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Background Clostridium difficile infection (CDI) is a leading cause of hospital-acquired diarrhea. Rifaximin is an antibiotic that offers marginal resistance to C. difficile bacteria. This study was conducted to evaluate the efficacy of rifaximin in metronidazole non-responsive CDI patients. Methods A cross-sectional study was performed from August 2019 to May 2020 at the Lahore General Hospital, Lahore, Pakistan. A total of 200 cases were included. Patients who developed diarrhea after receiving antibiotics for seven days and a positive C. difficile toxin stool test as detected by the enzyme immunoassay (BioCheck, Inc., CA) were diagnosed with CDI. Only patients who were unresponsive to metronidazole therapy were enrolled in our analysis. Two groups were formed. The intervention group was administered 200 mg tablets of rifaximin three times a day for 10 days. For patients in the control group, no new treatment was started. The efficacy of rifaximin was defined in terms of the resolution of diarrhea after two weeks of therapy and a negative stool test. All data were recorded in a predefined pro forma. Results The mean age of 45.41 ± 8.54 years was found in the intervention group. The majority of the patients were aged 35-50 years. The majority of the patients had watery diarrhea, abdominal cramping, and loss of appetite on presentation. Rifaximin was found to be significantly effective in the resolution of symptoms of CDI, which was previously unresponsive to metronidazole (p<0.00001). it was found that the duration of diarrhea of more than three weeks was significantly associated with failure of therapy (p=0.03). Conclusion We concluded that rifaximin therapy is effective for patients of CDI non-responsive to metronidazole in more than 65% of the cases. Even though several new developments are made to address the concerned subject, such as microbiota transplantation, antibiotics, and immunotherapy, rifaximin can be considered for patients with metronidazole non-responsive CDI.

Background: Spinal anaesthesia is a less expensive option to general anaesthesia for surgical procedures below the umbilicus in resource-constrained settings with a shortage of medical gases and specialized an anesthetists. The patient’s airway is not harmed by spinal anaesthesia, and both the patient and the doctor benefits from a host of additional benefits. Following the discontinuation of hyperbaric lidocaine for intrathecal injection because it can results in radiculopathy, bupivacaine is frequently used for spinal anaesthesia. For spinal, doctors employ pethidine, a lipophilic opioid with local aesthetic properties. In this study, pethidine bupivacaine were used as the only anaesthetic a gents to perform spinal anaesthesia, and the immediate postoperative problems and recovery profile were compared. Methodology: For quick surgical procedures on the lower body, 52 American Society of Anesthesiologists physical status I and II patients between the ages of 18 and 60 were randomly assigned to receive spinalanaesthesia. The patients' recovery times for pinprick sensation at S2, plantar flexion, big toe proprioception, and full motor recovery (Bromage score 0) were compared after receiving either 2.5mL of isobaric 0.5 percent bupivacaine or 1mg/Kg of preservative-free pethidine. The immediate postoperative period complications of pain, drowsiness, nausea and vomiting, pruritus, and urine retention were compared. Results: The time to return of pinkprick sensation at S2 was 94.6220.25 minutes and 205.9631.05 minutes, respectively, when pethidine and bupivacaine were compared. Pethidine and bupivacaine had a time to return of plantar flexion of 92.8812.01 minutes and viii 1 93.8539.56 minutes, respectively. Between pedthidine and bupivacaine, the mean recovery times f or the big toe’s proprioception were 31.159.41 and 172.5042.70 minutes, respectively, for full motor recovery (Bromage score 0). All recovery time variation were significant (p 0.0001) across the broad. There was no discernible change in the incidence of pain or sedation in the immediate postoperative period. In the Bupivacaine group, four patients (15. 38%) reported having hardly bearable discomfort. Both groups did not experience any instances of nausea or vomiting. Pruritus was experience by five patients (19.22%) in the pethidine group, but none in the bupivacaine group (0.00 %). Urinary retention incidence varied, and this difference was significant (p = 0.048) Conclusion: Compared to bupivacaine, pethidine had a quicker recovery profile and didn't lead to any major complications right after surgery.

