Background The aim of this study was to determine the frequency of hypoalbuminemia and in-hospital mortality in acute ischemic stroke patients at a tertiary care hospital in Hyderabad. Methodology This was a prospective observational study conducted at the Department of Medicine, Isra University Hospital, Hyderabad, from February 17, 2017 to August 18, 2017. A total of 196 consecutive cases of acute ischemic stroke were included. Hypoalbuminemia was defined as serum albumin of <3.5 mg/dL. In-hospital outcome in terms of survival or death within seven days of admission was assessed and recorded. Data were analyzed using SPSS, version 20.0. (IBM Corp., Armonk, NY, US). Chi-square test was applied, and p-value of ≤0.05 was considered significant. Results Out of the 196 acute ischemic stroke cases, 146 (74.5%) were males and 50 (25.5%) were females. The mean age was 49.31 ± 10.46 years. A total of 90 (45.9%) cases had hypoalbuminemia. Out of these 196 cases, 22 (11.2%) expired within seven days of presentation of acute ischemic stroke, and out of these 22 expired cases, 18 (81.8%) had hypoalbuminemia. In-hospital mortality was found to be strongly associated with hypoalbuminemia (p < 0.001). Conclusions Frequency of hypoalbuminemia was significantly higher in ischemic stroke patients and was found to be associated with in-hospital mortality, warranting monitoring at regular intervals, as well as recognizing and treating it early for risk stratification.

Introduction: Coenzyme Q10 (CoQ10) has a potential role in reducing the risk of myocardial infarction by slowing the progression of atherosclerosis and improving ischemia. In this study, we will assess the role of coenzyme Q10 in prophylaxis for reducing myocardial infarction and mortality related to myocardial infarction. Methods: This open-label two open placebo-controlled randomized clinical trial was conducted in a tertiary care hospital in Sukkur, Pakistan from April 2016 to September 2019. Eight hundred nighty-two (892) patients with clinically diagnosed and documented evidence of hypertension were enrolled in the study from the outpatient department. Participants were randomized into two groups by 1:1 ratio using an online randomizer software, Research Randomizer ( https://www.randomizer.org /). Group A received 100 mg coenzyme Q10 daily (coenzyme Q10 group) in addition to standard therapy and group B received standard therapy only (placebo group). Results: Participants who received coenzyme Q10 had fewer incidence of non-fatal myocardial infarction over 12 months (5.4% vs 8.4%) with relative risk reduction of 2.92 (confidence interval 95%, 0.55-2.76). The number needed to treat to prevent one non-fatal myocardial infarction was 34. Participants who received coenzyme Q10 had fewer incidence of fatal myocardial infarction over 12 months (1.5% vs 3.1%) with relative risk reduction of 1.65 (confidence interval 95%, 0.39-3.69). Number needed to treat to prevent one fatal myocardial infarction was 60. Conclusion: According to this study, coenzyme Q10 reduced the incidence of fatal and non-fatal myocardial infarctions. Clinicians should consider adding coenzyme Q10 to the treatment regimen of high-risk patients of myocardial infarction. We suggest coenzyme Q10 may be an effective prophylactic agent in patients at risk of myocardial infarction and it may help in reducing burden on the health care system.

Introduction: In recent time, developing countries of South Asia and Africa have seen significant increase in ingestion of Para-Phenylene Diamine (PPD) locally known as Kala Pathar either accidental or for suicide. Through this study we aim to study the clinical presentations and outcomes among patients who have ingested PPD. Method: This retrospective case series study was conducted in a tertiary care hospital of Pakistan, from April 2013 to August 2017. Data of patients of PPD poisoning was archived from the hospitals medical records. Around 174 consecutive cases were included in the study. Patients were evaluated based on self-administrated proforma. Result: Out of 174 cases of PPD poisoning that were identified, 57(32.8%) were males and 117(67.2%) were females. Approximately 170 (97.8%) patients used PPD for suicidal intention. The most common presentation was facial swelling which was present in 144(82.8%) patients followed by dysphagia in 143(82.2%) patients. Complications include metabolic acidosis in 50 (28.7%) patients and aspiration pneumonia in 36 (20.7%) patients. A total of 101 (58%) improved, while others were either referred or left against medical advice (LAMA). Conclusion:Increasing incidence of ingestion of PPD for suicide warrants the regulatory authorities to restrict the use of PPD in hair dyes and implement strict measures to educate masses and curtail the easy access of such poisonous substances among common people.

