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Introduction: AKI (acute kidney injury) can affect twenty percent of the patients who have been hospitalised. It also contributes to major health implications which can as a result affect socioeconomic implications. Objectives of the study: The main objective of the study is to analyse the arterial stiffness subsequent coronary artery bypass graft for prediction of acute kidney injury. Material and methods: This cross-sectional study was conducted in Health department Punjab during 2018 to 2019. Only the patients who due to have CABG were included in the study and all the others that had CKD stage 4 or 5 were excluded from the study. Blood and urine samples were collected of all the patients included in the study. Data regarding the demography, subject’s medical history which included heart rate, blood pressure and other factors were collected. All the assessments were done in the same visit. Results: The number of participants which were included in this study was 137 in a period of two years. In table 1, their demographic measurements are presented. 85 percent of the participants of the study were male (85%(n= 116)), the mean age of 66.3. Majority participants did not have a renal disease and were not unstable before surgery, but 29(40) percent of the patients developed AKI as defined by the criteria of KDIGO. Conclusion: It is concluded that PWV was assessed erstwhile to CABGs which predicted AKI events post-operative in this exploratory study.

Introduction: Hypertensive crises have been divided into two categories: hypertensive urgencies and hypertensive emergencies. Objectives of the study: The main objective of the study is to analyze the oral anti-hypertensive medication in blood pressure elevation. Methodology of the study: This cross-sectional study was conducted in Health department Punjab during October 2018 to March 2019. The data was collected from 100 patients which was suffering from high blood pressure and use oral antihypertensive medication. We defined the presence of a written item in the medical records consenting to the use of oral antihypertensive medication when blood pressure reached a certain level as antihypertensive prescription before elevation of blood pressure. Results: The data was collected from 100 patients who used antihypertensive medication. In 22 (50.7%) patients, prescription of antihypertensive medication before elevation of blood pressure occurred in the absence of treatment with maintained antihypertensive therapy. There are number of factors which influence on blood pressure levels. Age, cholesterol, BMI and diet are the main factors which directly effect on blood pressure levels. Conclusion: It is concluded that the results of the present study show a high frequency of prescription of antihypertensive medication preceding elevation of blood pressure.

With recent availability of Sofosbuvir, Chronic Hepatitis C treatment paradigmhas changed considerably. However for a resource constrained country like Pakistan, still thestandard treatment of Chronic Hepatitis C remains the combination of Interferons and Ribavirin.Depression, sometimes major, is a recognized side effect of this combination. Objective: Theobjective of our study was to analyze the prevalence of depression during treatment with pegylatedinterferon and ribavirin in patients infected with Hepatitis C at two tertiary care hospitals Lahore.Setting: All these patients were selected randomly from outpatient departments at FatimaMemorial Hospital and Alshafi Hospital Lahore. Duration of study: Duration of our study wastwo years and 3 months from January 2010 to April 2012. Patients and Method: We included180 patients in our study. We confirmed the diagnosis of chronic hepatitis C in all these willinglyparticipated patients. All these participants were put on combination of pegylated interferonand ribavirin. Serial follow ups were done for the assessment of development of depressionduring the treatment of Hepatitis C. Results: 46.8 (26%) patients developed depression duringtreatment. Depression was more common in the middle of treatment which gradually improvednear the end of treatment. Conclusion: We reached at a conclusion in our study that there isdefinite correlation of depression with pegylated interferon and ribavirin therapy in hepatitis Cpatients.