Objective: Determination of celecoxib and diclofenac effects in early young subjects. Study design: Randomized study designed Methodology: All the participants received celecoxib 225 mg two times/day and diclofenac 80mg two times/day. First 21 days all participants received celecoxib treatment, before the start of the following medicine diclofenac 3.5 weeks gap was given. The blood pressure (BP) of patients was measured using the ambulatory blood pressure monitoring device (space labs model 90217A). Results: Group one consisted of young participants had a mean ± SD age 29 ± 3.4 while group 2 elderly had a mean ± SD age 55 ± 5.5. The mean body mass index was (group 1) 21.7 ± 1.8 kg/m2 and for group 2 = 27.3 ± 1.0 kg/m2. Group one had 5 (38.46%) females and 8 (61.53%) males while group 2 had 4 (30.76%) females and 9 (69.23%) males. The celecoxib medication baseline BP shows that there was no significant difference found in systolic blood pressure. Similar results for diastolic (mm Hg) for day and night time. Mean arterial pressure was higher in the elderly group -2 than in young group 1, Plasma renin activity was less in group 2 on day one compared to group 1. Plasma renin activity and concentration were decreased after 7 days of celecoxib and diclofenac treatment. A non-significant result was obtained. Group 1 Aldosterone serum (ng/l) for celecoxib received patients 11 ± 2.2 (ng/l) value for day one, day 7 = 13.2 ± 3.2, day 14 = 14.2 ± 3.4. Similarly in the case of diclofenac, the Aldosterone serum (ng/l) value for day one = 11.3 ± 21, day 7= 12.2 ± 2.3, and day 14 = 12.3 ± 2.1. A decrease in values was observed in both groups for aldosterone serum. For group-2 celecoxib, day one=15 ± 2.2, day 7= 14 ± 2.4*. day14= 14 ± 1.4. For diclofenac day one 15 ± 2.2, 7day= 15 ± 1.5, and 14 days = 14 ± 5.1. The comparison of both groups shows that the sodium and potassium decrease in both treatments in both groups. Conclusion: Overall, we got a non-significant response of both drugs on renal function and blood pressure. Keywords: blood pressure, renin angiotensin aldosterone system, non-steroidal anti-inflammatory drugs (NSAIDs)

Background: Chronic kidney disease (CKD), is defined as progressive loss in kidney function. The study evaluated the mean change in estimated glomerular filtration rate (eGFR) with febuxostat in patients of advanced chronic kidney dysfunction with hyperuricemia. Methodology: A prospective observational study was conducted at the department of Nephrology, Sheikh Zayed Hospital, Lahore for 6 months, from January 2019 to October 2019. At baselines, the blood sample was obtained and sent to the laboratory for assessment of serum creatinine level. The eGFR was calculated by using the MDRD formula. Patients were then advised to take one oral Febuxostat 40 mg daily for 6 months. After 6 months, the blood sample was obtained for assessment of serum creatinine level. Results: The mean age of the patients was 40.72±14.90 years, male to female ratio was 1:1. The mean value of eGFR at baseline was 23.53±11.09 and its mean value at 6th month was 34.28+12.31, which was significant (p<0.001). Conclusion: Febuxostat effectively improved estimated glomerular filtration rate (eGFR) in patients presenting with advanced chronic kidney dysfunction with hyperuricemia. Keywords: Hyperuricemia, Kidney, Disease, Febuxostat, Dysfunction, Glomerular, Filtration

