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Objectives: To determine the prevalence of cerebellar Ataxia in patients with hypothyroidism. Materials and Methods: The design of this study was cross sectional study design and this study was conducted in Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. This study was conducted in the duration of 6 months from July 2022–Dec 2022. Total 13 patients with hypothyroidism were enrolled. Routine blood investigation and Thyroid Function Tests were done for all patients. MRI was done for all patients in order to rule out demyelinating, vascular and structural causes of cerebellar ataxia. All the data was collected in predesigned questioner. Results: A total of 13 patients with mean age of 50.92±11.21 years were enrolled. Out of total, 69.2% patients were male and 30.8% patients were female. Clinical characteristics of enrolled patients are given in table 1-0. The mean and SD value of T3, T4 and TSH were 50.9±11.21, 2.80±0.63 and 77.30±10.57 respectively. The TPO antibodies test were performed that shows mean value of 31.15±3.38, that fall in normal range. And MRI brain was also normal. Distribution of patients on the basis of Ataxia was done and it was found that 4 (30.8%) had ataxia. Practical implication: This study will help the clinical practitioner to keep in mind that there is chance of ataxia in patients suffering from hypothyroidism. So the clinical practitioner should take care of the patients to avoid such complication. There is evidence that the ataxia has been reversed by thyroid replacement therapy. Conclusion: It is concluded that Hypothyroidism is responsible to cause cerebellar ataxia. Therefore early treatment should be taken to avoid this manifestation. Keywords: Cerebellar Ataxia, hypothyroidism, Thyroid Function Tests

Objectives: To determine the effect of IV iron therapy on patients with Iron deficiency presenting with somatic symptoms. Materials and Methods: The design of this study was The Quasi-experimental study design and this study was conducted in Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. This study was conducted in the duration of 6 months from July 2022–Dec 2022. Totally 90 patients were enrolled. 5ml venous blood sample were collected from of each patient and sent to laboratory of the hospital for complete blood count and serum ferritin level. Patients with iron deficiency were treated with IV iron. Then after eight-week treatment the patients were followed again and 5ml blood were collected in EDTA containing tube. Serum ferritin level was evaluated again at the end of 8 weeks. Somatic scoring scale was used to assess somatic symptom burden before and after IV iron therapy. Results: Out of 90 patients, 40.0% were male and 60.0% were female with mean age of 39.70± 7.30 years. Most of the patients were of age group 41-50 years, followed by the age group of 31-40 years and least number of patients were of age group of 20-30 years. The mean difference of somatic score of our enrolled patients were 7.01±0.33 with P-value of

Objectives: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. Methods: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. Results: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). Conclusions: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users. doi: https://doi.org/10.12669/pjms.37.4.3476 How to cite this:Shaikh BA, Shaikh ZA, Shah AH, Kumar A. Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites. Pak J Med Sci. 2021;37(4):1075-1079. doi: https://doi.org/10.12669/pjms.37.4.3476 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.

Chronic kidney disease (CKD) is a world public health problem that is related with high morbidity and mortality. CKD patients can present with different skin manifestations, often benign with much impact on quality of patients life. Study Design: Case-series study. Setting: Nephrology Unit Civil Hospital Larkana. Period: From 1st January 2018 to 30th June 2018. Material and methods: 141 patients of ESRD on regular HD for at least 1 month. Patients were chosen randomly for evaluation of cutaneous changes regardless of their gender, age, sex and etiology of ESRD. General and dermatological examination of the skin, hair, nails, and oral mucosa was performed by consultant dermatologist. Data were analyzed by using IBM SPSS version 23.0. Descriptive analyses performed using mean with standard deviation and median with inter quartile ranges of quantitative data set. Count and percentages were reported for categorical data set. Results: In the present study there were one hundred and forty one patients. Out of them skin manifestations of patients, 87.9% had Xerosis, 31.9% found with skin hyper pigmentation, 9.2% had Subungal Hyperkeratosis, 24.1% had Uremic Pruirtis, 45.4% had Pallor, and 6.4% found with Bruises. There were 9.9% cases of Alopecia, 17.7% cases of half n half nail, 1.4% cases of half n half nail with alopecia, 9.2% cases of Koilionychia, 0.7% cases of Koilionychia with alopecia, 2.8% found with koilonychias and half n half nail, 2.1% with leuconycia and koilionychia, 15.5% with Leuconychia, 2.1% found with Leuconychia and alopecia, and 0.7% found with Leuconychia, koilonychia & alopecia in Hair and Nail changes. Conclusion: The range of skin manifestations vary in different studies. Although often benign with much impact on quality of patient’s life and life can be threatening. Early treatment of skin disorders can improve the quality of life.

