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Beckwith-Wiedemann syndrome (BWS) is a pediatric overgrowth disorder which predisposes to tumor development. The following case study examined a prenatal finding of omphalocele with postnatal findings of macroglossia and cutaneous hemangioma, ultimately leading to a diagnosis of BWS. This case highlighted the features of BWS, the diagnostic principles and the importance of a multidisciplinary team approach to its management.

A 14-year-old female patient presented with generalized body weakness and difficulty walking. Further history revealed growth and pubertal delay. On examination there was wrist widening, bowing of legs with breast, and pubic hair of tanner stage 2. Serum and urine investigations presented diagnoses of Fanconi syndrome associated with hypophosphatemic rickets with low LH and FSH levels and normal prolactin. MRI showed a normal-sized pituitary gland without any mass lesion. The patient was started with phosphorus, magnesium, and calcium supplements with 25(OH)D.

Budd-Chiari syndrome is a rare medical condition that affects one in a million people and can be caused by various thrombotic and non-thrombotic factors. In rare instances, multiple factors may contribute to its development, with coagulation factor deficiencies being a less commonly implicated cause. This case report presents a case of BCS associated with protein C deficiency and antiphospholipid syndrome (APLS). The patient is a 30-year-old woman who was brought in due to sudden abdominal distension. She had a three weeks history of intractable vomiting and loose stools. There was also a history of repeated miscarriages. The laboratory findings revealed slightly elevated liver enzymes, a positive Anti-β2 GPI screening, moderately decreased Protein C level and activated protein C resistance/FV Leiden. The patient was discharged after 21 days of inpatient treatment with symptomatic improvement.

Third wave of COVID-19 has affected several countries. Case fatality rates from first and second waves are expected to be surpassed by the current wave due to various variant transmissions. This study was aimed to compare and contrast the significant clinical markers between survivors and non-survivors during the third wave of COVID-19 to assess severity and prognosis.It includes all the patients who were diagnosed with COVID-19 polymerase chain reaction (PCR) during the third wave, and were monitored for their disease course and outcomes. A total of 209 patients were included in the analysis via non-probability consecutive sampling method.The median age was higher in non-surviving patients (p = 0.010). Majority of deaths occurred in intensive care patients (p 0.001) and those with diabetes (p = 0.032) and hypertension (p = 0.003). Fever was the most predominant symptom in all patients (78.9%), dyspnea was common among expired individuals (p = 0.043) while recovered patients were more likely to be asymptomatic (p = 0.044). Gastrointestinal symptoms were not found marked during this wave. Being on ventilator has higher mortality (p 0.001). Predominant radiological findings were interstitial patches or infiltrate (43.7%). Multivariable analysis showed hypertension (p = 0.042), BiPAP/CPAP (p 0.001), being on ventilator (p = 0.004), and ARDS (p 0.001) was associated with poor survival while patchy interstitial infiltrates on X-ray had good survival probability (p = 0.032). On Kaplan-Meier survival analysis, hypertension (p = 0.003), BiPAP/CPAP (p = 0.008), ventilator (p = 0.025), ICU stay (p = 0.001), high-grade fever (p = 0.001), and ARDS (p 0.001) had reduced cumulative survival.Certain biochemical markers were more predictive of disease severity in the third-wave than the preceding waves.

