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, Thoracic angle, Vestibular ocular reflex, 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 300-500 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 study aims to see the effect of sodium bicarbonate supplementation on the nutritional status of patients on maintenance hemodialysis Design: Single-centre, randomized clinical trial Settings and conduct: This single-center clinical trial will be conducted at the Pak Emirates Military Hospital (Dialysis Unit). Patients will be randomized to either a control or study group after consent. Hand grip strength, and triceps skinfold thickness along with serum bicarbonate, albumin, creatinine, and hemoglobin will be noted at baseline, 2, 4, 6 and 12 weeks.. Participants/Inclusion and exclusion criteria: Individuals from either gender who were > 18 years of age on twice weekly maintenance hemodialysis for more than 6 months, able to comply with study instructions, and having serum bicarbonate levels ≤23mmol/L were included in the study. Individuals having an active infection, unstable heart disease, congestive heart failure, limb amputation and renal tubular acidosis were excluded from the study. Moreover, patients on bisphosphonate therapy, and calcium or sodium bicarbonate therapy were also excluded. Intervention groups: The participants were divided into 2 groups. The control group was not given any medication while the Study group was given tablet Sodium Bicarbonate 600mg three times a day orally. Main outcome variables: Changes in hand grip strength, triceps skinfold thickness, serum bicarbonate, serum albumin, and hemoglobin will be noted.

Study aim: To compare the efficacy of pregabalin and sertraline in treating uremic pruritus Design: Randomized clinical trial Settings and conduct: This single-center clinical trial would be conducted at the Pak Emirates Military Hospital (Dialysis Unit). All patients to provide consent. Patients to be randomized to receive either Pregabalin or Sertraline. Urdu version of the 5-D Itch Scale would be self-administered to assess severity of itching at baseline, and at 6 weeks post commencement of treatment. Participants/Inclusion and exclusion criteria: Patients of both genders having age ≥19 years, on twice weekly HD for ESRD for at least six months, and having UP for at least six weeks, were included in this study. Exclusion criteria included dermatological or systemic diseases associated with pruritis, mental health issues affecting the ability to respond to the 5-D Itch Scale, and patients on a thrice-a-week HD schedule. Moreover, individuals already on some treatment for UP were generally excluded, except for patients on oral anti-histamines, for whom there was a washout period of two weeks before participation in this study Intervention groups: The Pregabalin group would be given Pregabalin 75mg once a day orlly, while Sertraline Group would be given sertraline 50mg once a day orally. Main outcome variables: Change in the severity of pruritus after six weeks of intervention.

Study aim: To Compare Efficacy of Intravenous versus Intramuscular Meglumine Antimoniate in Treatment of Cutaneous Leishmaniasis Design: Clinical trial which is parallel group, double blind, randomized, phase 3 trial. Settings and conduct: Dermatology Department, CMH Quetta Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA: Patients with biopsy proven cutaneous leishmaniasis and fulfilling the criteria for parenteral treatment with injection meglumine antimoniate. EXCLUSION CRITERIA: Patients of cutaneous leishmaniasis allergic to antimonial ,having comorbidities (diabetes, hypertension,chronic liver disease,chronic kidney disease, ),baseline ECG abnormality/heart disease,pregnant and breastfeeding women. Intervention groups: Intervention group A: Patients were given drug via Intravenous route. The drug should be given diluted in 50–200 ml of 5% glucose solution over 30–60 minutes in ICU/HDU with cardiac monitoring. Intervention group B: Patients were given drug via Intramuscular route. 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 Response

Study aim: Aim of the study to determined exercises management for pain and forward head posture in patient with cervical spondylosis Design: Randomized control trail study Settings and conduct: The current study carried out in WAPDA teaching hospital in physical therapy department Participants/Inclusion and exclusion criteria: The inclusion criteria of study includes both male and female, aged 40-60 year, no pervious history of trauma, surgery and diagnosed patients by orthopedic, pain is not more than 8 at VAS. Pregnant women, Pain is more than 8 at VAS, history of previous cervical surgery, vertebral compression fracture, history of malignancy, rheumatoid disorder and other systemic problems were excluded. Intervention groups: Group A or Interventional group will received cervical isometric and postural corrected exercises with shoulder dynamics exercises 4 session per week for 6 week. GROUP B or Control group will received cervical isometric and postural corrected exercises 4 session per week for 6 week. Main outcome variables: Pain and forehead posture

