Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41 ±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Objective: To determine the frequency of acute renal failure in patients presented with Blackstone poisoning in a tertiary care Hospital. Study Design: Cross sectional study. Setting: Medical wards and ICU at Peoples Medical College Hospital, Nawabshah. Period: September 2017 to March 2018. Material & Methods: All the patients of age 20 to 50 years having Paraphenylenediamine (PPD) poisoning (kala-patthar) during ≥6 hours after ingestion and either of gender were included. AKI was labelled as positive if either of any stage was present on the basses of urine output measurement for 24 hours through urine beg r urine output (UO) criteria. All the data was documented in self-made proforma. Results: The mean age for patients was 24.9±8.9 years, 46(19.08%) subjects were male and 195(80.91%) were female. 18(7.5%) study subjects had acute renal failure, out of them 6 study subjects had ARF of stage I, 5 patients had stage II and 7 study subjects had acute renal failure stage III. Conclusion: Acute renal injury is a common complication following PPD ingestion 7.5%. Paraphenylenediamine toxicity is a threat to the region of Asia and is evolving as a substitute to the poisoning of organophosphorus due to its easy accessibility and low cost.

Objective: To document different indications and findings of upper GI Endoscopy in our endoscopy suite. Methods: A descriptive study of 500 patients who underwent upper gastrointestinal (UGI) endoscopy was conducted in the Endoscopy Unit of PNS DRIGH LUMHS Jamshoro and Civil Hospital Hyderabad from April to September 2020. Included patients underwent UGI endoscopy. Demographic data including indications and endoscopic findings of the patients was collected via study proforma. Results: Total five hundred patients were studied; their mean age was 42.4±16.8 years. Out of all 52.8% were males. Upper GI bleed was the commonest indication (33.2%) followed by dysphagia (21.6%), epigastrium pain (10%), surveillance and screening of varices (9% and 8.2% respectively).  The most common endoscopic findings were esophageal varices (32.2 %), gastritis (18.8%), and normal (11.4%). In patients with esophageal varices, 77.4% had chronic liver disease with positive serology for HCV and HBV in 63.4% and 23% respectively. Conclusion: The most common indication was upper GI bleed with esophageal varices for upper GI endoscopy. The underlying etiology of varices reflects the high burden of chronic liver disease due to viral hepatitis.

Objective: Our research was designed to evaluate the association of uncontrolled hypertension with coronary artery disease and analyze the role of intervention in preventing CAD mortality ratio. Methodology: This case controlled single-center study was conducted in department of Medicine, Peoples University of Medical and Health Sciences Nawabshah Pakistan from January 2020 to September 2021. In this study, BP screening was done among the adult population aged 50 years or over. All the recruited patients of coronary artery disease were divided into two main groups for a clinical trial; case (identified cases of uncontrolled hypertension) and the control group (without history of cardiovascular disorders and used medication for hypertension). For evaluating physician intervention, both groups were divided into two main groups for treatments; the standard Bp control (having <140 mm Hg SBP level) and the intensive blood pressure control (whose SPB <120 mm Hg). we used BP-lowering medication which adjusted the systolic blood pressure around 135–139 mm Hg in the standard group and less than 120 in intensive group. Results: Overall the female prevalence was comparatively high (63.2%) than males (37%). No significant differences were found in the baseline characteristics of participants.  In 42% of cases, we found coronary artery calcification. Univariate logistic analysis of our study demonstrates the association of CAD with age, smoking, and BMI. We also found a positive association of CAD with higher CRP, and uncontrolled hypertension. Conclusion: Our study observed a significant association between uncontrolled hypertension and coronary artery disease. The results of our study concluded that interventions in terms of BP control might be affected due to pre-existing cardiovascular diseases. However, intensive BP treatment would help to reduce the mortality ratio of CAD patients.

Objective: To determine the frequency of vitamin d deficiency and insufficiency among patients of diabetes mellitus type II presented at medicine OPD of tertiary care Hospital Methodology: This cross-sectional study was done at Medicine department of Peoples University of Medical and Health Sciences for women Nawabshah (SBA). Study was done during six months from April 2020 to September 2020. All patients of diabetes mellitus type II, age >40 years and of either were included. A 5ml sample was taken from each patient and was sent to the diagnostic laboratory to assess the HbA1c level and vitamin D status. The normal range for vitamin D (25-OHD) was 30–40 ng/ml. The value <20 ng/ml was defined as deficiency while insufficiency was ranged between 20.1- 29.9 ng/ml. All the data was collected by the self-made study proforma. Data analysis was done by using the SPSS version 26. Results: A total of 62 patients of diabetes mellitus were studied for vitamin D level; their average age was 49.51+12.65 years and average duration of diabetes was 10.25+5.22 years. Average HbA1c was 7.33+3.5 and the average vitamin D level was 27.21+21.98. 36(58.1%) were males and 26(41.9%) were females. Average BMI was 28.41+3.63 kg/m2. Out of all study participants 48.40% of the cases were observed with vitamin D deficiency. Vitamin D deficiency was statistically insignificant according to gender and socioeconomic status (p=>0.05). Conclusion: As per study conclusion the vitamin D deficiency and insufficiency was observed to be higher among patients of diabetes mellitus type II and vitamin D deficiency was insignificantly linked to gender, socioeconomic status and severity of diabetes. Keywords: Vitamin D, Type II diabetes mellitus