Limited data exists about gender's impact on differences in risk factors and outcomes in our setting. Therefore, we sought to ascertain sex-related differences in patients with AMI in our setting.This retrospective study analyzed data from 247 myocardial infarction patients hospitalized in a tertiary care hospital, between March and October 2020. After hospital admission, all patients underwent ECG, myocardial enzymes, troponin and other biochemical tests followed by primary PCI.Patients were divided in two groups male (n = 153, mean age 55.2 ± 11.0 years) and female (n = 94, mean age 58.4 ± 12.7 years). The prevalence of smoking was higher in males than females (22.8% vs. 3.1%, p 0.01) and so was history of three-vessel disease (3VD; 18.9% vs. 7.4%, p = 0.013). History of myocardial infarction was lower in females than males (13.8% vs. 24.8%, p = 0.03) however the age did not vary significantly between the two groups (p = 0.21). Serum creatinine (sCr) levels (1.0 ± 0.77 μmol/L vs. 1.2 ± 0.73 μmol/L, p = 0.28) and body mass index (28.4 ± 5.3 vs 27.4 ± 4.8, p = 0.45) were lower in females as compared to males, however not statistically significant. The incidence of major adverse events, severe arrhythmia and in-hospital outcomes showed no significant difference (p 0.05) between the two groups. Post-op TIMI score and average length of hospital stay were not statistically different either (3.29 ± 2.9 vs. 2.6 ± 1.7, p = 0.726).Our study shows that females have a comparable age of onset of major cardiovascular events as that of males. Post-PCI clinical outcomes and in-hospital stay had no significant differences between the two groups.

Objective: To determine frequency of thrombocytopenia in patients with Chronic Hepatitis C infection. Methods: A 6 months cross sectional study was carried out to determine frequency of thrombocytopenia in all patients admitted with chronic hepatitis c infection in all medical units at Civil Hospital Karachi, from April 2, 2012 to October 1, 2012. Patients with platelet count 9 in Grade C. Results: Out of 141 patients, 46(32.6%) were male and 65(46%) were female with 1.17:1 male to female ratio. The average age of patients was 47.25 ± 11.52 years (95%CI: 45.33 to 49.17). Similarly average duration of illness was 3.06 ± 1.78 Years (Range 8 months to 9 Years) and average platelet count was 165156.74± 176324.9. Seventy five patients (53%) had thrombocytopenia (platelet count

Objectives: To determine the frequency of different types of self-reported sexualdysfunction among male type 2 diabetic patients attending diabetic clinics of National Instituteof Diabetes & Endocrinology (NIDE) at Karachi, Pakistan. Study Design: Descriptive crosssectional.Place and Duration of Study: National Institute of Diabetes & Endocrinology at DowUniversity Hospital, Ojha Campus, Karachi. From August 2014 to January 2015. Methodology:This study was conducted at diabetic clinics of NIDE at Karachi from August 2014 to January2015. Type 2 diabetic males with self-reported complaints of sexual dysfunction were selectedby non-probability convenient sampling after obtaining well informed consent. Inclusioncriteria was married type 2 diabetic males of age between 35 to 65 years with at least fiveyears duration of type 2 diabetes, taking oral hypoglycemic agents, HbA1c levels between6.5% to 9.4% and living in a stable relation with a female partner for at least one year. Patient’sdemographic, anthropometric, biochemical parameters and sexual history was recorded onpre-designed questionnaire. Arizona Sexual Experience Scale and Diagnostic and StatisticalManual of Mental Disorder-5th edition were used for quantification of sexual dysfunction. Datawas analyzed by SPSS-18, to compute mean ± SD, frequencies and percentages. P-value of

5 ORIGINAL PROF-3350 ABSTRACT... Objectives: To determine the frequency of different types of self-reported sexual dysfunction among male type 2 diabetic patients attending diabetic clinics of National Institute of Diabetes & Endocrinology (NIDE) at Karachi, Pakistan. Study Design: Descriptive cross- sectional. Place and Duration of Study: National Institute of Diabetes & Endocrinology at Dow University Hospital, Ojha Campus, Karachi. From August 2014 to January 2015. Methodology: This study was conducted at diabetic clinics of NIDE at Karachi from August 2014 to January 2015. Type 2 diabetic males with self-reported complaints of sexual dysfunction were selected by non-probability convenient sampling after obtaining well informed consent. Inclusion criteria was married type 2 diabetic males of age between 35 to 65 years with at least five years duration of type 2 diabetes, taking oral hypoglycemic agents, HbA1c levels between 6.5% to 9.4% and living in a stable relation with a female partner for at least one year. Patient's demographic, anthropometric, biochemical parameters and sexual history was recorded on pre-designed questionnaire. Arizona Sexual Experience Scale and Diagnostic and Statistical Manual of Mental Disorder-5th edition were used for quantification of sexual dysfunction. Data was analyzed by SPSS-18, to compute mean ± SD, frequencies and percentages. P-value of

