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Objective: To evaluate the diagnostic accuracy of Strain Elastography in detection of breast carcinoma taking histopathology as gold standard. Study Design: Cross sectional study. Setting: Department of Radiology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: June 2021 to May 2022. Methods: Patients aged 25 to 65 years with clinically palpable breast lump of any size with pathological nipple discharge. This study was conducted from June 2021 to May 2022 in department of radiology. Each patient will be subjected to sonoelastography followed by ultrasound guided trucut biopsy. The strain ratio cut off value of 4.8 will be used to differentiate benign from malignant lesion. Results of Strain Elastography will be compared with histopathology reports. Result: Mean age was 37.40 ±11.54 years. The sonoelastography showed sensitivity of 88.57%, specificity of 90.20%, positive predictive value of 75.61% and negative predictive value of 95.83%. So diagnostic accuracy of sonoelastography was 89.78% in diagnosis of malignant breast lesions. Conclusion: Sonoelastography has good sensitivity and specificity in diagnosis of malignant breast lesions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of oral zinc supplementation in cirrhotic patients with hepatic encephalopathy. Study Design: Retrospective Cohort study. Setting: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: 15th February 2019 to 15th August 2019. Material & Methods: Adult patients of either gender suffering from hepatic cirrhosis and presenting with hepatic encephalopathy of any grade were included. Zinc acetate in a dose of 600 mg was given orally to the patients for two weeks duration. Standard lactulose treatment was also given alongside. Blood ammonia measurement was done at baseline and also after 2 weeks of treatment. Performance was assessed by utilization of number connection test (NCT) at week 1 and week 2 weeks post treatment. Results: Study included of 135 patients among which majority 95 (70.4%) of the patients were males. The mean age of the patients were 55.72 + 10.32 years. 40 (26.62%) patients were seen in Child Pugh class A, 65 (48.14%) were seen in Child Pugh class B and 30 (22.2%) were seen in Child Pugh class C. Serum ammonia levels were reduced in 110 (81.48%) patients and improved performance in NCT was seen in 90 (66.66%) patients. There was significant reduction of ammonia levels and significant improvement of NCT test in male patients (p value <0.05) and in Child Pugh class A and B patients (p value <0.05). Conclusion: In addition to standard therapy, inclusion of oral zinc acetate resulted in normalization of blood zinc and ammonia levels with improved performance in NCT and overall hepatic encephalopathy. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of the common causes of lower gastrointestinal bleeding by Colonoscopy as a diagnostic modality in patients with gastrointestinal bleeding. Study Design: Cross Sectional Descriptive study. Setting: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: March 2021 to August 2021. Material & Methods: This study was performed in Liaquat University of Medical and Health Sciences, Jamshoro in patients presenting with lower gastrointestinal bleeding. History, examination and investigations were carried out. After stabilizing the patient lower gastrointestinal endoscopy was performed. Results: Total 139 patients were included in this study. Intermittent bleeding per rectum was the main presenting complaint followed by continuous bleeding per rectum. The average age of the patients was 45.61 ±16.40 years. Out of 139 patients, 94(67.6%) males and 45(32.4%) females. Bleeding related to internal hemorrhoids was present in 40(28.8 %) patients 30(21.6%) male and 10(7.2%) females as the most common cause of lower GI bleed followed by rectal ulcers 14(10.1%) and polyps in 9(6.5%) patients. infective colitis, proctitis and colonic ulcers were noted in 8(5.8%), 6(4.3%) and 5(3.6%) patients respectively. Malignant lesions in colon and rectum were noted in 8(5.8%) and 3(2.2%) patients while ulcerative colitis, crhon's and diverticular disease were noted in 5(3.6%), 1(1.4%), 2(0.7%) patients respectively. 29(%) had normal clonoscopic examination. Conclusion: In our population hemorrhoid bleed is the leading cause of lower gastrointestinal bleeding followed by bleeding due to rectal ulcer and polyps. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy of magnetic-resonance-cholangio-pancreatography (MRCP) in comparison with the endoscopic retrograde-cholangio-pancreatography (ERCP) in the diagnosis of obstructive biliopathy. Study Design: Cross Sectional study. Setting: Department of Radiology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: October 2020 to April 2021. Material & Methods: Patients with suspected obstructive biliopathies highlighting need for ERCP were included in this study. MRCP was performed. ERCP was performed by duodeno-videoscope and general electric fluoroscopy. MRCP and ERCP were done which were reviewed by radiologist and were reviewed by radiologist and gastroenterologist and both were to the results of both modalities. Results of obstructive biliopathy from both techniques were compared, according to the pathology found. The sensitivity, specificity, and positive and negative predictive values were calculated. Statistical significance was set at p<0.05 with 95% confidence interval. Results: MRCP had sensitivity, specificity, positive and negative predictive values of 87%, 80%, 83.3% and 84.2% respectively for obstructive biliopathy (choledocholithiasis). Conclusion: MRCP has high diagnostic accuracy for bile duct calculi and is a useful noninvasive technique to diagnose biliary pathologies and avoids unnecessary ERCPs and its complications. [ABSTRACT FROM AUTHOR]

Objective: Aim of study was to determine outcomes of patients treated with N-butyl-2-cyanoacrylate. Study Design: Retrospective study. Setting: Department of Gastroenterology at Liaquat University of Medical and Health Sciences, Jamshoro. Period: December 2019 to March 2020. Material & Methods: A Retrospective study was conducted between by viewing medical records and endoscopy reports. Total 31 patients were enrolled with gastric variceal bleed that underwent endoscopic injection of N-butyl-2-cyanoacrylate we examined the mortality rate, hemostasis, Hospital stay, need of blood transfusion, and effectiveness of procedure. Results: A Total of 31 patients, out of which 18 (58.1 %) were male; the mean age was 55.23±8.778 years. Of these patients 23 (74.2 %), had concomitant esophageal varices, Child-Pugh class-A, B, C were seen in 4, 20 & 7 patients (12.9, 64.5 % & 22.6) respectively. Average duration of hospital stay was 5 to 8 days in 22 cases (71.0 %). Less than 3 pints of PRBC were transfused in 17 cases (54.8 %). Hemostasis was achieved in 27 patients (87%). Overall mortality rate was 3 out of 31(9.7%). one patient was referred for TIPSS. No complications from cyanoacrylate injection were observed. Conclusion: Standardized injection technique and regimen ensures the success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices in experienced hands. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the frequency of renal impairment after spontaneous bacterial peritonitis (SBP) in cirrhotic population. Study Design: The study was conducted as Descriptive Cross-Sectional. Setting: Liaquat National Hospital Karachi. Period: For six months (October 01, 2015 to March 31, 2016). Methodology: The subjects with liver cirrhosis spontaneous bacterial peritonitis (SBP) were evaluated for serum creatinine and serum blood urea nitrogen (BUN) for evaluation of renal impairment while the patient's information was recorded on proforma and analyzed in SPSS-15.0. Results: The mean ±SD of age, BUN and serum creatinine for whole population was 50.69±10.69 years, 22.4197±11.64742 and 1.2207±0.92535. Renal impairment was detected in 40 (27.2%) individuals while it is normal in 107 (72.8%) subjects. Conclusion: The renal impairment after SBP in cirrhotic population is higher in present study. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between pre hospital use of proton pump inhibitors and spontaneous bacterial peritonitis in patients presenting with liver cirrhosis. Study Design: Case control study. Setting: Department of Gastroenterology at Liaquat National Hospital Karachi. Period: Six months (From March-2017 to August-2017). Material and Methods: There were 120 patients with cirrhosis were included in this study. Sixty patients were cases with spontaneous bacterial peritonitis (SBP) and 60 patients were control without spontaneous bacterial peritonitis. All patients were interviewed for pre hospital intake of PPI (as per operational definition). All the data was entered on predesigned proforma (attached). Results: The average age of the patients was 42.47±9.87 years. Rate of PPI use was significantly higher among cases with SBP (46.7%) as compared to the patients without SBP (23.3%). Conclusion: In conclusion, PPI use (acid suppression) was associated with the development of SBP in cirrhotic patients with ascites. We recommend that PPI indications in cirrhotic patients should be frequently re-evaluated with particular attention devoted to duration of use, especially following endoscopic variceal ligation (EVL). [ABSTRACT FROM AUTHOR]

