IAH is a poorly recognized clinical entity with potentially devastating impact on patient outcomes. Since majority of patients had IAH at the time of admission, all ICU patients especially on ventilator should have baseline intra-abdominal pressures measured at the time of admission and subjected to appropriate management to prevent them from developing abdominal compartment syndrome.

Objective: To evaluate Hepatitis C treatment by directly acting antiviral agents and its impact on glycemic control.            Study Design: This is an observational study. Setting: This study was conducted in Medicine department Civil Hospital Karachi from March 2018 to December 2019. Materials and Methods: Patients visiting the outpatient department of the hospital having documented HCV infection having type 2 diabetes mellitus were included in the study. All participants were given directly acting antiviral treatment for 12 weeks. After treatment they were assessed for achievement of sustained virological response (SVR). Pre-treatment and post treatment fasting blood glucose levels and HbA1c levels were checked. SVR is defined as serum HCV RNA which is undetectable (<50IU/ml) after 12 weeks of antiviral treatment. Results: Around 332 patients matched our inclusion criteria. Amongst these there were 219 males and 113 females. The mean age of patients was 39.44 ± 2.19 years. All the selected participants started therapy on Sofosbuvir-velpatasvir (pangenotypic NS5A-NS5B inhibitor single-pill combination regimen that has potent activity against hepatitis C virus (HCV) genotypes 1, 2, 3, 4, 5, and 6.) plus ribavirin. After treatment with directly acting antiviral therapy 231 (69.57%) patients achieved sustained virological response. Patients who achieved SVR showed improved glycaemic control than those who didn’t. Patients with cirrhosis showed decreased chances of attainment of SVR. Fasting blood glucose levels and HbA1c were also decreased, decreasing the amount of insulin required for diabetes control.  Conclusion: Our study showed that treatment with directly acting antiviral treatment improved glycaemic control in HCV infected patients. Other factors like BMI, presence of cirrhosis, mean serum HCV RNA levels and adherence to treatment were major predictors for achievement of SVR.

Objective: To assess the short-term adverse effects of two inactivated coronavirus disease-2019 vaccines, and the demographic factors associated with such events. Method: The cross-sectional study was conducted in Karachi from August to October 2021 after approval from the ethics review board of Dow University of Health Sciences, Karachi, and comprised adults of either gender who had received at least one dose of either Sinopharm or CoronaVac vaccine. Data was collected using a predesigned online and printed survey forms. The questionnaire investigated the symptoms experienced by the participants after the administration of the vaccine dose. Data was analysed using SPSS 22. Results: Of the 1000 survey forms filled, 896 were analysed; 505(56.4percent) women and 391(43.6percent) men were included in the study. Most of the participants were aged 18-30 years 644(71.9percent). Overall, 581(64.8percent) subjects had received Sinopharm vaccine, and 315(35.2percent) received CoronaVac. The incidence of side effects after the first and second dose respectively was 63.3percent (368 out of 581) and 55.2percent (239 out of 433) for Sinopharm and 65.4percent (206 out of 315) and 61.4percent (89 out of 145) for CoronaVac. The factors associated with a higher risk of side effects were female gender and young age (p 0.05). Conclusion: Most of the reported symptoms were minor in nature, like pain at the injection site, and women and those of young age reported such symptoms more than men and the elderly. Key Words: COVID-19 vaccine, Side effects, Sinopharm, CoronaVac, SARS-CoV-2.

Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC <80% of Predicted, (b) FEV1 <80% Predicted, (c) FEV1/FVC ≥70. Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001). Conclusions: NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages. How to cite this:Zuberi FF, Zuberi BF, Rasheed T, Nawaz Z. Non-specific impairment of Lung Function on Spirometery in patients with Chronic Hepatitis-C. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.73 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 determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. Methods: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. Results: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p<0.001). Adequate visibility in Group-A was seen in 41.1% and that in Group-B was 78.2% (p<0.001).Conclusion: Use of Simethicone significantly improves mucosal visibility during OGD. doi: https://doi.org/10.12669/pjms.36.2.1241 How to cite this:Zuberi BF, Shaikh MA, Ali FS, Rasheed T, Nawaz Z. Effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility: A single blinded, placebo control, randomized trial. Pak J Med Sci. 2020;36(2):---------.  doi: https://doi.org/10.12669/pjms.36.2.1241 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 determine frequency of Minimal Hepatic Encephalopathy in illiterate patients with compensated cirrhosis.Methods:Illiterate patients with compensated cirrhosis with F4 Score on Shear-wave Elastography were selected for study after informed consent. Sample size was estimated at 106. Selected patients were subjected to two tests for detection of MHE, Number Connection Test A and Block Design Test. Patients taking ≥ 30 seconds were labelled as Positive for MHE.Result:Out of 110 selected patients 10.9% were alcoholics and in 8.2% of patients no hepatic virus infection was detected. HCV was positive in 48.2% patients while HBV was positive in 13.6% of patients. MHE was detected in 72 (65.5%) of patients. Major differences were found in MHE Stage II & III by two tests. Over all BDT detected more cases and gave higher Staging in Stage II & III as compared to NCT-A test.Conclusion:Minimal Hepatic Encephalopathy (MHE) could be detected in illiterate patients using NCT-A and BDT Tests.

Objective: To determine the frequency of iron deficiency anemia in ischemic stroke. Methods: Total 200 patients with ischemic stroke were included. Investigations including Hemoglobin, Mean Corpuscular Volume (MCV), MeanCorpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) serum iron level, and serum ferritin level, Total Iron Binding Capacity (TIBC), White Blood Cell (WBC) count andplatelets count (PC) were done. CT scan of brain was also done.Mean±SD were evaluated for quantitative variables which were distributed normally. However, median with inter-quartile range were evaluated for quantitative variables which were non-normally distributed. Data was compiled using SPSS version 25. To check normality of data, Shapiro-Wilk test was applied. To compare the association of qualitative variables, Chi-square test was used. Pvalue ?0.05 was considered as statistically significant. Results: In our study, out of 200 patients having ischemic stroke, 156 (78%) patients were found with iron deficiency and 44 (22%) did not have iron deficiency. Total 164 (82%) patients were anemic and 36 (18%) did not have anemia. The results showed significant mean ranks for Ferritin (p<0.001), Iron (p<0.001), Hemoglobin(p<0.001), Mean Corpuscular Volume(p<0.001), Mean Cell Hemoglobin(p<0.001), Mean Corpuscular Hemoglobin Concentration(p<0.001), and Total Iron Binding Capacity(p=0.005) with respect to iron deficiency, however White Blood Count (p=0.417) and platelet counts (p=0.511) did not have significant mean rank with respect to iron deficiency. As far as anemia is concerned, significant mean ranks was observed for Ferritin (p=0.002), Iron (p<0.001), Hemoglobin (p<0.001), Mean Corpuscular Volume (p<0.001), Mean Cell Hemoglobin (p<0.001), and Mean Corpuscular Hemoglobin Concentration (p<0.001). However, white blood count (p=0.270), platelet counts (p=0.320), and Total Iron Binding Capacity (p=0.535) did not have significant mean rank. .A significant association of iron deficiency with anemia (p<0.001) was also observed Conclusion: Study results show thatsignificant number ofischemic stroke patients have iron deficiency anemia.

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