Liver disorders during pregnancy may have a strong bearing on both mother andthe foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regionalstudies have shown it to be the most common cause of Acute Hepatitis in pregnant females. Wecarried out our study to elaborate the demographic profile of pregnant females presenting withAcute Hepatitis E along with the fetomaternal outcomes. Study Design: It was a prospective,observational study. Intervention: None. Settings and Participants: Over a period of two years,73 pregnant patients were evaluated by our team in the Department of Gastroenterology forsuspicion of liver disease. Outcomes and Measurement: Data was evaluated for quantitativeand qualitative variables. Outcome of mother, pregnancy and neonates was also recordedwhere available. Results: During the study period 73 pregnant patients presented with liverdisease giving an incidence of 3.6%. Serological evidence of Acute Hepatitis E was found in 50(68.5%) of the patients. Fulminant hepatic Failure developed in 5 (10%) patients. All five patientswith FHF could not survive. There were 4 (8%) intra-uterine deaths, 1 (2%) abortion and 5 (10%)neonatal deaths. Shortcomings: Relatively small sample size. Conclusions: Acute hepatitis Eduring pregnancy predicts poor outcomes for the mothers, foetus and neonates

Objective To assess the utility of liver function tests (LFTs) for early recognition and prediction of severity of Dengue fever in hospitalized patients. Study design An analytical study. Place and duration of study Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September - December 2010. Methodology Admitted cases of Dengue fever were divided into 3 groups; mild, moderate and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. (survival or complication free stay) or (death or complications). RESULTS were analyzed in SPSS version 18. Results Out of the 353 patients with mean age of 37.12 ± 15.45 years, 245 (69.4%) were males and 108 (30.6%) were females. Seventy five patients (21.2%) had mild elevation of aminotransferases (2 fold increases), 265 patients (75.1%) had moderate increases (3 to 4 fold) and 13 (3.7%) had severe (> 4 fold increase). ALT was statistically higher in patients with septicemia, hepatic and renal failure (p-value ² 0.05). AST was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. Conclusion AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases.

Combination therapy with interferon and ribavirin has become the standard of care in the treatment of Chronic Hepatitis C (CHC) infected patients. Treatment response, however, is not 100% and is accompanied with side effects faced by the patient as well as observed in haematologic indices. Studies are focusing on daily or high-dose induction therapy with interferon, the titration of interferon dosing to initial viral load, higher doses of interferon throughout treatment, and adjustment of interferon dosing to the viral responses. The safety and efficacy of these approaches have not been sufficiently established. Objectives were to see the response of 2 different dosage regimens, effects and side effects and to assess the efficacy and side effects of 2 treatment regimens of Interferon and Ribavirin in CHC.A total of 32 patients with CHC at Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute Lahore from June 2001 to February 2003 were included in the study and were divided into two groups for treatment. Group A (14 patients) received 5 MU of injection Interferon alpha 2 b S/C daily for 2 weeks followed by 3 MU thrice weekly for the next 22 weeks. Group B (18 patients) received injection interferon alpha 2 b 3 MU S/C thrice weekly for 24 weeks. Ribavirin therapy was started at 1200 mg daily in 3 divided doses and later modified according to side effects. Patients were evaluated at 2, 4, 8, 12, 16, 20 and 24 weeks during the therapy and then 24 weeks after the completion of treatment.Out of 32 adult patients included in the study, 18 were males and 14 females. Haemoglobin was more than 12 gm/dl in females and more than 13 gm/dl in males, WBC count was more than 3.0 x 10(9)/L and Platelet count was more than 100 x 10(9)/L. Twenty patients completed 6 months combination treatment, 16 reported with their end of treatment HCV RNA PCR results, 8 from each group. Twelve patients were lost to follow up. End of treatment response (ETR) in group A was 88% and 62.5% in group B. Sustained virological response in group-A was 5/8 (62.5%) and 4/5 (50%) in group-B. The frequency and severity of flu like symptoms like fever, body aches, skin rash, hair loss, cough and psychiatric symptoms were more in group A than in group B. There was no significant difference in the 2 groups for haematologic side effects.Treatment with 5 MU interferon daily for initial two weeks followed by 3 MU thrice weekly for 22 weeks is more effective than 3 MU thrice weekly for 24 weeks but with more side effects.

Ectopic intestinal varices are rarely responsible for lower gastrointestinal (GI) haemorrhage. A case of 55 years old male with recurrent melena is being presented, who was found to have scattered varices on small as well as large intestine. Selective review of literature regarding presentation, diagnosis and management of these cases is also part of presentation.