Objectives: To determine the frequency of common bacterial isolates cultured from diabetic foot infection in patients with type 2 diabetes mellitus (DM) falling in Wagner's grade-2 and grade-3 classification of diabetic foot (DF) infection. Study Design: Descriptive study. Period: A six months. Setting: Dow University of health sciences and civil hospital Karachi. Methods: Completed to examine the bacterial identification in cases admitted with the infection diabetic foot along with gave Wagner's evaluation 2 and 3 at tertiary care hospital Karachi. Bacteriological finding and anti-biotic affectability profiles were completed and analyzed with utilizing standard strategies. Results: Out of 115 cases, 82 (71%) were male and 23 (29%) were female. The mean age of patients was 51.7 ±9.45 years, mean duration of diabetes was 10.6 ± 4.73 years, similarly mean length of time of diabetes foot wound was 46.15±23.75 days. 45 (39%) patients had Wegner's evaluation 2 and 70 (61%) patients had Wagner's evaluation 3. 99 cases indicated with culture growth, out of which 65 (65.65%) with gram negative microbes and 25 (25.25%) gram-positive microbes. The most successive bacteria's were Proteus (35.35%), Staph. Aureus (25.25%), Klebsiella (16.16%) and Pseudomonas (15.15%). Both gram positive and gram negative showed frequent resistance to Cloxacillin, Amoxacillin, Levofloxacin, and Linezolid, gram negative life forms likewise indicated high resistance rate to Clindamycin, Vancomycin, and Cefotaxime. Tienam (Imipenem), Sulzone (salbactam in addition to cefoperazone) and Amikacin were the best effective against gram -ve and gram +vemicrobes. Staph. Aureus and Staph. Epidermidis were profoundly susceptible to Ciprofloxacin, Ceftriaxone, Clindamycin, and Vancomycin. Conclusion: Gram negative microbes were more common than gram positive living beings. Proteus, Staph Aureus, Klebsiella and Pseudomonas aeruginosa were the most widely recognized microorganisms of DF infection. Tienam (Imipenem), Sulzone (salbactam in addition to cefoperazone), and Amikacin were best effective agents.

Objective: To compare the angiographic findings in patients with acutemyocardial infarction (AMI) and compare it with diabetic and non-diabetic patients admittedin the cardiology department of LUHMS. Study Design: Descriptive analytical study. Setting:Department of cardiology at Liaquat University of Medical and Health Sciences (LUMHS)Hospital, Hyderabad. Period: Periods of 1st June 2012 to 31st July 2013. Patients & methods:All patients with AMI and had diabetes mellitus and age eighteen or more than eighteen yearsboth male and female were included after taking informed consent. Results: Out of 297 patientsdiagnosed as AMI, 195 (65.65%) patients had acute ST elevation Myocardial Infarction and 102(34.35%) patients had acute non ST elevation myocardial infarction. Among 297 patients, 190(64%) patients were non-diabetic and 107 (36%) patients were diabetic. Diabetic patients wereolder, more often males, but prevalence of smoking was less marked. Coronary angiographicfindings among patients with AMI and diabetics revealed three vessels disease. Conclusion:Older patients with male predominance presented with AMI and had diabetes mellitus werefound to have three vessels disease in coronary angiography.

