Background: Renal failure affects about 1.1 million people worldwide, and the number is growing at a frequency of 7% each year. Anemia is a prevalent complication of chronic renal disease, which is linked to a high rate of morbidity. Objective: To assess the impact of haemodialysis on haematological parameters in patients with chronic kidney failure Methodology: This study design was cross-sectional, carried out at the Institute of Kidney Disease, Hayatabad Medical Complex, Peshawar for a period of six months from July 2021 to December 2021. Totally, 160 chronic kidney failure patients were included in the current research work. All the blood samples taken were analyzed by using automatic hematology analyzer (Sysmex XE-21 analyzers) for complete blood count. Data analysis was carried out by using IBM SPSS version 24. Results: Based on the stages of anemia, amongst 160 patients, 17 (10.63%) patients were normal whereas the mild, moderate and severe anemia was observed in 64 (40%), 72 (45%) and 7 (4.68%) patients respectively. In comparison to pre-dialysis, significant increase was observed in RBC, RDW HB, MCHC and HCT after post-dialysis whereas significant decrease in TLC, MCV and non-significant decrease in Platelets was observed after post-dialysis in chronic kidney failure patients. Conclusion: Our study concludes that haematological parameters are significantly affected by the hemodialysis. For hemodialysis patients, hemoglobin is an important risk factor. Our study recommends that all the patients should be screened for hematological parameters before hemodialysis Keywords: Haemodialysis; Haematological parameters; chronic kidney failure

Toxoplasmosis and Brucellosis are zoonotic infections having worldwide distribution. Toxoplasma gondii and Brucella species are the causative agents of these infections. The human can be infected by contact with infected animals. These infections affect the reproductive system of humans and animals. The study aimed to determine the prevalence of Toxoplasma gondii and Brucella species in infertile women of District Dir Lower. A cross-sectional study was conducted in General Hospital and Maternity Home District Dir Lower and a total of 576 infertile women were screened for the detection of Toxoplasma gondii and Brucella antibodies. ICT method was used for the detection of Anti-T. gondii and the detection of Brucella antibodies, the serum agglutination method was used. The overall prevalence of T.gondii was 11.3% (IgG=10.6% and IgM=0.7%), Brucella Abortus was 14.5% and the prevalence of Brucella Melitensis was 15.1%. The highest prevalence of T.gondii was observed among the age group 26-34 years while the lowest prevalence was observed among the age group 15-25 years. The highest prevalence of Brucella species was observed among the age group 35-45 years and the lowest prevalence was observed among the age group 15-25 years, and the prevalence of Brucella species was higher than T. gondii.

Introduction: Diabetes is common in Pakistan, with prevalence rates ranged from 7.6 -11%. Diabetics especially type 2 diabetes mellitus have a much higher odds of being vitamin d deficient. Objective: To compare mean decrease in glycated hemoglobin in vitamin D supplementation with placebo in the treatment of type I diabetes mellitus Methodology: This study design was randomized controlled trial carried out at the medicine department Lady Reading Hospital Peshawar for duration of six months after synopsis approval from July 2021 to December 2021. Sixty patients were included in our study. Patients in group A were subjected to routine diabetes therapy plus vitamin D supplementation in a dose of 600000 units per oral every two weeks for 3 months and patients in group B were subjected to only routine diabetes therapy. Data was entered and analyzed by statistical package for social sciences (SPSS) version 20. Results: Base line HbA1C Level among Group A patients was analyzed as Mean was 9.27 and Std. Deviation was 1.58 whereas in group B subjects, the mean HbA1C Level was 9.28 and Std. Deviation was 1.59. Post HbA1C Level in Group A patients was analyzed as Mean was 7.29 and Std. Deviation was 1.40 whereas in group B subjects, the post mean HbA1C Level was 7.51 and Std. Deviation was 1.73 Conclusion: Our study concludes that supplementation of Vitamin D could improve Vitamin D level in blood but have no significant association with the reduction of HbA1c level in patients with Type II diabetes mellitus. Keywords: Glycated hemoglobin; Vitamin D supplementation, Type II diabetes mellitus

Introduction: Chronic liver disease (CLD) is the major cause of morbidity and rate of death across the globe. Chronic liver diseases lead to many complications like cirrhosis, endocrines disorders, cardiac disorders, hepatorenal syndromes and metabolic disorders. Objective: To determine the frequency of thrombocytopenia in patients with chronic liver disease at Tertiary care hospital Peshawar Methodology: This Descriptive Cross sectional Study was carried out at the Medicine Department of Hayatabad Medical Complex, Peshawar for duration of six months from June 2020 to December 2021. A total of 189 patients were observed to determine the frequency of thrombocytopenia in patients with chronic liver disease. All the data was analyzed statistically by using SPSS version 23. Results: Among 189 patients males were 134(70.9%) and females were 55(29.1%). In our study, thrombocytopenia was observed in 116(61.4%) patients while it was not observed in 73(38.6%) patients. Conclusion: Our study concludes that thrombocytopenia is frequently present in chronic liver disease patients. In individuals with chronic liver disease, severe thrombocytopenia raises the risk of bleeding and may often complicate or delay therapeutic management. Keywords: Thrombocytopenia, Chronic liver disease, Morbidity