Objective: To determine the frequency of premature ejaculatory dysfunction in rheumatoid arthritis patients. Methods: After approval from IRB, cross sectional study was conducted from November 1st, 2020 to August 1st, 2021 at Department of Rheumatology, Indus Medical College, Pakistan. RA patients were included, written and informed consents were taken. Demographic data was noted and detailed history and examination was carried out. Each participant BMI and Blood pressure was measured. Afterward 5-ml of blood was drawn by a trained phlebotomist for CBC, ESR, fasting blood sugar levels, HBs Ag and anti HCV Antibody test. DAS-28 Calculator was used for RA clinical activity. Premature ejaculation diagnostic tool was used for the assessment of premature ejaculation. Results: Total 168 patients with mean age 32.27 (SD=±9.49) and mean disease duration of 6.35 (SD=±3.95) years were included,. Prevalence of premature ejaculation dysfunction was (44.6%), with mean PED of score 9.17 (SD=±5.23). Hypertension, HCV, Hakeem medications, use of DMARDS had positive association while High BMI and higher DAS-28 has negative association with PED (p<0.05). Conclusion: There is high prevalence of PED in RA, it needs proper evaluation, treatment and urgent research is needed to know more about it. doi: https://doi.org/10.12669/pjms.38.8.5698 How to cite this:Wagan AA, Chandio SA, Surahyo P. Premature Ejaculatory Dysfunction in Rheumatoid Arthritis (PED-RA Study). Pak J Med Sci. 2022;38(8):---------. doi: https://doi.org/10.12669/pjms.38.8.5698 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To study the pattern of existing common pathogen of Urinary Tract Infection and their drug sensitivity pattern. Methods: It was a cross sectional study held in Medical Unit-I, CMC Teaching Hospital, Shaheed Mohtarma Benazir Bhutto Medical University(SMBBMU), Larkana with collaboration of Pathology Laboratory CMC Larkana, Aga Khan University Hospital Lab, Rahila Research Lab and Chughtai Lab. All the participants meeting inclusion criteria were enrolled. The reports of Urine culture were collected from above mentioned laboratories which include bio data, causative organism, their count and drug sensitivity pattern. The results were copied on proforma by researcher himself. SPSS version 25 was applied for data analysis. Results: Total 302 participants were registered in the study. Out of them 75.8% of them were female and 24.2% were male. Mean age of the patients was 40 ± 9 years. E-coli was found in 52.3%, Enterococcus in 13.2% and Klebsiella pneumonia in 9.6% cases. Meropenem was found sensitive in 92.4%, while cefoperazone sulbactam, Amikacin and Fosfomycin were found to be sensitive in 86.6%, 85%, 76.2% respectively. Ampicillin and Vancomycin was used in 50 cases for Enterococci. Ampicillin was found sensitive in 70% of cases where as vancomycin was found sensitive in 100% of cases with no vancomycin resistant Enterococci. For Enterobacteria Moxifloxacin was found resistant in 84.4% of cases, Ampicillin in 83.5%, Nalidix acid in 78% cases. While Ceftazidime and Amoxiclav was found resistant in 71.1% and 54.1% respectively. Conclusion: E-coli, Enterococcus and klabsella were the most pathogens found in this study. The drug sensitivity pattern showed that Meropenem, Cefoperazone Sulbactam, Amikacin, Fosfomycin and Vancomycin were found commonly sensitive while Moxifloxacin, Ampicillin, Ceftazidime and Amoxiclav was found resistant. Keywords: Urinary Tract Infection, Culture and Sensitivity, Meropenem, Vancomycin, Cefoperazone Sulbactam CMC @ SMBBMU, Larkana.

Objectives: To determine the frequency of Hepatitis C infection in patients with ischemic Stroke at CMCH Larkana. Study Design: Cross-sectional study. Setting: Medical wards of Shaheed Mohtarma Benazir Bhutto Medical University Larkana. Period: From January 2018 to December 2018. Material & Methods: This study was conducted on 125 diagnosed ischemic stroke patient with age >18 years or both genders. Patients with sudden history of partial or complete weakness of half the body persisting for more than 24 hours and clinical examination supporting reduced power and presence of focal sign and CT brain showing hypodense area in respected blood supply. Patients were considered suffering from Hepatitis C who were reactive to anti HCV on second generation ELISA. Results: We surveyed 125 patients admitted with clinical diagnosis of ischemic stroke after exclusion criteria with mean age of 54.53 ± 10.994. In this study male were 51.2% and female were 48.8%. About 40 (32% patients were anti HCV reactive. Conclusion: It is revealed that HCV infection significantly increased the risk of stroke.

Objectives: To observe the effects of different combinations of medicines in GERD patients by using FSSG score. Study Design: Observational Study. Setting: Al-Tibri Medical College Hospital, Isra University Karachi Campus Karachi. Period: June 2017 to December 2017. Material & Methods: The study was conducted on GERD patients at Tertiary Care Hospital of Karachi. Adult patients from male and female gender with clinical symptoms suggestive of GERD were included. During clinical history taking patients were interviewed to respond symptoms frequency of FSSG questionnaire score from 0 to 4 on each question. All 154 eligible patients enrolled in the study and divided into three groups Group I (PPI alone), Group II (PPI with prokinetic) and Group III (PPI, prokinetic and SSRI). After 2 weeks of treatment, FSSG score of every participant was calculated. Results: Results of 134 patients 72 (53.3%) males and 63 (46.7%) females were analyzed. The cumulative mean age was 37.12±8.221 (range 16 – 60) years. The patients were grouped by single blind randomization method, each group I and group II consisted of 45 subjects and 44 patients were enrolled in group III. The mean FSSG score prior to treatment and after treatment was 21.194±4.786 and 14.962±3.696 respectively, hence, the gradient of pre-treatment and post-treatment was 6.231±4.601. The three groups shown significant improvement in FSSG score after treatment but the group III had shown highest improvement in mean FSSG score of 7.522±3.592, followed by group II with 7.2889±3.805and group I had shown the lowest improvement of 3.911±5.346 but statistical analysis revealed these improvements within each group as insignificant while turned to be significant when groups were analyzed with each other. (p 0.003). Conclusion: The results of this study suggests that PPIs alone have good therapeutic role but as dysmotility aspect of GERD and psychological comorbidity is very common in those patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment. Hence, addition of prokinetic and anxiolytics can augment the response rate.