Background: There is no valid and accurate documentation on the combination therapy of bupropion along with naltrexone. The experimentations on these actions of combination drugs have resulted in rare success. Methods: A complex interaction occurs in the central and peripheral nervous system for reducing weight loss. It is difficult to find out the major mechanism of action of these drugs on weight reduction. Naltrexone and bupropion is the experimental combination for reducing the weight. For obesity, the combination of naltrexone/bupropion therapy’s mechanism working is still unknown. Results: The attempts for weight loss rarely have a long-term effect. It is an outcome of more likely some complex interaction between various peripheral and Central Nervous systems, and an overwhelming lack of real obesity treatment may be explained. Based on the evidence that obesity involves a change in the hypothalamic melanocortin system in addition to a brain reward system, which causes food craving and mood swings, this investigational combination therapy of NB was developed. Naltrexone and bupropion work in an interesting way. Conclusion: It affects the parts of the brain that influences food craving, food intake, eating behaviors, and loss of body weight. We will have a review on the working of naltrexone, and bupropion separately, and Vivo, current in vitro, and clinical evidence will be provided, describing how NB affects food intake and food craving. Keywords: CNS, obesity, medicine, weight lose, NB, therapy.

BackgroundThe study examined the efficacy of eplerenone in the management of chronic central serous chorioretinopathy (CSCR) with the aim of short-term observations. The study also aimed at observing changes in optical coherence tomography (OCT) parameters and visual acuity. MethodologyThis retrospective study was conducted at Layton Rahmatulla Benevolent Trust (LRBT) Eye Hospital from September 2019 to October 2020. A thorough ocular examination, color fundus photographs, fluorescein angiography, and macular OCT were performed on all patients. We administered one tablet of 50 mg eplerenone on day one and further advised the use of the same dose for 30 days. After the administration of the tablet, the patients were further analyzed on weeks one, two, and four. On every visit, we examined ophthalmic conditions by visual acuity, slit lamp, and dilated fundus examinations along with macular OCT and measured blood pressure. At follow-up, we measured the levels of serum creatinine at weeks one and four. Student's t-test and chi-square test were used for normal distribution and nominal variables. A p-value < 0.05 was considered statistically significant in all the analyses. ResultsA total of 15 patients were selected for this research, but unfortunately, two of them withdrew amid the study. For the remaining 13 patients, the mean duration of observing symptoms was three months and three weeks. At one-month follow-up, the mean subretinal fluid (SRF) height (94.18 μm) decreased, but we did not find any statistical significance between the SRF height at one-month follow-up and baseline (113.15 μm). In four patients, the SRF height increased up to 3-30 μm after four months of treatment. In our study, we found some negative consequences of eplerenone therapy in terms of hypertension, cramps, nausea, and migraine. ConclusionWe concluded that short-term eplerenone treatment assists in the reduction of the choroidal thickness (CT) and central macular thickness (CMT) among patients with central serous chorioretinopathy. However, eplerenone treatment failed to decrease subretinal fluid height and does not bring any significant improvement in the visual acuity of patients. Some mild adverse effects of the treatment include hypertension, abdominal cramps, nausea, and migraine.

BACKGROUND & OBJECTIVE: Thyrotoxicosis is a disease in which thyroid hormones are raised, and we have seen multiple patients suffering from this ailment in Pakistan. Methimazole is an anti-thyroid drug for thyrotoxicosis. Hepatotoxicity and liver ailments were common with methimazole prescribed for hypothyroid patients. Hypothyroidism, a common side effect of this drug, has been seen in a majority of patients, but liver toxicity remained unaddressed. So, in this study, we have observed histological changes in the liver after methimazole administration. METHODOLOGY: The pilot study was carried out in the University of Health Sciences (UHS), Lahore, and was ended in twenty-one days. We divided animals in 2 groups. Each group comprises 12 animals. Group-I was negative control, and water was given through the oral route for 21 days. Group-II was administered methimazole orally 60mg/kg/day for twenty-one days. At the end;S animals were dissected, and livers were removed for histological examination. RESULTS: The histological picture of the liver showed 75% severe disruption in liver architecture, inflammation, and fatty change in group 2, indicating liver damage. CONCLUSION: Methimazole, hepatotoxic with discernable damage to its architecture, epithelium, and inflammatory changes.