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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

Background: Liver has a special and unique system of glucose metabolism which keeps its levels under normal ranges. In chronic liver hepatitis and cirrhosis this mechanism is altered. Aim: To evaluate undiagnosed diabetics through HbA1C and 2 hours post prandial blood sugar levels in confirmed hepatitis B and C cirrhotic adult patients. Study design: Descriptive cross-sectional study Place and duration of study: Department of Gastroenterology, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1st July 2020 to 30th June 2021. Methodology: One hundred and twenty four patients >50 years with liver cirrhosis due to hepatitis B and C were enrolled. All clinical, demographic data of patients as well as their blood analysis was performed for testing HbA1C and two hour post prandial blood sugar (as well as liver function test). Results: The mean age was 57.9±5.9 years and majority of patients were males in both hepatitis cases. There were 39.5% of liver cirrhosis patients having undiagnosed diabetes which was confirmed by 2 hours post prandial blood sugar and HbA1c. Within this value 54.8% had hepatitis C and 24.2% had hepatitis B. Conclusion: There is a high prevalence of elevated HbA1c, post prandial blood sugar and consequently diabetic population (undiagnosed) among hepatitis B and C liver cirrhotic adult patients. Keywords: Post-prandial blood sugar, Cirrhotic adult patients, HBsAg, Anti-HCV, Diabetics

Background: In chronic hepatitis diseases the liver impairment results in imbalance in glucose homeostasis and metabolism resulting in type 2 diabetes Aim: To estimate the frequency of type 2 diabetes in chronic hepatitis B and C patients. Study Design: Cross sectional analytical study Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana 1st October 2020 to 31st March 2021. Methodology: One hundred patients of hepatitis were recruited. Fifty patients of hepatitis B and 50 patients of hepatitis C age 20-65 years were enrolled. Their fasting blood sugar and HbA1C levels were analyzed and correlated with their clinical symptoms. Results: 20% hepatitis B and 26% hepatitis patients had asymptomatic type 2 diabetes. There were more men affected from hepatitis than women and type 2 diabetic respectively. Conclusion: Asymptomatic type 2 diabetics need suffering from hepatitis B and hepatitis C need to be screened for better treatment plan. Keyword: Hepatitis B, Hepatitis C, Type 2 diabetes

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 determine the frequency of cognitive impairment and it associated risk factors in patients presented with systemic lupus erythematosus. Study Design: Cross-sectional study Place and Duration: Department of Medicine, Chandka Medical College Hospital Larkana from 1st July 2018 to 31st December 2019. Methods: Ninety five patients of either gender presented with systemic lupus erythematosus were enrolled in this study. Patients detailed medical history, demographics including age, sex, education level, socioeconomic status and co-morbidities were recorded after taking informed written consent. Frequency of cognitive impairment was examined by Mini-mental state examination. Predictors of cognitive impairment were examined. Results: Seventy five (78.95%) were females while 20 (21.05%) patients were males. Fifteen (15.79%) patients were ages 60 years. Cognitive impairment was found in 22 (23.16%) patients. Among 22 cognitive impairment patients 17 (77.27%) had mild cognitive impairment and 5 (22.73%) had dementia. Cardiovascular disease, disease duration, low socio-economic status, and steroids use were the risk factors significantly associated with cognitive impairment (p-value Conclusion: The frequency of cognitive impairment in systemic lupus erythematosus patients was high. Diabetes mellitus, cardiovascular disease, low socio-economic status and hydroxychloroquine were the major risk factors associated with cognitive impairment. Keywords: Systemic lupus erythematosus, Cognitive impairment, Cardiovascular disease, Socioeconomic status, Diabetes mellitus, Steroids.