Objective: To determine the frequency of various clinical presentations of snakebitten admitted patients. Study design: Descriptive case series study. Place and duration ofstudy: This study was carried out in General Medicine ward, at Medical department of PeoplesMedical University & Hospital Nawabshah, from September 2011 to March 2012. Methodology:This study consisted of 55 patients admitted through the outpatient department, as well as fromcasualty department of Peoples Medical University & Hospital Nawabshah. Detailed History wastaken from all the patients with special regard to type of snake, age , sex , site , time of bite, timelapsed between bite and reaching to hospital. Detailed clinical examination of local features werefang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting,echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure ofenvenomation. Systemic review was also done to see any co-morbidity. All patients underwentfor base line and specific investigations especially clotting time (CT). Inclusion criteria were thatall diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history ofsnake bite with irrespective of toxicity were included. Patients with history of thorn prick, insectbite were excluded criteria. Results were prepared with help of tables and graphs. Data wasanalyzed through SPSS software. Results: Out of 55 patients included in this study, 39 were men(70.9%) and 16 patients were female (29%); with male to female ratio of 2.4:1. There was widevariation of age ranging from a minimum of >12 year to 60 year. The mean age was 39±5.8 years.In our study mostly patients 35(63.63%) reached hospital within 60 minutes followed by12(21.88%) patients within 30 minutes. 5(9%) patients reached within 90 minutes and onepatients reported more than 120 minutes. Symptoms of patients were pain at the bite side in55(100 %), ecchymosis in 18(32.72%), discharge from wound in 9(16.36%), bleeding from gum in8(4.4%) Nausea and vomiting in 7(12.72 %), hematuria in 11(20%), ptosis in 8(14.54%),drowsiness in 5(9%) and respiratory failure in 5(9%). Conclusions: We conclude that males arecommonly affected than females and the farmers and labourers are the most vulnerable sectionof the population for snake bites. In this study age, presence signs and treatment by faith healersis independent predictors of death in case of snake bite. This may provide important evidence toformulate preventive strategies especially health education.

Objective: To detect the frequency of Obesity in type 2 diabetic patients. Methods: It was a Cross Sectional study carried out at Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre Karachi from 1st Jan 2012 to 30th June 2012. Three hundred and eighty seven (387) type II diabetic patients of either sex and any age were included in the study. Non-purposive convenience sampling technique was used to enroll patients in the study. History regarding diabetes, hypertension (HTN), Cerebrovascular Accidents (CVA), smoking and other tobacco exposure was taken. Physical examination was carried out and height, weight, body mass index (BMI), blood pressure, peripheral pulses and ankle-brachial index (ABI) was calculated. Categorical variables such as Gender, Age groups, BMI groups, HTN, smoking, hyperlipidemia and ABI were expressed as frequencies and proportions. Means with standard deviations were calculated for continuous variables such as age, duration of diabetes, BMI, duration of HTN and duration dyslipidemia. For categorical variables, differences between patients were tested using the chi-square test. P value of ≤ 0.05 was considered significant. Results: Males were 128 in number (33%) and female were 259 in number (67%). Mean age was 52 yrs (+/- 9.67) and the mean duration of diabetes was 9.36 yrs (+/- 6.39). Hypertension was seen in 210 people (54%). 49(12.7%) were smokers and 39(10%) chewed tobacco. Normal BMI was seen in 62 patients (16%), 44 (11.4%) were overweight and 281(72.6%) was obese. Obesity was much more prevalent amongst the female gender that is 208(80%) versus male which was 73 (57%) and this was statistically significant (p-value 0.001). Hypertension was also more prevalent in obese patients and was statistically significant (p-value 0.04). Statistically significant lower mean BMI was found in smokers, tobacco chewers and/or had exposure to tobacco (0.001, 0.04, and 0.001 respectively). Conclusion: The study shows that there is a strong association of diabetes with obesity. Female gender had relatively higher BMI. Hypertension was more prevalent in obese diabetic subjects. Smoking and nicotine exposure was associated with significantly lower BMI.