Objectives: To correlate severity of thrombocytopenia with different grades of esophageal varices in chronic liver disease patients undergoing EGD in a tertiary care hospital. Study Design: Cross sectional study. Setting: Gastroenterology & Hepatology Department at Liaquat National. Period: Six months from Jan to June 2016. Material and Methods: Seventy six subjects of chronic liver disease were recruited and studied for correlation between platelet count and esophageal varices by gastroscopy while the data was analyzed in SPSS version 17. Period: From July 2016 to Dec 2016. Results: There were 55 (72.4%) males and 21 (27.6%) females. The mean age was 45.6 ± 14.7 years. 10 (13.2%) had Hepatitis B, 58 (76.3%) Hepatitis C, 01 (1.3%) Wilson's disease, 03 (3.9%) Autoimmune disease and 04 (5.3%) Alcoholic liver disease. 09 (11.8%) had Child-Pugh Class A, 41 (53.9%) Class B and 26 (34.2%) had Class C. The mean platelet count was 85/μl ± 40.2/μl. Out of 76 patients 70 (92.1%) had esophageal varices. 23 (30.3%) had grade III varices, 19 (25%) had grade II, 14 (18.4%) each had grade I & IV and 06 (7.9%) had grade 0 varices. Conclusion: thrombocytopenia can predict the occurrence of esophageal varices in cirrhotic population while gastroscopy has high yield for varices. [ABSTRACT FROM AUTHOR]

To evaluate the frequency of Helicobacter pylori in individuals with functional dyspepsia. Study Design: Cross sectional descriptive study. Period: Six months from 01-May-2014 to 31-10-2014. Setting: Liaquat National Hospital, Karachi. Materials and Methods: All the patients between 18 to 70 years of age diagnosed as functional dyspepsia for more than 03 months duration were admitted and evaluated for Helicobacter pylori infection through histopathological examination. Results: Total 121 subjects with functional dyspepsia were screened for Helicobacter pylori infection. The mean ±SD for age of subjects with functional dyspepsia was 41.74±08.87. The mean age ±SD of Helicobacter pylori infected individuals was 40.70±7.82 while the mean ±SD of age in helicobacter pylori negative patients was 40.55±10.63. Majority of the subjects were out-patients, 30-39 years of age with male predominance. The most common duration of disease observed was 6-9 months with epigastric pain and burning the predominant symptoms. The Helicobacter pylori infection was observed in 78(64.4%) individuals, of which 55 were males and 23 were males (p=<0.01). Conclusion: The functional dyspeptic patients are prone to acquire Helicobacter pylori infection therefore present study reported 64.4% prevalence for H. pylori infection with male gender predominance. [ABSTRACT FROM AUTHOR]

To determine the frequency & severity of liver involvement in dengue infection among adults at tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology and Department of Medicine Liaquat National Hospital, Karachi. Period: Six months (9th May 2016 to 9th Nov 2016). Materials and Methods: A total of 343 patients with Dengue fever were selected to conduct this study with mean age of 34.67±9.09 years. Results: Mean duration of the fever was 7.31±1.62 days. Mean duration of hospital stay of the patients came out to be 3.50+0.82 days. Severity of liver enzymes derangement was mild in 80 patients (23%), moderate in 246 (72%) & severe in 17(5%). Mortality was seen in 14% (47 patients) & 100% mortality was seen in dengue fever patients with severely deranged Liver enzymes. Conclusion: Dengue fever patients with deranged liver enzymes had statistically worse outcome thus can lead to early recognition of high risk cases. [ABSTRACT FROM AUTHOR]

To evaluate the frequency of H. pylori stool antigen in individuals with dyspepsia. Study Design: Cross sectional study. Setting: Liaquat National Hospital, Karachi. Period: July-2017 to 31st December-2017). Materials and Methods: The individuals with dyspeptic symptoms for =3 months durations were included and explored for H. Pylori infection by H. Pylori stool antigen while the result were analyzed and frequencies and percentages were calculated. Results: The mean ± SD for overall population was 36.29±8.57 years while the frequency of H. pylori was recorded as 38.57% (54/140) patients respectively. Conclusion: H. pylori infection usually observed in dyspeptic individuals and should be screened for eradication therapy. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of hepatoma in patients with cirrhosis attending tertiary care hospital Karachi. Study Period: Six months July to December 2017. Study Design: Descriptive cross sectional study. Setting: Department of Gastroenterology, Liaquat National postgraduate Medical centre Karachi. Patients and Methods: The clinical history was taken from patients and ultrasound of liver was done to and mass if any and its size was noted. Noninvasive criteria for diagnosing hepatoma were utilized and all information was noted and entered in the proforma and analyzed in statistical software. Results: A total of 213 cases, 15.02% individual hepatitis B and 21.13% subject hepatitis C. Frequency of hepatoma in cirrhotic population detected as 10.33% (22/213). Rate of hepatoma was not significant among different age groups (p=0.202). Rate of hepatoma was also not significant between male and female (p=0.59). Conclusion: Persistent chronic viral hepatitis B and C infection with cirrhosis responsible for acquiring hepatoma. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of fungal urinary tract infection among patient with chronic liver disease. Study Design: Cross-sectional study. Period: Six months from 18th March 2016 to 18th September 2016. Setting: Department of Gastroenterology, Liaquat National Hospital Karachi. Patients and Methods: All the patients between 18 years to 60 years of age, either gender and diagnosed case of chronic liver disease of child class A & B for > 1 years duration were enrolled and explored for fungal urinary tract infection while the data was saved and analyzed in SPSS 16 to present the frequencies, percentages and mean ±SD. Results: A total of 236 CLD patients were included in the study of which 70 patients (30%) were male and 165 patients (70%) were female, with mean age of 53.47±5.51.30 years, mean duration of CLD and mean BMI was 3.50±1.50 years and 27.32±1.88 kg/m2 respectively. Most of the patients (85%) were child class C whereas 141 patients (59.7%) had fungal UTI. Conclusion: Fungal urinary tract infection in CLD patients is common as these patients are immunocompromised and has excessive use of antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of culture positive (SBP) and culture negative spontaneous bacterial peritonitis (neutrocytic ascites) in cirrhotic population. Period: The six months (November 08th 2012 to May 07th 2013). Study Design: Descriptive crosssectional study. Setting: Department of Gastroenterology at Liaquat National Hospital. Total 107 patients of liver cirrhosis with ascites admitted in our hospital. All the specific patients had ascitic fluid DR and C/S were enrolled and evaluated. Patient's information was recorded on proforma and analyzed by using SPSS-20.0. Results: SBP was detected in 10 7 patients aged between 18 and 67 years included in study. Out of 107 patients with SBP 23 (21.5%) were culture positive while 84 (78.5%) were culture negative. In the culture positive group, 19 (82.6%) were male and 4 (17.4%) were female while in culture negative group 46 (54.76%) were male and 38 (45.24%) were female. The ascitic fluid mean total leukocyte count in patients with culture positive ascites was 5140.39 / mm3 and in culture negative ascites was 2654.26 / mm3. The ascitic fluid mean neutrophils count in subjects with culture positive ascites was 75.57% and in culture negative ascites was 76.02%. The ascitic fluid mean lymphocyte count in individuals had culture positive ascites was 26.09 % and in subjects had culture negative ascites was 23.97%. Conclusion: Frequency of culture negative ascites is greater than culture positive ascites in SBP. The ascitic fluid mean total leucocyte count for culture positive ascites is greater than culture negative ascites. Mortality is high in culture positive ascites. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of tamsulosin with and without tolterodine in patients having benign prostatic hyperplasia (BPH) with irritative (overactive bladder) symptoms. Study Design: Randomized clinical trial. Setting: Department of Urology and Kidney Transplantation, Sheikh Zayed Hospital Lahore. Period: Six months from July to Dec 2017. Patients and Methods: Sixty patients of BPH had irritative (overactive bladder) & obstructive presentation were recruited. Patients were categorized in two groups and were compared for efficacy according to international prostatic symptom scoring while the data analyzed in SPSS 16. Results: Patients with BPH having irritative (overactive bladder) symptoms, after receiving Tamsulosin with Tolterodine, 76.60% (23/30) of patients reported symptomatic improvement whereas only 40.00 % (12/30) of subjects improved with tamsulosine only. Rate of improvement was observed to be higher in individuals with tamsulosine with tolterodine (Group B) than group A (includes tamsulosin only) with statistical significance) chi-square = 8.297; p=0.004). Conclusion: Efficacy of tamsulosin with tolterodine is higher than tamsulosin alone in subjects with BPH had irritative (overactive bladder) & obstructive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency & histopathological type of gastric pathology in individuals presenting with epigastric pain. Period: Six months from July to Dec 2017. Study Design: Cross sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital Institute for Postgraduate Medical Studies and Health Sciences, Karachi. Patients and Methods: The total of 333 patients had history of epigastric pain were included in this study. The specimen for mucosal biopsy was taken during endoscopy and sent to the clinical laboratory for histopathology examination for the classification. All the information was entered and saved on the annexed / proforma. Results: The mean ±SD of age for all the patients was 41.31±7.89 years. Frequency of gastric pathology in patient presenting with epigastric pain was 51.35% (171/333) cases. There were 171 histopatholocal diagnoses, non- Noeplastic lesion was confirmed in 99.42% (170/177) and one case had Noeplastic lesion. Regarding the type of gastric pathology, 25.73% (44/171) had gastric ulcer, 48.54 (83/171) was H. pylori gastric and 25.15% (43/171) had chronic gastritis. Conclusion: The study frequency of gastric pathology in patient presenting with epigastric pain was high. [ABSTRACT FROM AUTHOR]