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

Objective: To examine the effectiveness and safety of drotaverine 80mg with paracetamol 500mg in patients presented with acute infectious gastroenteritis. Study Design: Randomized controlled trial. Place & Duration of Study: Department of Medicine, Chandka Medical College Hospital Larkana from 1st May 2019 to 31st October 2019. Materials and Methods: Two hundred patients of both genders with ages 18 to 55 years presented with moderate to severe abdominal pain due to acute infectious diarrhea were included in this study. Patients were divided into two groups Group A consist of 100 patients and received drotaverine HCL 80mg and paracetamol 500mg thrice a day for three days, Group B contains 100 patients and received paracetamol 500mg alone with same compliance. VAS was used to examine the intensity of pain. Relief in pain, global assessment of pain relief, decrease of stool frequency and complications were examined and compare the findings between both groups. Results: There were 58% males and 42% females in Group A with mean age of 29.55+10.45 years. In Group B 55% were males and 45% were females with mean age of 31.50+11.25 years. Pain frequency was significantly decreased in 30%, 65% and 90% at 1st, 2nd and 3rd days in Group A than 18%, 45% and 68% in Group B (p=rd day in Group A was 65% and 82% and in Group B it was 40% and 64%. Global improvement in abdominal pain by patients in Group A was 96% and in Group B it was 89% and by clinician it was 99% in Group A and 95% in Group B. Conclusion: The use of fixed-dose combination of drotaverine HCL 80mg and paracetamol 500mg is safe and effective oral therapy in patients with moderate or severe abdominal pain due to acute infectious gastroenteritis. Keywords: Abdominal pain, Infectious gastroenteritis, Drotaverine , Paracetamol.

Background: Worldwide, intestinal parasitic infections are major causeof human mortality and morbidity especially among developing countries wherein publichealth standards are not much better like developed countries. Intestinal parasiticinfections are linked with poor sanitation, lack of safe drinking water, inadequate dietaryand cultural habits and climate conditions. Objective: To assess the frequency, riskfactors and clinical manifestations related to intestinal parasite infections in patients withgastrointestinal disorders. Study Design: Cross-sectional multi-centre study. Setting:Department of Medicines, Chandka Medical College Larkana and Civil Hospital, KhairpurMirs. Period: 1st January 2017 to 31st December 2017. Method: 260 patients, the patientswith gastrointestinal disorders presenting one or more symptoms (e.g. diarrhea, dysentery,abdominal pain, nausea and vomiting, cramping and constipation) were included.Results: Frequency of intestinal parasites was 32.3%. The most common parasites wereEntamoeba histolytica (10.4%), Giardia lamblia (8.5%) and Hymenolepis nana (6.9%). Age,education, monthly income and contact with animal were significantly associated withintestinal parasite infections. Concerning symptoms, the presence of intestinal parasitesinfection was significantly associated with diarrhea and dysentery. Conclusion: Studyconcluded that most prevalent parasites were Entamoeba histolytica, Giardia lambliaand Hymenolepis nana. Significant association was found in age, education and monthlyincome.

Introduction: Pancytopenia is said to exist in an adult when the hemoglobin level is less than 13.5gm/dl in males and 1 l.5gm/dlin females, white cell count less than 4xl09IL and platelet count less than 150x109/L1. The causes of pancytopenia are aplastic anemia, subleukemicleukemia, myelodysplasia2 multiple myeloma, nutritional deficiencies leading to megaloblastic anemia, hypersplenism, paroxysmalnocturnal hemoglobinuria, AIDS, infections such as miliary tuberculosis, leishmaniasis, brucellosis etc. Objectives: To determine the frequencyof various causes of pancytopenia in gender at Chandka Medical College, Larkana. Study design: Cross Sectional Study. Setting: OPD &Medical Ward-ll, Chandka Medical College Hospital Larkana. Duration with dates: 01 years study from February 2007 to February 2008.Subject and methods: Patients of either sex, who attended medical ward-ll of Chandka Medical College Hospital Larkana, either as inpatientor out patient department, from February 2007 to February 2008 and fulfilled the inclusion criteria, were included in this study. Pancytopeniawas considered as hemoglobin value less than 13.5gm/dl in males or 11.5gm/dl in females, a white cell count less than 4x109/L and Plateletscount less than 150x109/L. Patients of less than 12 years and pregnant females were excluded from the study. Result: Out of 40 patients, 29(72.5%) were males and 11 (27.5%) were females. Female to male ratio was 1:2.6. The mean ages of males were 29.10 ± 16.46 years whereasof females 36.14 ± 15.6 years (P = 0.22). Aplastic anemia was the most common pathology encountered and was diagnosed in 13 cases(31.5%), followed by hypersplenism 09 (22.9%), Megaloblastic anemia 06 (15%) and hodgkin's lymphoma in 04 (10%) cases. Other lesscommon causes detected were multiple myeloma 02 (5%), drug induced 02 (5%) and malaria, milliary tuberculosis, myelodysplastic syndrome,hemophagocytic syndrome was 01 (2.5%) case in each. Conclusion: We concluded that aplastic anemia was the most common cause in ourpatients and more than 2/3rd patients were young males. We think the causes of aplastic anemia in this study may be misuse of drugs, kushtas,exposure to chemicals and viral infections.