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Introduction: Asian countries have the highest burden of liver diseases. Polygonum plebeium (P. plebeium), a.k.a. the common knotweed, is a species of plant in the knotwood family that can act as a blood purifier and has been widely used in Pakistan to cure liver disorders like jaundice and hepatitis. The plant is also used in the treatment of pneumonia, bowel complaints, diarrhea, dysentery, eczema and ring worms. Tannins, flavonoids, saponins and alkaloids are the major components of P. plebeium. Since its use in folk medicine in Pakistan, there has been little scientific evidence or information on it. Therefore, this study was aimed at investigating the anti-fibrotic effects of P. plebeium in carbon tetrachloride (CCl4)-induced hepatic toxicity and fibrosis. Methods: The extracts of whole plant of P. plebeium were prepared and administered by oral gavage in rats. Liver fibrosis was induced by intraperitoneal (i.p.) administration of CCl4. To evaluate the hepatoprotective activity of P. plebeium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (γGT) levels were quantified. Histological evaluation of liver tissue revealed tissue necrosis and extracellular matrix deposition. Real-time PCR was done to evaluate mRNA expression of genes related to liver fibrosis. Results: The groups treated with P. plebeium extract showed an ablation in liver damage; the elevated enzyme levels of ALT, AST and γGT were decreased. Treatment with P. plebeium extract treatment restored the CCl4-induced tissue fibrosis by significantly suppressing alpha-smooth muscle actin (α-SMA), tumor growth factor beta (TGF-β) and collagen mRNA expression levels. Histology of liver sections also showed that the CCl4-induced fibrosis was improved in the treatment groups. Conclusion: Polygonum plebeium has therapeutic potential and can be used for preventing fibrosis in inflammatory liver disease.

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Objective: To look for frequency and associated socio-demographic factors of newly diagnosed patients of heaptocellular carcinoma (HCC) among patients treated adequately for hepatitis C infection. Study Design: Correlational study. Place and Duration of Study: Gastroenterology Department, Pak Emirates Military Hospital Rawalpindi, fromNov 2017 to Oct 2018. Methodology: This analysis was performed on 170 patients treated effectively for hepatitis C with standard antiviral therapy at our hospital. They were followed up for two years after the sustained viral response has been achieved. Ultrasonography was done in all cases and contrast enhanced computerized tomography scan done on patients who were positive on ultrasound. Factors like age, gender, genotype of heaptocellular carcinoma, presence of cirrhosis and model for end-stage liver disease (MELD) score were related with presence of heaptocellular carcinoma among the target population. Results: Out of 170 patients included in final analysis 121 were male, 49 were female. About 53 patients werediagnosed as suffering from heaptocellular carcinoma while 117 were negative for that. Thirty six patients hadcirrhosis while 134 non cirrhotic. After applying the binary logistic regression genotypes other than 3, high model for end-stage liver disease score & presence of cirrhosis had a strong relationship with presence of heaptocellular carcinoma among the patients treated for hepatitis C virus. Conclusion: Physicians and patients cannot ignore the possibility of a malignant outcome even after successfultreatment of hepatitis C. Local protocols should be set for screening especially the high risk cases even aftertreatment of hepatitis..........

Objective: To assess the severity of ulcerative colitis on first colonoscopic examination. Study Design: Prospective cross-sectional (correlational) study design. Place and Duration of Study: Study was conducted in Gastroenterology Outpatient Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2017 to Oct 2018. Methodology: An aggregate of 200 patients within the age range of 12-70 years, were included in the studythrough non-probability consecutive sampling. The data was collected by the self-administered questionnaireincluding age, gender, stool frequency, P/R bleed, systemic features of ulcerative colitis & colonoscopic findings.Effectiveness of the procedures was noted on a pre-designed performa and the endoscopic assessment was based upon mayo score severity of colitis graded from Normal (0) to Severe (3). Data was analyzed by using SPSS-19. Results: The mean age of the participants was reported 38 ± 2.1 years. Out of 200 participants 104 (52%) weremale, diarrhea with PR bleed was positive in 180 (90%) & anemia in 154 (77%). Colonoscopic findings showedthat 72 (36%) were with Left sided colitis (Montreal Class E2) & 82 (41%) with proctitis (Montreal class E1). Severe disease (Mayo endoscopic Score 3) was positive in 118 (59%) patients. Conclusion: Assessment of severity of UC is important as it determines the long term management & alsovaluable for risk stratification to predict the prognosis. Our findings feature the requirement for system levelenhancements to encourage the proper delivery of colonoscopy services dependent on individual risk. Keywords:  , , , .

Background: Malnutrition is known to be a poor prognostic factor affecting the outcome of pediatric cancers. The objective of this study was to assess the pre-existing malnutrition in newly diagnosed pediatric cancer patients presenting at the Pediatric Oncology Department, Children Hospital, PIMS and their number of hospital admissions due to causes other than chemotherapy. Methodology: Data of 44 newly diagnosed children with cancer was analyzed to find out the association of nutritional status according to z-score for weight and height for age, body mass index (BMI) and mid-upper arm circumference (MUAC) with their number of hospital admissions for 6 months since their date of diagnosis. Results: The mean age of the study subjects was 4.25 ± 2.85 years, out of which 33(75%) were males and 11(25%) females. Most of the patients were diagnosed with leukemia or lymphoma.  Nutritional status evaluation of thirty patients who got admitted was mild to moderate wasting in 24(80%) assessed by weight for age, mild to moderate stunting in 21 (70%) according to height for age and mild to severe malnutrition in 10 (33%) based on body mass index and mid upper arm circumference (MUAC). There was significant association between nutritional status of patients at the time of diagnosis with additional hospitalization with p value less than 0.05 Conclusion: Malnutrition at the time of diagnosis is significantly associated with an increase in the number of hospital admissions in pediatric cancer patients. Key words: Hospitalization, Malnutrition, Oncology, Pediatric

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Aim: To determine the diagnostic accuracy and epidemiology of placenta accreta spectrum (PAS) in patients of placenta previa. Design: Systematic review. Methods: PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between January1992 and December 2020. Studies on placenta previa complicated by PAS diagnosed in a defined obstetric population. This research was carried out using standard methods and protocols and keeping in view Newcastle-Ottawa scale for observation and assessment of case study along with the difference approved by consensus. The overall diagnostic accuracy of ultrasonographic findings is the main outcome of this study, whereas the prevalence of placenta accreta in patients of placenta previa and its incidence among different countries all over the world is also described. Results: In this review study, about 300 articles were evaluated. More over about 15 prospective and 14 retrospective case studies incorporated for assessment having complication with placenta previa and PAS. According to the meta-analysis, a significant (p<0.001) heterogeneity was found between case research that evaluate PAS prevalence and incidence in the placenta previa cohort. The median prevalence in case of placenta previa along with PAS came out to be 0.113% (IQR 0.048–0.17).Whereas incidence in females having placenta previa along with complication of PAS came out to be 11.3% (IQR 7.3–20.0). The overall median sensitivity of the ultrasound to find cases of placenta accreta spectrum in patients of placenta previa is 83.33 %( IQR 77.0-94.34) and specificity is 95.9 %( IQR 88.0-98.4). Conclusions: The high level of diversity observed in results obtained by diagnostic and qualitative data showed strong emphasis should be made on implementation of standard methods and protocols for assessment and diagnosis of pregnancy complication like placenta previa, its type and PAS. However, transvaginal and transabdominal ultrasound remains the gold standard diagnostic tool for placenta previa and placenta accreta spectrum. Keywords: Placenta accrete, placenta previa, sonography