Background: A persistent and chronic illness called dementia is associated with cognitive decline, changes in personality, poor thinking, and problems with executive function. Various studies linked vitamin B12 deficiency with the dementia in elderly patients. Objective: To find out the frequency of vitamin B12 deficiency amongst elderly patients presenting with dementia Methodology: The current study was descriptive cross-sectional carried out at the Medicine Department, Fauji Foundation Hospital, Peshawar Cantt for duration of six months from January 2022 to June 2022. All the data like age, sex and other relevant information were recorded in the pre-designed Performa. IBM SPSS version 23 was used for the statistical analysis of the data. Results: In the current study, totally 250 patients were enrolled. There were 188 (75.2%) males and 62 (24.8%) females with the mean (±SD) age of 81 (±2.99) years. Vitamin B12 deficiency was observed amongst 95 (38%) patients while it was not observed amongst 155 (62%) patients. Based on the stratification of vitamin B12 level in serum with the age and gender, no significant association was observed (p˃0.05). Conclusion: In the current study we observed that the frequency of vitamin B 12 deficiency in elder patients with dementia was 38%. Other studies in multiple centers with large number of dementia should be carried out to get better results. Key words: Vitamin B12 deficiency; Elderly patients; Dementia

Background: Diabetic ketoacidosis (DKA) is a life-threatening diabetic condition characterized by metabolic and homeostatic disturbances. KDA is a common condition in people with diabetes, especially in children and adolescents Objective: To compare ringer’s lactate versus 0.9% normal saline solution in the management of diabetic ketoacidosis Methodology: The study design was randomized control trial carried out at the Medical ‘A’ ward Khyber teaching hospital (KTH) Peshawar for a period of six months after synopsis approval. Patients were divided into two groups, groups A, receive 0.9% normal saline infusion and group B receive ringers lactate infusion. 82 subjects were included in each group. SPSS software version 20 was used for analyzing data. Results: In group B subjects, the serum bicarbonates level was higher than group A subjects (p=0.091). The Anion gap and blood PH level increases non-significantly in both the groups over a period of time (p=0.061). The mean hospital stay in group A and group B was 13.11 hours and 11.5 hours respectively (p=0.0031). The fluid quantity required in group A was more than group B (p=0.0031) Conclusion: When prescribing fluid, clinicians should always be cautious since any fluid may be dangerous if dosed wrongly. The ringer’s lactate was shown to be superior to 0.9 % normal saline in terms of alleviating DKA quicker in our study. Keywords: Diabetic ketoacidosis; 0.9 % normal saline; ringer’s lactate

Introduction: One of the most serious complications of liver failure is the development of the condition known as hepatic encephalopathy (HE), which affects the personality, cognitive and motor functions of patients. The sodium level in serum in hepatic encephalopathy has been studied and has been found lower than the normal individual. Objective: To find out the frequency of hyponatremia in patients with hepatic enchapalopathy Methodology: This Descriptive Cross-Sectional study was conducted at the Department of Medicine, Hayatabad Medical Complex, Peshawar from October 2020 to April 2021. In this study a total of 170 patients were observed to find out the frequency of hyponatremia in patients with hepatic enchapalopathy. Results: Based on grades of hyponatremia among 170 patients, Mild (130-134 mmol/L) was observed in 101(59.4%), Moderate: 125-129 mmol/L in 50(29.4%) and profound: < 125 mmol/L was observed in 19(11.2%) subjects. Hepatic encephalopathy was found in 91(53.5%) subjects while not found in 79(46.5 %) subjects. Conclusion: Chronic liver disease is linked to abnormal serum sodium concentrations, according to our findings. The most prevalent anomaly in this research is hyponatremia. In comparison to individuals with blood sodium levels of greater than 136mEq/L, patients with serum sodium levels of less than 135mEq/L had a higher prevalence of encephalopathy. Patients with a serum sodium content less than 130 mEq/L are the most severely affected. Key words: Hyponatremia; Hepatic enchapalopathy; Serum sodium level

As a result of peripheral neuropathy, diabetes-related mortality and morbidity rates increase. It is possible that a folate deficiency raises the risk of developing diabetic neuropathy since folate is required for the creation and maintenance of neurons. This study evaluated diabetic neuropathy and the role of folic acid in neuropathic and non-neuropathic diabetic individuals. This study was conducted from October 2019 to March 2020 in Peshawar on both from neuropathic (n=105) and non-neuropathic patients (n=100) of having diabetes mellitus type II. Blood samples were collected for estimation of HBA1c, folate and random blood sugar (RBS). Positive family history (87.6%), hypertension (53.3%), and dyslipidemia (54.3%) were more determined in neuropathic patients. HbA1c level was found high among neuropathic patients. Patients with diabetic neuropathy had a considerably greater frequency of folate insufficiency (16 percent ). A significant increase in the number of people with diabetic neuropathy who are folate deficient shows that folate plays a critical role in delaying the onset of diabetic neuropathy. Keywords: Folic Acid, Diabetes, Neuropathy, Diabetic Neuropathy, HBA1c