Aim: To determine the effectiveness of antiviral drugs such as sofosbuvir, daclatasvir and ribavirin in hepatitis C patients and frequency of complications associated to antiviral therapy. Study Design: Prospective study. Place and Duration: This study was conducted at the department of Gastroenterology and General Medicine AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital Rawalakot Azad Kashmir for one year duration from 5th July 2020 to 5th July 2021. Methodology: 150 patients of both genders presented with hepatitis C were included. Patient’s ages were ranging from 25 to 70 years. After taking informed consent from all the patients, detailed medical history including age, sex, residence and education were recorded. Quantitative PCR test was obtained before starting the antiviral therapy, kit method was used. Treatment response was examined after completion of therapy. All the statistical data was analyzed by SPSS 24.0. Results: 88 (58.67%) patients were males while 62 (41.33%) patients were females. Mean age of patients was 48.52±9.38 years. At the end of treatment, 132 (88%) patients were cured and 15 (10%) patients were not cured, 3 (2%) patients had lost to follow-up. Complications associated to therapy were noted as anemia, ascites, hepatic encephalopathy and liver cirrhosis in 40 (26.67%), 20 (13.33%), 7 (4.67%) and 6 (4%) patients respectively. Conclusion: Combination antiviral therapy with Sofosbuvir, daclatasvir and ribavirin shows better results in patients with Hepatitis C with 88% cure rate. Anemia was the most frequent complication found at end of therapy. Keywords: Hepatitis C, Sofosbuvir, Daclatasvir, Ribavirin

Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019. Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines. Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001). Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the..........

Objective: To find out prevalence of iron deficiency anemia among hospitalized children aged 6-months to 5 years at a tertiary care hospital of Poonch, Azad Kashmir, Pakistan. Study Design: A cross-sectional study. Place and Duration of the Study: Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to December 2020. Material and Methods: A total of 189 admitted children of both genders aged between 6 to 60 months were included. At the time of enrollment, age, gender, area of residence and socioeconomic status of all children were noted. To label IDA, a World Health Organization (WHO) criterion was adopted as hemoglobin below 11 g/dL. Chi square test was used to compare data between IDA and non-IDA children considering p-value < 0.05 as significant. Results: Out of a total of 189 cases, there were 103 (54.5%) male. Overall, mean age was 29.3±6.8 months while 106 (56.1%) children were aged between 6 to 24 months. There were 130 (68.8%) children who belonged to rural areas of residence. Socio-economic status was low in 110 (58.2%) children. Malnourishment was identified in 38 (20.1%) children. Gastrointestinal disorders were the commonest reasons of admission found in 82 (43.4%) children. The prevalence of IDA was noted in 103 (54.5%) children. Table-2 is showing association of anemia with respect to various variables studied. Younger age (p=0.0091), rural area of residence (p=0.0039), low socio-economic status (p=0.0036) and malnourishment (p=0.0001) were observed to have significant association with the prevalence of IDA. Conclusion: The prevalence of IDA was high (54.5%) in admitted children aged between 6 to 60 months. Younger age, rural area of residence, low socio-economic status and malnourishment were observed to have significant association with the prevalence of IDA. Keywords: Iron deficiency anemia, hemoglobin, malnourishment, gastrointestinal disorders.

Objective: To find out the frequency of electrolyte abnormalities among children with acute gastroenteritis. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to December 2020. Material and Methods: A total of 159 children of both genders aged between 1 month to 5 years and presenting with acute gastroenteritis at outpatient or emergency department were included. At the time of enrolment, clinical and physical examinations were performed while medical history and presenting complaints were recorded. Frequency of electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia and hyperkalemia were noted on a predesigned proforma. Results: In a total of 159 children, 86 (54.1%) were male. Mean age was noted to be 2.1+1.7 years while 69 (43.4%) children were aged between 1 to 3 years. Majority of the children, 104 (65.4%) belonged to rural areas of residence. Abdominal pain, vomiting and lethargy were the other most frequently observed presenting complaints noted among 91(57.2%), 60 (37.7%) and 51 (32.1%) children respectively. Among all children, mean serum sodium was noted to be 140+11.3 meq/L. Hyponatremia was found to be among 45 (28.3%) children while hypernatremia was present in 28 (17.6%) children with AGE. Mean serum potassium was calculated to be 4.2+3.7 mmol/L. Hypokalemia was found to be present among 28 (17.6%) children while hyperkalemia was noted to be among 10 (6.3%) children. Conclusion: Frequency of electrolyte abnormalities was found to be high among children with acute gastroenteritis. Timely identification and treatment of children presenting with acute gastroenteritis coupled with electrolyte abnormalities needs to be done to reduce the morbidity and mortality associated with these diseases. Keywords: Acute gastroenteritis, hypokalemia, hyperkalemia, hypernatremia, hyponatremia

Background and Aim: Jaundice and associated liver disease are frequently diagnosed in patients with acquired immunodeficiency syndrome (AIDS). The assessment of jaundice causes, etiology, and outcomes in human immunodeficiency virus (HIV)-infected patients with liver disease have not been addressed. The present study aimed to evaluate jaundice and associated liver disease in human immunodeficiency virus (HIV)-infected patients. Materials and Methods: This cross-sectional study was conducted on 272 human immunodeficiency virus(HIV)-infected patients with liver disease at the Department of Gastroenterology AK CMH/ Sheikh Khalifa bin Zayad Al Nahyan Hospital Rawalakot, Medicine Medical Unit A, Hayatabad Medical Complex, Peshawar and department of Medicine, Fauji Foundation Hospital Rawalpindi for duration between 5th January 2020 and 5th December 2020. Jaundice was defined as a serum bilirubin concentration of 3 mg/dL or higher. The etiology of jaundice was determined using a pattern of liver disease biochemistry test, radiographic studies, liver biopsy and clinical follow-up. Results: About 272 HIV-infected patients were evaluated liver disease; the prevalence of jaundice was 46 (16.9%). Drug-induced hepatitis was the more prevalent cause in Jaundice 19 (41.3%) followed by neoplasms in 14 (30.4%) patients. Out of 14 neoplasms, the extrahepatic and intrahepatic disease was present in 8 and 6 patients respectively. Alcoholic liver disease was present in 5 (10.9%). Various potential causes were present in three patients. The use of abdominal ultrasonography and CT was beneficial in determining the fundamental cause of the infection. five of these patients died as a result of liver disease. Conclusion: Jaundice is rare and can be caused by a number of opportunistic and non-opportunistic etiologies in AIDS. The most common cause is drug-induced hepatitis, which can be fatal. Long-term survival was dismal. Keywords: Jaundice, Liver Disease, Human immunodeficiency virus (HIV)