Study aim: To check the effects of knee and hip muscles strengthening and stretching exercises in patellofemoral pain syndrome Design: Experimental Settings and conduct: District Head Quarter Hospital Study will be conduct in Orthopedic department Participants/Inclusion and exclusion criteria: inclusion criteria : sedentary females with age of 21-50 Exclusion Criteria: Female who are pregnant or suffering with neurological disorders or any surgery of effected limb Intervention groups: Group A will receive knee and hip muscle strengthening exercises Group B will receive knee and hip muscle stretching exercises Main outcome variables: pain Functional status

Study aim: To evaluate and compare the effects of muscle energy techniques (post isometric relaxation and reciprocal inhibition) to improve hamstring flexibility, anterior pelvic tilt, functional status and pain with knee osteoarthritis Design: Single Blinded Randomized Clinical Trial Settings and conduct: District Head Quarter (DHQ) hospital Allied hospital Madinah teaching hospital Participants/Inclusion and exclusion criteria: Inclusion criteria: Age : 45-60 years old Gender: Both Pain : mild to moderate osteoarthritis: grade II and III Womac (The Western Ontario and McMaster Universities Arthritis Index) scoring: 65-75 Active knee extension test: 15-20 degree. Exclusion criteria: Patients with low back issue Patients with previous history of infection, trauma, implant and surgery of affected limb Intervention groups: Group A ( Post isometric relaxation) Group B ( Reciprocal Inhibition) Main outcome variables: Hamstring flexibility - Anterior pelvic tilt - Functional status - Pain

Study aim: Prevention of preeclampsia by taking vitamin D supplements Design: Two-arm parallel group randomised trial with blinding Settings and conduct: Gynecology department unit III of Nishtar Hospital, Multan Participants/Inclusion and exclusion criteria: Patients who presented at the outpatient department of the hospital for prenatal care and had a previous history of preeclampsia during a previous pregnancy were included. Patients with renal insufficiency, cardiac disease, and hypertension before pregnancy, lack of confidence in cooperation, immunological disease and leaving during study were excluded Intervention groups: In the intervention group, patients were given 50000 IU capsules of vitamin D3 once every 2 weeks. Main outcome variables: Occurrence of Preeclampsia Type of delivery Abortion rate

Study aim: To compare the efficacy of Aripiprazole versus Risperidone augmentation of SSRIs for in the treatment of resistant OCD. Design: Two arm parallel group randomised trial, single blinded Settings and conduct: Lahore general hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria:  Patients of age 16-65 years of either gender  Patients diagnosed with obsessive compulsive disorder (as per operational definition) with Y-BOCS score ≥16. Exclusion Criteria:  Pregnant females.  Patient allergic to trial drugs.  Patient having an organic cause for their symptoms.  Patient with comorbid conditions that aggravate the condition or develop depression and anxiety. Intervention groups: In group A, patients will be given Aripiprazole started with a 2.5 mg daily dose and will be gradually increased to 10 mg daily by the end of the second week. In group B, Risperidone initiated with a 1 mg daily dose and was gradually increased to 2 mg daily by the end of the second week. Main outcome variables: Y-BOCS SCORE

Study aim: To determine the effect of vitamin D supplementation on serum total cholesterol, triglycerides, low density lipoproteins and high density lipoproteins among patients with metabolic syndrome Design: Two arm parallel group randomized trial without any blinding in outcome assessment. Randomization sequences would be generated online and concealed using opaque envelopes. There will be a minimum of 74 patients, equally divided into the two groups. Settings and conduct: This trial would be done in the outdoor medical clinic of Pak Emirate Military Hospital. Patients would be selected by non-convenience probability sampling technique and included in the study subject to provision of consent. They would be randomized into two groups using computer generated sequences. Allocation concealment would be done using opaque envelopes. Patients in the intervention arm would receive a single dose of oral Vitamin D as stated above, in addition to usual care. Those in the control arm would receive the usual standard care only. Participants/Inclusion and exclusion criteria: Inclusion criteria: Patients satisfying National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome Exclusion criteria: Current use of lipid lowering drugs Use of vitamin D supplements in the last 6 months Hypothyroidism Pregnancy Chronic kidney disease stages 3- 5 Cholestasis Nephrotic syndrome Intervention groups: Patients would be given two doses of oral Vitamin D 200000 IU to be taken orally at weeks 0 and 4, in addition to usual medications. Patients in the control group would not be given Vitamin D supplements. They would just receive their usual medications Main outcome variables: Changes in serum total cholesterol, triglycerides, high density lipoproteins and low density lipoproteins levels