Objective: To determine the frequency of various neurological and psychiatric symptoms associated with B12 deficiency.Study design: Observational and descriptive study. Place and duration of study: The study was conducted on patients presenting to theneurology clinics and inpatients who were admitted through the emergency department at Aga khan University Hospital Karachi, from 1stJuly 2011 to March 2012. Subjects and methods: 150 patients of either gender and age more than 18 years. Detailed history was takenfrom all the patients with special regard to anemia. Inclusion criteria were that patients above 18 years of age of either sex with low serumB12 levels. Patients having any type of neurological tumors, major ischemic stroke, major intracranial haemorrhage, patients onneuroleptic medications and any evidence of toxin induced neuropathy were excluded. All patients underwent for specific investigationcomplete blood count, serum B12 levels (derived by Radio Assay method (RIA). Further investigations Nerve Conduction Studies /Electromyography and CT Scan / Magnetic resonance Imaging of the Brain / spinal cord were carried out as and when required,depending on the clinical scenario. Results: There were 69 (46%) males and 81(54%) females. Female to male ratio was 1:0.8. The ageranged between 18 to 90 years with the mean age of 45.7+ 5.6. Out of 150 patients 107 patients (71.3 %) had severe vitamin B 12deficiency while 43 (28.7%) had mild to moderate deficiency. Neurological manifestations which were observed included; Memory wasimpaired in 13 (8.7%) of the patients. Dysarthia, along with other cerebellar signs (Nystagmus and dysdiadochokinesia) was present in9 patients (6%). 4 patients (2.7%) sought medical attention regarding their abnormal gait and their neurological examination revealedextensor planter responses and hyperreflexia. Cranial nerve examination revealed Anosmia in 2 (1.3%) and upper motor neuron facialweakness in 1 (0.66%) patients. Motor weakness was found in 2 patients (1. 3%), and spasticity in 2 (1.3%) patients. 5 patients (3.3%)had sensory complains and were found to have impaired pain and touch perception. Proximal muscle weakness in one patient whileanother patient had asymmetric muscle weakness and rest of the patients had normal muscle power. None of the patient had autonomicdysfunction. In six neuropsychiatric problems were commonly seen in vitamin B 12 deficient people. In these patients depression wasobserved in 16%, agitation 12.7 %, memory impairment 8.7%, cerebellar signs and dysarthria 6%, sensory symptoms 3.3% and gaitabnormality and hyperreflexia and extensor planters 2.7 %. Conclusions: Various Neuropsychiatric problems are associated with vitaminB 12 deficiency and the most common Neuropsychiatric illness found in these patients were depression, agitation, and memoryimpairment.

Objective: The objective of this study is to determine the pattern dyslipidimia in patients of Type 2 diabetes mellitus. StudyDesign: Cross-sectional study. Place and Duration: This study was carried out in General Medicine department of Peoples MedicalUniversity & Hospital Nawabshah and Civil Hospital Karachi, from June 2011 to July 2012. Methodology: This study consisted of seventypatients. Detailed history was taken from all the patients with special regard to increased thirst and frequent urination, increased hunger,weight loss, fatigue, blurred vision, slow-healing sores or frequent infections and an areas of darkened skin. Inclusion criteria were that allpatients after counseling for study and taking written consent were included in this study >35 years of age with either sex admitted ingeneral medicine ward through outpatient department and diagnosed as case of DM type 2 on the basis of history , clinical examinationand investigations. Exclusion criteria included patients on dialysis, patients on lipid lowering agents, patients with acute complication ofdiabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, nephritic syndrome, type 1 DM and HTN, lacticacidosisand hypoglycemia. Results were prepared with the help of tables and graphs. Data was analyzed through SPSS software.Results: Out of 70 patients included in this study 46 were men (65.8%) and 24 patients were female (34.2%); with male to female ratio of1.9:1. There was wide variation of age ranging from a minimum of 35 year to 75 year. The mean age was 48.65+7.8 years. Mean totalserum cholesterol was 196.04 ± 44.02mg/dl, mean serum triglycerides was 193.04 ± 108.64 mg/dl , mean high density lipoprotein29.28 ± 8.48mg/dl, mean low density lipoprotein 125.24 ± 39.68mg/dl and mean very low density lipoprotein was 31.28 ± 8.48 mg/dl.Total cholesterol was abnormal (>200mg/dl) in 56(80%) patients out of 70[ 21(87.5%) were females and 35 (76.1%) were males],Triglycerides was abnormal (>150mg/dl) in 62(88.5%) patients [ 22 (91.66 %) were females and 40 (86.95%) were males], high densitylipoprotein was abnormal (< 35 mg/dl) in 51(72.8%) patients[ 18(75%) were females and 33(71.73%) were males], LDL was abnormal(>130 mg/dl) in 40(57.1%) patients [ 17 (70.83%) were females and 23(50%) were males] and VLDL was abnormal (> 30 mg/dl) in47(67.14%) patients [19(79.16%) were females and 28(60.86%) were males]. Conclusions: We conclude that dyslipidemia is commonamong type 2 diabetic patients. Males are more prone to suffer from this complication. Patterns of dyslipidemia found more commonlywere decreased HDL levels, increased LDL and Triglycerides levels. There is a need for early detection and treatment of this problem toprevent type 2 diabetic complications .

