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Objectives: Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency in cirrhosis. These patients mainly bleed from esophageal varices. The aim of the present work was to determine the prevalence of fundal varices; gastro-oesophageal varices type2 (GOV-2) and isolated gastric varices type1 (IGV-1), as a cause of AUGIB. Study Design: Cross-sectional study. Setting: Gastroenterology Department of Nishtar Hospital Multan, Pakistan, using non-probability consecutive sampling. Period: July to December 2018. Material and Methods: Emergency upper gastrointestinal (UGI) endoscopy was performed in 165 cirrhotic patients and the findings documented. Results: The mean age was 50.15 ± 12.72 years. There were 103 (62.4%) males and 62 (37.6%) females (p

Autoimmune pancreatitis (AIP) is a rare entity leading to inflammation of the pancreas. It can be broadly categorized into two types. Type 1 AIP is more common and primarily presents with jaundice. Less commonly it can also progress to multiorgan involvement. Here we report a case of a 19-year-old male who presented to us with complaints of abdominal pain and vomiting. His laboratory investigations showed raised serum amylase and lipase. A contrast-enhanced CT revealed a diffuse enlargement of the pancreas with internal low-density foci. Due to the repeated episodes of pancreatitis, the patient's blood was tested for serum IgG4 (immunoglobulin type G4) which was markedly elevated pointing toward the diagnosis of AIP. Endoscopic ultrasound (EUS) showed a sausage-shaped pancreas with hyper- and hypoechoic strands. EUS-guided fine needle aspiration cytology of the lymph nodes performed in the celiac region showed a mixed population of lymphoid cells. Based on all the workup, our patient was diagnosed as type 1 AIP. He was managed with steroids and his condition progressively improved. This case is clinically significant because of the close resemblance of AIP with other pancreatic disorders like neoplasm. A timely diagnosis can prevent the unnecessary performance of invasive procedures in these patients.

Objectives: To study the association of waist circumference (WC), waist to hip ratio (WHR) and body mass index (BMI) with hypertension in type 2 diabetes mellitus (DM) patients in a tertiary care hospital. Methods: The anthropometric measures of patients were recorded in the Diabetic Outdoor of Nishtar Hospital Multan from 2013 to 2018 after taking approval from the Institutional Ethical Review Committee. All patients were evaluated in detail after obtaining informed consent. Data was entered and analyzed in SPSS version 20 (IBM Corp., Armonk, NY, USA). Results: Data of 4556 type 2 DM patients, 2549 (55.9%) females, and 2007 (44.1%) males, was analyzed. Mean age of the study population was 47.72 years. Mean age of females was 47.32 years, while of males was 48.23 years. A total of 3393 (74.5%) of the patients had hypertension, 1912 females and 1481 males. The mean systolic blood pressure (SBP) was 130.84 mmHg, while the mean diastolic blood pressure (DBP) was 82.65 mmHg. Mean WC was 102.85 cm. Mean hip circumference was 100.33 cm. Mean weight was 66.93 kg. Mean height was 1.59 m. Mean WHR was 1.02. Mean BMI was 26.37 kg/m2. Obesity (BMI >27 kg/m2) was found in 1,891 (41.5%) of patients. Central obesity was found in 80.7% and 94.7% of type 2 DM patients according to the WC and WHR cutoff, respectively. Hypertension was significantly associated with all the obesity indicators (p27 kg/m2 were more likely to be hypertensive as compared to those with a normal range (18.5 to 22.9 kg/m2) BMI (83.1% versus 64.4%, OR 2.7, p

Objective The objective of this study was to analyze the demographic profile of type 2 diabetes mellitus (DM) patients presenting to a tertiary care hospital of Southern Punjab, Pakistan. Methods This descriptive study was carried out at the Diabetic Outdoor Nishtar Hospital Multan from 2013 to 2018 after taking approval from the Institutional Ethical Review Committee. All patients were evaluated in detail after obtaining informed consent. Results Data of 4,556 patients with type 2 DM were analyzed. There were 2549 (55.9%) female and 2007 (44.1%) male participants in our study. The mean age of our study population was 47.72 years with a standard deviation (SD) of 10.82 years. Seventy-nine percent of the patients belonged to urban areas. Symptoms of polyuria, polydipsia, and polyphagia were found in 72%, 67%, and 59% of patients, respectively. Hypertension was found in 3391 (74%) patients. The mean waist circumference (WC) was 102.85 cm with an SD of 18.14 cm. The mean waist to hip ratio (WHR) was 1.02 with an SD of 0.102. The mean body mass index (BMI) was 26.50 with an SD of 5.57 kg/m2. Obesity (BMI >27 kg/m2) was found in 1,891 (41.5%) of patients. Central obesity was found in 80.7% and 94.7% of type 2 DM patients according to the WC and WHR cutoff, respectively. Females were more likely to be obese than males in all parameters of obesity. Central obesity was much more common in female diabetics as compared to male diabetics (odds ratio 4 in WHR criteria versus odds ratio 1.8 in BMI criteria for obese). Conclusion Diabetes is more prevalent in females than males and especially affects the middle age group. Hypertension and obesity are important comorbid associations of DM. WC and WHR are more reliable indicators of obesity in type 2 DM patients especially in this part of the world. Central obesity was more prevalent in female type 2 DM patients.

Background & aims Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in high patient morbidity and mortality. There are numerous causes of UGIB. The aim of our study was to evaluate the endoscopic findings in patients of UGIB in this part of the world. Methods This retrospective study was conducted at the Department of Gastroenterology Nishtar Medical University & Hospital Multan from June 2018 to March 2019. Record of all patients undergoing esophagogastroduodenoscopy (EGD) for evaluation of UGIB was reviewed. Data was entered and analyzed using SPSS version 20 (IBM, Armonk, NY, USA). Results Record of 730 (464 male and 266 females) patients undergoing EGD for UGIB was reviewed. Mean age of study population was 49.38 years with standard deviation of 14.86 years. Age of the youngest patient was 14 years while the oldest patient was 99 years of age. More than half of the patients (53%) belonged to the 41-60 years age group. The most common endoscopic finding was esophageal varices in 371 (50.8%) patients, followed by gastropathy (114, 15.6%), gastritis (68, 9.3%), cardio-fundal varices (58, 7.9%) and duodenal ulcer (26, 3.6%). Esophageal varices, gastritis, duodenal ulcers and gastric carcinomas were more likely to be found in male UGIB patients as compared to female patients (p = 0.039). Gastropathy, esophageal ulcer and gastric ulcer were more likely to be found in female UGIB patients. Esophageal varices and cardio-fundal varices were more likely to be found in UGIB patients from middle age group (p = 0.000). Whereas gastritis, duodenal ulcer, gastric erosions and duodenitis were more likely to be found in older (>60 years) UGIB patients (p = 0.000). Conclusion UGIB was more likely to occur in male gender. In our study, bleeding from esophageal varices was the most important cause of UGIB in this part of the world and bleeding from duodenal ulcer was quite uncommon as compared to the western world. Variceal bleeding had a significant association with male gender and middle age group patients. While duodenal ulcer bleed had a significant association with older age.