Study aim: Primary Objective: To evaluate the effects of arm crank exercises on Dyspnea, Left Ventricular Ejection Fraction and exercise capacity in patients with angioplasty. Secondary Objective: To evaluate the effects of arm crank exercises on hemodynamic parameters (heart rate and blood pressure) Design: Randomized Controlled Trial Settings and conduct: Cheema Hospital Gujranwala Participants/Inclusion and exclusion criteria: Inclusion Criteria:  Patients having planned angioplasty  Both male and female patients  Post extubation  Signed written informed consent  Age 40-60years(15) Exclusion Criteria:  PCI to nonnative vessel  Implantation of >3 stents  Evidence of thrombus  Presence of infection  Ejection fraction <30%(16) Intervention groups: Group A: Patients will be treated by standard angioplasty medical protocol. Group B: Patients will be treated by using arm ergometer. Main outcome variables: Dyspnea Left Ventricular Ejection Fraction Exercise capacity Hemodynamic parameters (heart rate and blood pressure)

Study aim: The aim of this study is to find the potential benefits of these exercises in promoting overall physical health and functional recovery in individuals who have experienced a stroke. Design: Randomized Clinical Trial Settings and conduct: Tariq Hospital Lahore Participants/Inclusion and exclusion criteria: Inclusion Criteria • Age between 35-55 years • Both male and female gender • History of Ischemic Stroke • Patient with Hemiplegia • Patient 6 months after stroke consider chronic • Berg balance scale value greater than 45 • Hemodynamically stable • Stable medical and Musculoskelton condition allowing physical activity Exclusion Criteria • Stroke patient with flaccid paralysis • Cognitive Impairment • Patient with cardiothoracic surgery • Uncontrolled hypertension • Sever joints disease such as OA, RA and Gout. • Any other neurological disease • Chronic pulmonary disease like COPD Intervention groups: Group A: Experimental Group will receive Calisthenics Exercises. Group B: Experiment Group will receive Circuit Tanning.. Main outcome variables: Cardiorespiratory Fitness Chest Expansion Pulmonary Functions

Study aim: The previous literature shows lack of studies specifically comparing the effects of routine physiotherapy with and without FDM on pain, functional disability, and ROM in patients with CLBP. Understanding the effects of routine physiotherapy with and without FDM on pain, functional disability, and ROM in patients with CLBP can provide valuable insights into the effectiveness of these interventions and guide evidence-based clinical decision-making. The findings of this study may have implications for the development of more effective treatment protocols for chronic low back pain. Design: Parallel study with conveniet sampling technique . It is a Randomized Control Trial with single blinding of group division. Data will be collected for 6-9 months after approval Settings and conduct: Data will be collected from DHQ hospital Muzaffargarh Participants/Inclusion and exclusion criteria: Inclusion criteria: low back pain of more than 3 months; age 30-65 years old; both male and female. Exclusion criteria: low back pain associated with any structural deformity e.g scoliosis; osteoporosis; spinal fracture; LBP with Radicular symptoms; cauda equina syndrome. Intervention groups: Fascial distortion model will be implied as Intervention group. There will be a three-week treatment plan with total 6 sessions each group that can be divided into baseline, first week second week and third week, comparing the two interventions. Main outcome variables: Pain

Study aim: The purpose of the current study will be to assess the impact of cervical traction and MST on pain, functional disability and grip strength in subjects suffering from cervical radiculopathy. Design: It is a randomized controlled trial with double blinding of subjects. Data will be collected for 6-9 months after approval Settings and conduct: Data will be collected from Physical therapy department of Ibn e siena Hospital, Multan Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA Both male and female individuals aged 30-50 years, Individuals with upper-limb pain that had been radiating from their neck for more than three weeks, The clinical prediction rule will be used to diagnose the participants which includes four elements out of which, presence of three elements confirm Cervical Radiculopathy diagnosis. EXCLUSION CRITERIA History of previous cervical or thoracic spine injury, Recent fracture or surgery in and around the shoulder, Any systemic disease, Any comorbid factors, Pregnancy Intervention groups: Patients will be randomly allocated to two groups Patients in both groups will receive conventional therapy. Group A will be treated with cervical traction. Group B will be treated with Myokinetic Stretching technique, which consists of active and passive stretches with myofascial release (MFR) Main outcome variables: Pain and functional disability

Study aim: The objective of this study is to compare the differences in postoperative complication, surgical procedure length, duration of hospitalization, duration of return to work and relapse frequency between the enhanced view totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches for inguinal hernia repairs. Design: Randomized control trial, non blinded, with parallel group design of 50 patient for suspected period of 6 months after approval of RCT. Settings and conduct: This study was conducted in Sheikh Zayed Hospital Rahim Yar khan. The study was not blinded. The patient were told about the surgery. The surgery was done after informed written consent. Participants/Inclusion and exclusion criteria: Patient with age 15 and 60 year of any gender were included. Patient with reducible inguinal hernia were included. Patient having previous history of mildline surgery and with recurrent inguinal hernia were excluded. Patient with strangulated and obstructed hernia were excluded. Intervention groups: Two groups wer made. In one group A patients were undergone trans abdominal preperitoneal hernia repair (TAPP) and in group B total extraperitoneal hernia repair (e-TEP) was done after informed written consent. Main outcome variables: Postoperative complication, Surgical procedure length, Duration of hospitalization, Duration of return to work and relapse frequency

Study aim: To compare the immediate effects of Muscle energy technique (post isometric relaxation) and primal reflex release technique in hamstring tightness. To check the improvement in ROM, pain and flexibility in hamstrings in the people suffering from hamstring tightness Design: Randomized, superiority, paralell group trial, single blinded. randomised was done through lottery method. Settings and conduct: the trial was conducted in The University of Faisalabad. it was single blinded trial and only participants were blinded. Participants/Inclusion and exclusion criteria: inclusion criteria: 1- Age group between 17 to 25 years healthy subjects (females). 2- Should have long sitting in daily routine 3- NPRS scale 3 or more. 4- Sit and reach score below 19 exclusion criteria: 1- history of lower extremity injury in past 3 month 2- motor neuron lesions 3- pregnancy 4- open wounds 5- systemic illness history Intervention groups: Subjects were randomly allocated in two groups by using lottery ticket method. Pre values were recorded before the session. Moist hot pack will be used as baseline treatment. Group A received Muscle Energy Technique and group B received Primal Reflex Release Technique. Post values were recorded after the session Main outcome variables: • Rom • Pain • Flexibility of hamstrings

Study aim: To compare the effects of post isometric relaxation and active release technique on calf muscles tightness in young females. Design: A Randomized Clinical Trial with two parallel groups, a single- blinded study of third phase with 15 patients in group, which is 30 in total. Settings and conduct: Subjects were randomly selected from outdoor Patient Department OPD and following clinical setup. Allied Hospital Faisalabad. Patients were kept unaware about which group they allocated. Participants/Inclusion and exclusion criteria: • Age group 20-40 • Had symptoms of pain, tightness and functional loss. • Patient with calf pain VAS moderate(4-7) • Lower extremity functional scale functional disability due to calf tightness • Weight bearing wall lunge test positive in patients • Ankle fracture. • Pregnancy. • Deep Vein Thrombosis. • Medication like cholesterol lowering drugs. • Compartment syndrome. • Radiating pain. • Sports related injury Intervention groups: Group A of Muscle Energy Technique Group B Active Release Technique Main outcome variables: 1. Pain 2. Ankle Range Of Motion 3. Functional Disability

Study aim: To decrease the patient load in the resource limited setups by decreasing the mean hospital stay of the patients admitted with TTN. Design: Randomized, Concealed, doub;e blinded study Settings and conduct: being conducted in CMH Bahawalpur. it was blinded by the study designer, consultant pediatrician Participants/Inclusion and exclusion criteria: Inclusion criteria: Inclusion criteria included all full term and late preterm infants diagnosed with Transient tachypnea of newborn of both sex born via either caesarian section and spontaneous vaginal delivery. Exclusion criteria: Exclusion criteria included. Patients of respiratory distress but not under umbrella of Transient tachypnea of newborn. Diagnosis was made on the basis of detailed examination, CXR, blood glucose levels, Complete blood count and C-reactive protein. Patients of the Diseases that were excluded were the cases of Meconium aspiration (Cord and skin stained with meconium , Chest x-rays showing lung opacities and hyperinflation of lungs), Pneumonia (consolidations), Neonatal Respiratory Distress Syndrome(NRDS) (Air bronchograms on CXR), , Neonatal Sepsis(early onset) (positive C reactive protein), Hypoglycemia (BSR less than 54mg/dl respectively), Polycythemia(Hematocrit greater than 60%), Heart Murmur ( via auscultation ) and Tachycardia (heart rate greater than 180/min). Intervention groups: I/V furosemide was given. Main outcome variables: to try to decrease the mean hospital stay of the patients admitted with TTN.

Study aim: The study will be conducted to investigate the best technique in increasing flexibility in post burn contractures in elbow joint Design: This study will be a Randomized clinical trial with a sample size of 60 burn patients with contractures who had decreased muscle flexibility as a result of partial thickness burn. Data will be selected through convenient sampling from the Burn Unit Ward of Allied Hospital, Faisalabad. However, Informed consent will be taken from participants. Palpation, Visual analogue scale and goniometer will be used for pre and post-assessment. Sixty patients will be divided into two groups, thirty in each group. Group (1): received Muscle Energy Technique (MET), Group (2): received 20 sec of static stretching exercise. Measurements of elbow extension range of motion were conducted before treatment, post 5 days of treatment, and after 8 days of treatment. Settings and conduct: Burn Unit Ward of Allied Hospital, Faisalabad Participants/Inclusion and exclusion criteria: Inclusion criteria: Age 20-50 years Gender (both) 2nd degree deep and 3rd degree burns in elbow Patients with unilateral tight elbow flexors Superficial skin grafted individual Subjects not involved in any exercise activity at the start of the study Exclusion criteria: history of serious pathology (e.g. malignancy, inflammatory disorder, infection) history of cervical radiculopathy hand deformities fractured or dislocated elbow Intervention groups: Sixty patients will be divided into two groups, thirty in each group. Group (1): received Muscle Energy Technique (MET), Group (2): received 20 sec of static stretching exercise. Main outcome variables: Pain; Range of motion

Study aim: Assessing the comparative effect of integrated neuromuscular inhibition technique and percussive massage with stretching on pain, function and balance of patients with plantar fasciitis. Design: Randomized clinical trial Settings and conduct: THQ hospital Jaranwala and Khidmat e Insani hospital Jaranwala Participants/Inclusion and exclusion criteria: Inclusion: Age of 25 to 40 Y, Heel pain untreated for less than 6 months, Subjects with plantar fasciitis diagnosed by Windlass test, Pain on medial tubercle of calcaneus. Exclusion: Recent lower limb fractures and arthrosis, congenital deformity of foot, ankle sprain, calcaneal spurs on medial side of calcaneum, fibromyalgia syndrome, Rheumatoid arthritis, pregnant and tarsal tunnel syndrome Intervention groups: Group A will receive Percussive Massage with Stretching Group B will receive Integrated Neuromuscular Inhibition Technique Main outcome variables: Pain (Numeric Pain Rate Scale) Lower extremity dynamic balance (Star Excursion Balance Test (SEBT)) Lower limb disability (Foot and Ankle Disability Index)

, Pakistan Allied Hospital, Faisalabad, Punjab, Pakistan Hospitals mentioned above are the settings used to