objective: To determine the frequency of proteinuria in HIV positive patients at a tertiary care hospital in Karachi. Studydesign: Cross-sectional. Place and duration of study: This study was carried out in Infectious diseases wards and all medical wards of CivilHospital Karachi, from Jan 2011 to the Dec 2011. Methodology: A total of 170 patients from infection diseases wards and all medical wards ofCivil Hospital Karachi. Age more >12 years of either sex who were newly diagnosed cases of HIV based on positive HIV serology by ELISA andWestern blot in Infection diseases ward were Included. Patients having known kidney disease. urinary tract infection, serum creatinine morethan 1.5 mg/dl, diabetes mellitus, high blood pressure and old diagnosed cases of HIV who have already taken or who are taking HIV infectiontreatment were excluded from this study. Spot urinary sample was taken to measure the proteinuria by urine dipstick. To minimize bias allspecimen sent to same laboratory of the hospital. Results: 170 newly diagnosed cases of HIV were included in this study. Gender distributionshowed male preponderance (Male: Female = 6.4:1). Majority of cases 120 (70.6%) had age between 26 – 50 years. Mean age of women was30.3 ±7.4 years (min – max = 18 – 45 years) and for males was 34.3 ±9.6 years (min – max = 15 – 56 years). Out of 170 HIV positive casesfrequency of > 1+ protein in urine on urine dipstick analysis was found in 27 (15.9%) cases. Out 27 cases, 16 (59.3%) cases had age between26-50 years (mean ±SD = 32 ±10.1 years, min – max = 18 – 55 years). Proteinuria was high in increasing age groups. Proportion of proteinuriawas high in married and depressed patients , out of 27 cases, 18 (66.7%) were married and 9 (33.3%) unmarried. Frequency of proteinuria washigh in labor class, 11 of 27 (40.7%) were labors followed by house wife 6 (22.3%), while 5 (18.5%) were private job holder. Conclusions: In thisstudy I found a high prevalence of proteinuria in HIV positive patients. Such subjects show male preponderance distribution. We conclude thatHIV positive patients should be screened for proteinuria and if they found to have proteinuria, they should be subjected to appropriate treatmentto retard the progression of nephropathy and associated complications.

Objectives: To determine the frequency of dyslipidemias in patients with stroke and to compare the lipid levels in ischemic andhemorrhagic stroke patients. Study design: An observational study. Setting: Medical wards of Civil Hospital Karachi. Period: January 2010 toJune 2011. Methodology: A total of three hundred and fifty- five patients above the age of 18 years with clinical evidence of stroke. CT scanbrain and fasting lipid levels were done in all patients. The lipid levels were compared between the ischemic and hemorrhagic stroke patients.Data was analyzed with SPSS version 16.0. Results: Out of the 355 patients 161 (45.4%) had dyslipidemia. Among the dyslipidemic patients,there was not a statistically significant difference in serum cholesterol, triglycerides, and LDL and HDL levels between ischemic andhemorrhagic stroke. (p- value > 0.05). Conclusions: There is a high frequency of dyslipidemia in stroke patients. While comparing ischemicand hemorrhagic strokes there was not a significant difference between the various lipid fractions.