Objective: To determine the frequency of seropositive helicobacter pylori (H. pylori) among patients presented at outpatient department (OPD) with dyspepsia at tertiary care Hospital. Methodology: This descriptive case-control study was conducted at medicine department of Peoples University of Medical and Health Sciences for women Nawabshah (SBA). Study duration was six months from October 2018 to March 2019. All the patients of age 18-70 years, presented with complaint of dyspepsia, either of gender were included in the study. After taking informed consent all the patients underwent serological assessment for H. pylori. From each study participant a 5ml blood sample was taken and sent to the laboratory for the diagnosis of H. pylori. After collection of the laboratory reports, all the data was collected via self-made study proforma. Data analysis was done by using SPSS version 20. Results: Total 78 patients of dyspepsia were enrolled, their mean age was34.23+6.22 years and average duration of symptoms was 15.23+7.14 months. Males were 43(55.1%) and females were 35(44.9%). Feeling of abdominal distension after meal was among 21(26.9%) cases, epigastrium pain was in 14(17.9%) cases, heart burn was among 32(41.0%) patients, 07(09.0%) had belching and 19(24.4%) had multiple complaints. Seropositivity rate of H. pylori was 33.30% among patients of dyspepsia and it was statistically insignificant according to gender and socioeconomic status (p->0.05). Conclusion: As per study conclusion the seropositivity of H. pylori was observed to be higher among patients of dyspepsia and seropositivity of H. pylori was insignificantly linked to gender and socioeconomic status. Keywords: Dyspepsia, H. pylori, seropositive

Objective: The objective of this study was to evaluate the low bone mineral density (BMD) in patients with liver cirrhosis. Methodology: This cross sectional study on 151 Liver cirrhotic patients was conducted at Liaquat University Hospital Hyderabad/Jamshoro. This study duration was 6 months, July 2015 to December 2015. The Assessment of bone mineral density (BMD) for each relevant patient was done using ultrasound impedance Dual Energy X-ray Absorptiometry  (DEXA) by senior pathologist having ≥05 years of experience, across the calcaneum, at lumbar spine  (LS) and femur neck (FN),  were computed by using computer supported device. The BMD was expressed in terms of T score. The WHO standard value was utilized to define the low BMD / osteoporosis is T score -1.5. Results: The mean age of subjects was 31.32±6.18 years. Out of all, 62.9% were males whereas 37.1% were females. About 21% patients had low/abnormal bone mineral density (BMD). Among these, 17.9% had bone mineral density (BMD) of -1.5 to -2.5 and 4% had BMD of <-2.5. Rest of 78.1% patients had a normal (>-1.5) bone mineral density (BMD). Majority of patients, 63.6% had a CTP grade B of liver cirrhosis, whereas 22.5% had A grade and 13.9% had C grade of liver cirrhosis. Conclusion: Conclusively, the risk of low bone mineral density (BMD) was evidently high for patients with hepatic cirrhosis. Male gender and age above 30 years were found at greater risk and CTP grade B of cirrhosis was most common.

Objective: To determine the burden of thyroid dysfunctions in Rheumatoid Arthritis (RA) patients attending tertiary care hospital of Karachi, Pakistan. Methods: A cross-sectional study was conducted at rheumatology clinic of a Jinnah Post Graduate Medical Centre in Karachi, Pakistan from April 2019 to January 2021. All diagnosed cases of RA having seronegative or seropositive RA were consecutively enrolled. Clinical records and laboratory data of these patients were collected along with outcome variables. Results: Of 136 patients, thyroid abnormality was observed in 56 (41.2%) patients. In particular, 80 (58.8%) had normal, 8 (5.9%) had hypothyroidism, 14 (10.3%) had hyperthyroidism, 32 (10.5%) had subclinical hypothyroidism, and 2 (1.5%) had subclinical hyperthyroidism. A significantly lower hemoglobin levels (p-value <0.001), mean corpuscular volume (p-value 0.011), total leucocyte count (p-value 0.004), and platelet counts (p-value 0.040) were observed in patients with thyroid abnormality than those without thyroid abnormality. Furthermore, a significantly lower urea (p-value <0.001) and creatinine levels (p-value <0.001) were also observed among patients with thyroid abnormality than those without thyroid abnormality. Conclusion:In patients with RA, thyroid dysfunction has been shown to be highly prevalent. Subclinical hypothyroidism, the most common thyroid disorder and obvious hyperthyroidism were observed.