention groups: All patients received the same levothyroxine regimen of 1.6 mcg/kg/day. Main outcome variables: Primary variables studied were mean change in serum lipid levels assessed by total serum cholesterol, serum low density lipoproteins, serum triglycerides and serum high density lipoproteins.

Study aim: To compare the outcomes of intranasal versus intravenous dexmedetomidine for procedural sedation in pediatric patients undergoing MRI. Design: Non Randomized Control Trial Settings and conduct: Setting: Department of Radiology and Imaging Conduct: Data will be collected prospectively after approval of the synopsis, from eligible children aged 1 month–12 years requiring MRI under sedation, following pre-anesthesia assessment and written informed consent. Participants will be consecutively allocated by alternate assignment into Group A (intranasal dexmedetomidine, n=63) and Group B (intravenous dexmedetomidine, n=63). Standard monitoring will be applied, and sedation depth will be assessed every 5 minutes using the University of Michigan Sedation Scale (UMSS), with MRI initiated once UMSS ≥2 is achieved. Sedation onset time, duration, physiological parameters, rescue sedation requirements, and adverse events will be recorded. Failure to achieve adequate sedation within 20 minutes or significant movement during MRI requiring rescue sedation will be considered primary sedation failure Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA: Children aged 1 month to 12 years scheduled for elective MRI. American Society of Anesthesiologists (ASA) physical status I and II. EXCLUSION CRITERIA: Known allergy to dexmedetomidine. Contraindications to dexmedetomidine (cardiac failure, cardiac arrhythmias, long QT syndrome, baseline bradycardia or hypotension, use of beta-blockers or digoxin, uncontrolled arterial hypertension, or recent stroke/intracranial bleeding). For the intranasal group only: children with URTI or nasal blockage within the preceding two weeks, as this alters mucosal drug absorption. Intervention groups: Two Groups. Group A for Intranasal Rout Group B for Intravenous rout Main outcome variables: Onset time Duration Recovery time

Study aim: To determine the effects of clubbell and plyometric exercises on shoulder pain, range of motion and performance in bowlers Design: RANDOMIZED CONTROLLED TRIAL Settings and conduct: 1. Pakistan Sports Board 2. Aleem Dar Cricket Academy 3. Shoaib Akhtar Cricket Academy Participants/Inclusion and

Study aim: The aim of the study is to find the compare the effects of electrical stimulation with and without motor re-learning programme on spasticity and upper limb function in stroke patients Design: Two arm parallel group randomized trial , single blind , of 62 stroke patients Settings and conduct: Sir Ganga Ram Hospital Participants/Inclusion and exclusion criteria: Inclusion criteria was as follows: • Aged between 25-65 years • Both Male and females • Stroke Onset ≥3 months • Ischemia Stroke • Patients with limb spasticity equal to 2 or less than 2 on modified Ashworth scale • Patients with English reading and writing skills Exclusion Criteria: • Patients with visual and auditory defects • Patients with severe shoulder or wrist pain • Patients with upper limb fractures/dislocations • Contraindication to Electrical stimulation such as skin allergy Intervention groups: Both groups will receive electrical stimulation for 15 minutes with hot pack and the Stretching of muscles will be performed at the end. The sessions will be last 60 minutes five days a week for an 8-week period. Electrical stimulation will be used to stimulate flexion and extension of wrist and elbow. In Group A participants will receive electrical stimulation with motor relearning programme which consist of 4 steps as Step 1: Analysis of Task Step 2: Practice of missing component Step 3: Practice of Task Step 4: Transference of training In Group B Electrical stimulation without motor re-learning programme will be given. This protocol will be as including different exercises like Wrist flexion and extension, Finger flexion and extension, Forearm supination and pronation, tapping table top with all fingers, Opening of all fingers and Counting with fingers. These exercises which can be performed for 5-10 repetitions depending on patient's capacity. Main outcome variables: Spasticity Upper limb function neurological function

Study aim: To evaluate the effectiveness of lower limb strength training and aerobic exercises in combination with lifestyle modification on strength, aerobic fitness and quality of life in patients with type II diabetes Design: Parallel group randomized clinical trial and Randomization will be achieved through computer generated random allocation software. Settings and conduct: District Head Quarter (DHQ) teaching Hospital Faisalabad, Tehsil Headquarter Hospital Gojra, AL Barkat Hospital Gojra, Hajra Tufail Hospital, Gojra. Patients and outcome assessor will be blinded. It will be assessor and participant who will be blinded about the type of intervention. Treatment will be given by principal /investigator. Participants/Inclusion and exclusion criteria: Inclusion criteria: Both male and female patients, Age: 40 to 60 years, Patient with diabetes type II diagnosed by physician Exclusion criteria: Unsafe blood pressure, Mental retardation, Any recent surgery (cardiac, musculoskeletal and neurological) ,Fracture ,Limb amputation and joint replacement ,Central nervous system dysfunction (stroke, Parkinson disease) Intervention groups: The intervention group will include lower limb strength training, aerobic exercises, and a lifestyle modification program. Session duration will be 45 minutes, thrice a week, and 24 sessions over 8 weeks. The interventions of the control group will include lower limb strength training, aerobic exercises, and unguided lifestyle instructions. Session duration will be 45 minutes, thrice a week and 24 sessions over 8 weeks. Main outcome variables: Strength, Aerobic fitness, Quality of life

and conduct: Pakistan Institute of Medical Sciences Islamabad. Physiotherapy department. Participants