To find out the frequency of hyper-homocysteinaemia in ischaemic stroke patients and its relation with other risk factors.The cross-sectional study based on convenience sampling was conducted at the Civil Hospital, Karachi, from May to July 2012. It comprised ischaemic stroke patients selected from the Out Patient Department and Emergency Department. An overnight 8-hour fasting venous blood sample (4 ml in ethylenediamminetetraacetate) was drawn for analysis. Rest of the data was collected through a structured proforma and was analysed using SPSS 17.0.The mean age of the 96 patients in the study was 64.9 ± 10.9 years (range: 40-85). Overall, 56 (58.3%) cases had hyper-homocysteinemia.The frequency was significantly high in the age 60-79 age group (p0.007).Hyper-homocysteinaemia, a modifiable risk factor, is associated with a high number of ischaemic stroke patients. Hence, steps should be taken to minimise this risk factor by screening and early intervention.

Background. End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported.Methods. This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient.Results. 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 years. Sixty percent (n=262) of the children were boys. The most common etiology of ESRD was kidney stones (n=44, 29.3%). HBV was positive in 11 children (2.5%) while HCV was positive in 13 (2.9%).Conclusion. This study asserts the need for carrying out further work to confirm these findings and expand our recommendations. It is imperative to reliably determine the burden of HBV and HCV disease and to determine the aetiology of their spread especially in children with ESRD.

To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country.Cross-sectional, observational study.Medical Wards of Civil Hospital, Karachi, from January to June 2013.Patients aged ≥18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA).Atotal of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5%) were males and 45 (42.5%) females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. Atotal of 17 (16%) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of60 years of age, 26% developed hyperthermia compared to 7.1% in patients of ≥60 years of age (p=0.008). On gender stratification, among male patients, 14.8% developed hyperthermia compared to 17.8% in female patients (p=0.43).It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia.

To determine the frequency and factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients presenting at Civil Hospital, Karachi.A cross-sectional study.Department of Medicine and Diabetic Clinic of Civil Hospital and Dow Medical College, Karachi, from November 2010 to May 2011.A total of 358 adult type-2 diabetics with hypokalemia were selected for this study. With aseptic measures, venous blood was collected for serum magnesium, potassium, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) from each subject after an overnight fasting and was analyzed on Roche Hitachi 820 Photo Spectrometry. The data was analyzed on SPSS version 17 to determine the factors associated with hypomagnesaemia like duration of diabetes, Body Mass Index (BMI), diabetic nephropathy, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) level.Mean age of study population was 55.62 ± 9.9 years. Most of them (n=228, 63.7%) were males. Out of the 358 subjects, 198 (55.3%) had hypomagnesaemia. There was significant association between hypomagnesaemia with duration of diabetes, Body Mass Index (BMI), diabetic nephropathy, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) level.Hypomagnesaemia is very common in type-2 diabetic hypokalemic patients. Therefore, it should be routinely sought by the clinicians. Early recognition and subsequent treatment of hypomagnesaemia may help in better glycemic control, may delay the chronic complications and decrease the mortality in diabetic hypokalemic patients.

Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons.Descriptive study.Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011.The study group comprised consecutive patients with acute coronary syndrome (unstable angina, Non ST-Elevation Myocardial Infarction (NSTEMI), ST-Elevation Myocardial Infarction (STEMI) admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, (winter, spring, summer and autumn).The mean age of the 428 cases was 48.5 ± 10.4 years (range 27 to 73 years). Among the study group, 261 (61%) and 167 (39%) cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 (48%), 128 (30%) and 94 (22%) respectively. Among the 428 patients, 184 (43%) cases had hypertension, 133 (31%) cases were smokers, 103 (24%) cases had dyslipidemia and diabetes mellitus and 08 (2%) cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 (36.9%) and Summer 130 (30.3%) in comparison to Spring 80 (18.69%) and Autumn 60 (14.02%) season.It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season (winter) but also in hot season (summer) with sudden changes in temperature.

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report on a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour.

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration.