Objective: Toassesspatients' awareness andattitude towardsintra-articulartherapy.Todetermine the frequency of refusal among patients who were offered intra-articularsteroid injections and to identify the variousreasons for this refusal. Method: This was a cross-sectional study done at the Rheumatology CMH Lahore outpatient clinic from 1st June to 31st July 2022. A total of 204 patients 16 years or above who were potential candidates for intraarticular corticosteroids (IACS) or who had received injections in the past were asked about their knowledge, beliefs, and consent for intra-articular injections as per pre-defined questionnaire. Results: Out of the total 204 patients, 34% refused to get the intra-articular injection. Their major concern was fear of injection, dependence, and only temporary pain relief. Consent was directly correlated with disease severity as determined by pain visual analogue score (VAS) and affected activities of daily living (ADLs), and physician guidance (p=0.001). A negative review from a relative or a personal bad experience leads to rejection of IACS (p=0.001). Those who did not have prior knowledge of IACS, and its response variability agreed more (p=0.01). Conclusion: The patients' fear of dependency, partial effectiveness, and pain were major concerns that lead to the refusal of IACS in almost one-third of the patients. Information gathered from different sources apart from doctors misleads the patients.

Objective: To assess the effectiveness of PRP (Platelet Rich Plasma), and to compare with Triamcinolone 40mg (Steroid) on functional activity, stiffness and pain in Grade I & II Knee OA. Method: A comparative cross sectional study was conducted at outdoor departments of Advanced Pain Relief Center, Lifeline Hospital Lahore (Pakistan) from January 2022 to December 2022. The present study included a total of 235 participants, out of whom 190 individuals were deemed eligible for inclusion based on predetermined criteria. The remaining 45 participants were excluded from the study due to non-adherence to eligibility criteria and lack of approval from institutional ethical committee. Out of a total of 190 subjects enrolled in the study, 64 (33%) were characterized as male while 126 (67%) were classified as female. The participants' mean age was 53.5 ± 6.4 years. Alternative patients were treated with intra-articular injection of either triamcinolone 40mg or PRP. Patients randomized in Steroid group (n=95) were gives intraarticular 40mg Triamcinolone acetate (1ml) along with 2ml of Local anaesthetic Lignocaine 1%, whereas patients randomized in PRP group (n=95) were injected 5ml PRP. “The Western Ontario and McMaster Universities Arthritis Index” (WOMAC) Scale was used for functional disability and pain before and after the therapy for the targeted knee joint at the baseline 1 week, 5 weeks, 8 weeks and 20 weeks follow-ups. Visual Analogue Scale (VAS) scores were also recorded for pain. Data analysis was done by using SPSS version 20. Results: There wasn't any serious adverse effect observed during the study and follow-ups. 25 WOMAC functional activity scale showed statistically significant improvement with Intraarticular knee injection of PRP compared to steroids(40.64±1.87vs.27.17±6.01)(p=0.000). WOMACpainscaleresultsalsodemonstrated that intraarticular knee injection of PRP was more effective in reducing knee pain than steroids (p = 0.000) at 20 weeks follow-up. Conclusion: On the basis of the results of our study, we concluded that platelet rich plasma is more effective than intra-articular steroids in terms of improvement in functional activity and reduction of pain in patients with Grade I & II knee osteoarthritis. Both PRPand steroid intraarticular injections are safe.

Objective: To show case the early appearance of anti-TPO antibodies, before the onset of thyroid hormone disruption. Methods: It was a cross-sectional study in which 227 antenatal women who were euthyroid (normal free T4 and free T3 levels) were included and their Anti-TPO antibodies were analysed and recorded. Results: The mean age of the pregnant females was 25.67 + 4.531 years and the mean gestational age was 25.18 + 9.214 weeks. Among 227 pregnant females, 97.8% had anti TPO antibodies levels in the 0-30IU/ml range while only 2.2% had >30IU/ml. The mean anti TPO level among pregnant females was 7.020 + 4.004IU/ml. There was significant association (p<0.05) between trimesters and anti TPO Ab level while insignificant association (p>0.05) of anti TPO Ab with gravidity, parity and abortion. Conclusion: Study concluded that adding anti-TPO antibodies together with markers of thyroid function such as TSH, FT4 and FT3 is not cost effective in identifying pregnant females who might develop thyroid dysfunction and associated pregnancy loss, preterm birth. The prevalence of Anti TPO Ab in euthyroid pregnant females in our study was only 2.2%.

Objectives: To compare the characteristics of methotrexate-tolerant and intolerant patients having rheumatoid arthritis. To determine the association of methotrexate intolerance with the patient and disease-related factors. Method: This cross-sectional study was carried out at the rheumatology department of Combined Military Hospital Lahore from 31st April to 30th June 2022. It included 181 rheumatoid arthritis (RA) patients using methotrexate (MTX) for > 3 months. Patient demographic variables, disease duration and activity, and information regarding MTX intake were recorded. English methotrexate intolerance severity score (MISS) questionnaire was used to calculate MTX intolerance. Different variables were compared between methotrexate-tolerant and intolerant patients. Association of age, disease duration, and activity, MTX route/dose with MTX intolerance was determined. Results: The majority of patients were females 140(77%). The median disease duration was 6(1-40) years. MTX intolerance was found in 48(26.5%) of RA patients. Intolerant patients had a higher disease activity score (DAS 28>5.1 in 20.8 vs 3.8%; P = 0.002) and longer duration of MTX intake in months (23.5 vs 12; p=0.018) compared to tolerant patients. Additionally, MTX intolerance was associated with younger age, longer disease duration and higher MTX dose>10mg/wk (P=0.007, P=0.025, P=0.050). There was no significant difference between the two groups in gender, marital status, education, and use of other DMARDs or steroids. (P >0.05). Conclusion: There was a significant association between age, disease duration, and MTX dose with MTX intolerance. We also noted a significant association between disease activity and route of intake with MTX intolerance but this was lost when adjusted for multiple confounders.

Objective: To compare the efficacy of medical termination versus manual vacuum aspiration in firsttrimester miscarriage. Method: This was a quasi-experimental study done at Department of Obstetrics and Gynaecology Services, Institute of Medical Sciences Lahore from January to September 2018. Women who chose medical termination were offered 600 micrograms of misoprostol given sublingually and dose repeated after 3 hours. Patients were chosen manual vacuum aspiration and were explained the method, informed consent was taken, and MVA was performed after cervical ripening. A designed proforma was filled in terms of pain score, amount of blood loss, and general symptoms like fever and diarrhoea. Results: Of all women who were enrolled in the study were 408. Out of the medical termination was chosen by 228(56%) and manual vacuum aspiration was selected by 180(44%). For those patients who chose medical termination, the majority of them had fear of intervention i.e., almost 77% followed by a fear of infection after surgical intervention (62%). Patient with medical termination experienced more pain and increase blood loss as compared to MVA(p<0.05). Conclusion: MVA is a safe and effective method for early pregnancy termination as compared to medical termination

Objective: The time of eruption of wisdom tooth predicts the age of the person. Material and Methods: Study holds a comparative analysis of 293 students regarding wisdom tooth eruption status was categorized into fully erupted, partially erupted, un-erupted or surgically maneuvered. Statistical analysis, including descriptive statistics and correlation analysis, was performed to establish relationships between age and eruption status. Results: Preliminary findings suggest a statistically insignificant relationship between the age of the students and the eruption status of their wisdom teeth. The majority of students aged 19-23 years exhibited various stages of wisdom tooth eruption. Discussion: The results suggestion indicate that there is a discernible correlation between the age of individuals (within the age group of 19-23 years) and the eruption status of their wisdom teeth. Conclusion: Estimation of age based on the eruption time of wisdom teeth holds promise as a non-invasive and easily accessible method. Within the specific age range of 19-23 years the wisdom tooth is inconclusive.