Study aim: The aim of the study is to add in the evidence of physical therapy protocols after the surgical procedure of Total Hip Arthroplasty. Design: Randomized controlled trial, single-centered, concealed, two arm parallel group of 82 patients, with blinded outcome assessment Settings and conduct: Settings- Mayo Hospital Lahore (Orthopedics and Physiotherapy Department ) Blinded outcome assessor Participants/Inclusion and exclusion criteria: Inclusion Criteria Age 30 to 60 years, Total hip arthroplasty, 1 to 16 weeks after THA, Able to understand instructions, Willing to come for all follow-ups, Exclusion Criteria Tumor / cancer, Total knee replacement, Revision arthroplasty surgery, Any underlying terminal disease, Suspicion of infection following joint replacement, Intervention groups: Group A will receive Functional Exercise Protocol Group B will receive Conventional Exercises Protocol Main outcome variables: Pain, stiffness, physical functioning, Health related quality of life,

Study aim: To determine the effects of proprioceptive neuromuscular facilitation, mime therapy and sensory exercises on facial symmetry and function in patients with Bell’s Palsy. Design: randomized controlled trial Settings and conduct: Setting: Pediatric Physical Therapy and Neuro Rehabilitation Centre, University of Lahore Teaching Hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria: • Age range of 20-45 years • Both the genders • Acute cases Bell’s palsy (1-3 weeks) (Mishra & Sayed, 2021) Exclusion Criteria: • Dental metal prosthesis • Participants with cognitive disorders (Mishra & Sayed, 2021) • Subject along with surgery for ear & facial nerve palsy (Bhagat & Kakkad, 2021) Intervention groups: Group A: PNF • In the treatment session EMS will be applied for 10 minutes, PNF will be applied for 15 minutes along with stretching and strengthening exercises will be performed for 10 minutes Group B: PNF, Mime Therapy and Sensory Exercises • In the treatment session EMS will be applied for 10 minutes, PNF will be applied for 15 minutes along with stretching, Mime therapy will be applied for 10 minutes and sensory exercises will be performed with 5 repetitions each for 10 minutes 3 sessions of 40 minutes will be given to the patient per week for 18 weeks (1.5 months) Main outcome variables: Bell’s Palsy: Bell’s Palsy is a lower motor neuron lesion, the facial symmetry is assessed by Sunnybrooke Facial Grading System. Facial Function: The Facial Clinimetric Evaluation Scale (FaCE) is a validated patient-based facial grading instrument developed in 2001.

Study aim: To evaluate whether topical application tranexamic acid is effective in reducing post-surgical ooze/drain after supraomohyoid neck dissection for oral, head and neck cancer surgeries, thus reducing the length of hospital stay and complications like infection. Design: Two arm parallel group randomized trial with double blinding.Simple randomisation using a randomisation table created by computer software with allocation using concealed envelopes. A sample size of 44 with 22 in the control group and 22 in the study/intervention group at a tertiary care hospital. Settings and conduct: Tertiary care hospital of CMH (Combined Military Hospital) Lahore and CMH Lahore Medical College and Institute of Dentistry Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients 18 years of age or older, and who agree to participate willing undergoing supraomohyoid neck dissection due to oral, head and neck cancers. Exclusion Criteria: Patients who have a history of hypersensitivity or any adverse reaction to tranexamic acid. Patients having thromboembolic events in the past or any related disorder like DVT, bleeding disorders, who have contraindications to TXA, on anticoagulant or antiplatelet therapy. Patients who do not consent. Intervention groups: The intervention group will get topical tranexamic acid (20ml at 25mg/ml) sprayed over the surgical site of neck dissection, after hemostasis has been achieved. Followed by neck drain placement and neck closure in 2 layers. Control group will not receive this topical tranexamic acid, and neck shall be closed in 2 layers after placement of neck drain. Main outcome variables: Post-operative drainage for the first 24 hrs., first 5 days and the day of removal of drain are the primary outcomes. Whereas the secondary outcomes are surgical site infection (grade of infection), hematoma formation, flap necrosis for neck dissection complications.

: Data will be collected from District Headquarter hospital ,Toba Tek Singh, Pakistan. Participants