Aim: To determine knowledge of hypoglycaemic symptoms & their self-management among pts with type II diabetes mellitus. Study Design: Descriptive, cross-sectional. Place and duration of study: OPD Clinic of Department of Medicine, Chandka Medical College Hospital Larkana from 23rd May 2019 to 22nd November 2019. Methodology: One hundred and thirty five patients with type II diabetes mellitus of age 35- 60 years were selected. Patients with type I DM and neuro-psychiatric illness were excluded. The symptoms of hypoglycemia and their responses to those symptoms were recorded. Results: The mean age of 47.07±6.04years and majority of the patients 83 (61.48%) were between 46-60 years of age. Seventy two (53.33%) were male and 63 (46.67%) were females. Mean duration of diabetes mellitus was 6.90±3.86 years. Adequate knowledge of hypoglycemic symptoms and their self-management among patients with type II diabetes mellitus was found in 62 (56.9%) patients. Conclusion: Hypoglycemic patients are significantly unaware of their condition and have a very low knowledge about hypoglycemia and its self-management. Keywords: Type II diabetes, Hypoglycemic symptoms, Knowledge

Objective: To examine the clinical outcomes of cirrhotic patients presented with variceal and non-variceal gastrointestinal bleeding. Study Design: Retrospective/observational Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana from 1st January 2019 to 31st December 2019. Materials and Methods: One hundred cirrhotic patients of both genders with ages >20 years presented with upper gastrointestinal bleeding were enrolled. Fifty cases with acute variceal bleeding and 50 cases with non-variceal bleeding were examined. Clinical outcomes such as mortality, length of hospital stay, Intensive care admission and 60 day readmission were examined and compare the findings between both groups. Results: There were 68 (68%) male patients and 32 (32%) female patients. Mean age of patients in variceal group was 54.25±8.55 years and in non-variceal group mean age was 59.52±10.25 years (p=0.004). Oesophageal varices was the most common etiology in acute variceal bleeding group 34 (68%) and in non-variceal bleeding that was 32% (p=0.005). There was no significant difference found in term of mortality between both groups 16% vs 12% in variceal and non-variceal. No significant difference was found in length of hospital stay 4.5±1.5 vs 5.7±2.8 days. Readmission was significantly high in patients with non-variceal bleeding 28% than variceal bleeding 16%. Conclusion: There were no significant difference found regarding mortality, length of hospital stay between acute variceal bleeding patients and non-variceal bleeding patients. However, we found significant difference in term of readmission between both groups. Key words: Cirrhosis, Upper gastrointestinal bleeding, Variceal, Non-variceal, Outcomes, Mortality

To determine the frequency of HDV among hepatitis B surface antigen (HBsAg)-positive liver disorders.An observational cross-sectional study.Medical Unit I, Chandka Medical College Hospital, Larkana, from July 2003 to June 2008.Adult patients with HBs liver related disorders were evaluated for the presence of delta antibodies using commercially available ELISA kits. Descriptive statistics were used for describing data. Proportions of anti D antibodies between gender and age were compared using chi-square test with significance at p0.05.Of the 774 cases, 438 were males (60.4%) and 336 were females (39.6%). The mean age was 36.5 ± 14.39 for males and 34.03 ± 13.16 years for females ranging from 15 to 60 years. Anti-HDV was positive in 183 patients (23.6%).The frequency of HDV was not significantly different between the gender groups (p=0.718). HDV infection was markedly higher in chronic than acute liver disorders.The HBV/HDV co-infection is frequent in the studied area. Therefore, practitioners and health care managers should be made aware of the risk of dual infection with HBV and HDV.