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Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41 ±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value

Background Rheumatoid arthritis (RA) is second leading arthritis worldwide which is characterized by severe joint inflammation. There are several environmental and genetic factors that can influence its pathogenesis. Omentin-1, produced by omental adipose tissues has anti-inflammatory property. The study is designed to evaluate the association between Omentin-1 serum levels and single nucleotide polymorphisms (rs2274907 and rs2274908) with susceptibility to Rheumatoid arthritis (RA). Methods and Results The study involved 792 participants, 396 RA patients and 396 healthy controls. It was found from ELISA that serum Omentin-1 levels were significantly different between cases and controls (p 2 = 72.6, p p p p Omentin-1 polymorphism (A/T rs2274907) may act as possible molecular and genetic targets for early diagnosis of RA and help to develop better therapeutic protocols.

A study was conducted to investigate the effects of free-range, part-time free range, and confinement rearing systems on growth performance and slaughter traits in Lakha, Mushki, Peshawari, and Sindhi Aseel for 10-week duration (7-16 week). In total, 216 Aseel cockerels (6-wk-old), 54 from each variety, were allotted to 12 experimental groups, in a 3 × 4 (rearing system × Aseel variety) factorial arrangement under a randomized complete block design, replicated 3 times with 6 birds in each. Final body weight, weight gain, folds of increase, and mortality parameters of growth performance and carcass yield, breast, thigh, drumstick, wing, liver, gizzard, and heart parameters of slaughter traits were evaluated. Data were analyzed by using 2-way ANOVA under factorial arrangement. The results indicated increased body weight gain, folds of increase, breast and drumstick in both confinement and part-time free range (P

BACKGROUND: Thyroid dysfunctions frequently co-exist in patients with Autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus (SLE), and Vasculitis. Presence of thyroid dysfunctions in patients with rheumatoid arthritis increase the co-morbidities and mortality some time because of cardiovascular complications. Objective This study was conducted to determine the burden of thyroid dysfunctions in rheumatoid arthritis patients attending tertiary care hospital of Karachi, Pakistan. METHODS: A cross-sectional study was conducted at rheumatology clinic of a Jinnah Post Graduate Medical Centre in Karachi, Pakistan from April 2019 to January 2021. All diagnosed cases of rheumatoid arthritis having seronegative or seropositive rheumatoid arthritis were consecutively enrolled. Clinical records and laboratory data of these patients were collected along with outcome variables. RESULTS: Of 136 patients, thyroid abnormality was observed in 56 (41.2%) patients. In particular, 80 (58.8%) had normal, 8 (5.9%) had hypothyroidism, 14 (10.3%) had hyperthyroidism, 32 (10.5%) had subclinical hypothyroidism, and 2 (1.5%) had subclinical hyperthyroidism. A significantly lower hemoglobin levels (p-value

Metabolic Syndrome is strongly associated with Rheumatoid Arthritis, which significantly increases cardiovascular complications and hence morbidity and mortality. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This study evaluates prevalence of metabolic syndrome in young Rheumatoid Arthritis patients.This Cross-sectional study was conducted in rheumatology department of a tertiary care hospital in Karachi. All diagnosed cases of rheumatoid arthritis from April to August 2018 were consecutively included. Disease activity of rheumatoid arthritis assessed by Clinical Disease Activity Index (CDAI). Associate determinants of rheumatoid arthritis were measured along with outcome variables.Out of 104 rheumatoid arthritis patients, 34 (32.7%) found to have metabolic syndrome in whom 20 (58.8%) of patients were seropositive. A significant association of metabolic syndrome was found with age (p-value 0.023), BMI (p-value 0.006), waist circumference (p-value 0.002), FBS (p-value0.001), SBP (p-value0.001), DBP (p-value0.001), TG (p-value0.001), HDL (p-value 0.022), and Methotrexate drug history (p-value 0.030).We conclude that metabolic syndrome is highly prevalent in young rheumatoid patients with rheumatoid arthritis. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This young population base study will help out to estimate the exact burden of Metabolic Syndrome to decrease overall morbidity and mortality.

· COVID-19 pandemic has emerged and spread rapidly across the world · Novel behavior of coronavirus has been seen in Pakistan · Number of COVID-19 cases has been increasing despite many control and preventive measures taken by government of Pakistan · Mathematical models help public health professionals estimate the size of epidemic in near future

Background A substantial number of deaths and morbidities are caused by pulmonary involvement in connective tissue disorders (CTDs). The majority of patients suffering from CTDs show diverse clinical presentations arising in the lungs, the diaphragm, vasculature, and the pleura during the course of their disease. The clinical course is highly variable ranging from asymptomatic to symptomatic and from reversible to an irreversible stage. The most common occurring pulmonary appearance is the interstitial disease of the lung. In our study, we aim to determine the prevalence and pattern of pulmonary manifestation in patients with CTD presenting at a tertiary care hospital of Karachi, Pakistan. Methods A descriptive cross-sectional study was conducted in the department of Rheumatology Medical Unit II, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All patients having CTD were enrolled. Patients with human immunodeficiency virus (HIV) infection, smokers, chronic obstructive pulmonary disease (COPD), bronchogenic carcinoma and patients with underlying cardiac disease were excluded from the study. Pulmonary manifestations like nonspecific interstitial pneumonia (NSIP), pleural effusion, usual interstitial pneumonia (UIP), interstitial pneumonitis, pulmonary arterial hypertension (PAH), tuberculosis, and pulmonary embolism were observed. In addition to this, treatment history and immunological test findings of these patients were also recorded. Results A total of 290 patients with rheumatologic disorders were included in this study, out of which 90.7% (263) were females and the average age of the entire cohort was 35.13 ± 12.53 years. A majority, 71% (206), of the patients were young (≤ 40 years of age). Rheumatoid arthritis (RA) was the most commonly observed rheumatologic disorder in this cohort which was in 70.3% (204) patients. RA was more prevalent in patients above 40 years of age as compared to young patients (≤ 40 years of age) with a frequency of 81% vs. 66%; p=0.012. Pulmonary involvement was observed in 27.2% of the patients while no pulmonary involvement was noted in 72.8% of patients. Conclusion Pulmonary manifestations in patients with CTD is not that uncommon (27.2%). PAH and NSIP collectively account for three-fourth of the total prevalent cases of pulmonary involvement in CTD patients.

Low back pain (LBP) is considered as one of the most frequent health problems which is responsible for forming a huge worldwide burden. This study was conducted with the aim to determine the frequency of axial-Spondyloarthropathy (axSpA) in patients presenting with chronic backache using Assessment of Spondyloarthritis International Society (ASAS) Criteria for axSpA.A total of 231 participants of either gender were enrolled with complaint of backache of more than or equal to 3 months duration and younger than 45 years. In the first stage, patients were interviewed and examined using standard questionnaire. In the second stage after going through laboratory investigations and imaging patients were classified into either axSpA (those meeting ASAS Criteria for axSpA) or non-SpA.There were 65 males and 166 females. Mean age was 36.26 years. Eighty-nine (39%) patients were found to have axSpA as per ASAS Criteria. Majority of patients 70 (78.6%) in the imaging arm of ASAS Criteria were picked via MRI of sacroiliac joints. Peripheral arthritis was seen in 57 (64%) and Enthesitis in 52 (58.4%).MRI performed exceptionally to reveal sacroiliitis highlighting the importance of this imaging modality in axSpA, which we recommend to be included in diagnostic algorithm in evaluating patients with chronic backache under 45 years age.

Polyarteritis nodosa is a rare form of systemic vasculitis. Cutaneous polyarteritis nodosa (cPAN) is subtype of systemic PAN which predominantly affects the skin, extra-cutaneous findings include fever, malaise, myalgias, arthralgias, and neuropathy. The true incidence of cutaneous PAN is unknown. cPAN is recognized as a separate entity and is essentially a benign disorder which should be distinguished from systemic PAN, as the clinical course and management of the two conditions is different. In this case report, we have described a patient with fever and gangrene of both hands and feet. The patient underwent a very extensive workup in order to determine the cause of her condition, which finally turned out cPAN on skin biopsy

Pegylated interferon remains the first line treatment for patients with hepatitis D virus and more than one year therapy may be necessary. Interferon a has the most extensive clinical application and is used for the treatment of chronic hepatitis B and D virus as well as HCV infections. The attachment of polyethylene glycol to interferon increases its half-life. Treatment with peg interferon is associated with many troublesome and occasionally with serious or even life-threatening side effects. In this case report, we have described a patient with chronic hepatitis B and D, who developed Raynaud's phenomenon, ischaemic digital necrosis and bilateral olecranon bursitis during Pegylated interferon therapy. The patient underwent a very extensive workup in order to determine the underlying cause of his digital ischaemia and olecranon bursitis, which was finally determined to be secondary to the use of Pegylated interferon.

Osteoporosis is an early and common feature in rheumatoid arthritis. Apart from other manifestations, Osteoporosis is an extra-articular manifestation of rheumatoid arthritis whichmay result in increased risk of fractures, morbidity mortality, and associated healthcare costs. This study evaluates bone mineral density changes in patients withrheumatoid arthritis of recent-onset.This cross sectional descriptive study was conducted in the Rheumatology Department of a tertiary care hospital in Karachi. Data was collected from 76 patients presenting with seropositive or seronegative rheumatoid arthritis. Bone mineral density of these patients measured at lumbar spine and hip by using dual energy x-ray absorptiometrys can. Variables like age, gender, BMI, menstrual status, disease duration, erythrocyte sedimentation rate, vitamin D level, clinical disease activity index and seropositivity for rheumatoid arthritis were measured along with outcome variables.A total of 104 patients fulfilling inclusion criteria were registered with 28 excluded from study. A mong the remaining 76 patients, 68 (89.50%) were female, with mean age of patients (with low bone mineral density) as 50.95 ± 7.87 years. Nineteen (25%) patients had low bone mineral density, 68.52% had low BMD at spine while 10.52% at hip and 21.05% at spine and hip both. Low bone mineral density was found higher in patients with seronegative 7 (50%) as compared to seropositive patients 12 (19.4%) (p-value 0.017), whereas low bone mineral d ensity was found higher 12 (70.6%) among post-menopausal women.Low BMD was found in 25% of patients at earlier stage of the rheumatoid arthritis with seropositivity, age and menopausal status as significant risk factors.

To determine the frequency and risk factors of low bone mineral density in patients with spondyloarthropathies.The cross-sectional study was conducted at the Rheumatology Department of a tertiary care hospital in Karachi between June and November 2014, and comprised spondyloarthritis patients whose bone mineral density of lumbar spine and hips was measured using dual energy X-ray absorptiometry scan. Variables like disease duration, diagnosis, human leukocyte antigen subtype B27, erythrocyte sedimentation rate, C-reactive protein, Bath ankylosing spondylitis disease activity Index, Bath ankylosing spondylitis functional index, Bath ankylosing spondylitis metrology index were measured along with outcomes, differentiating between osteopenia and/or osteoporosis. SPSS 21 was used for statistical analysis.Of the 25 patients in the study, 16(64%) were males, 19(76%) had predominant axial involvement, and 20(80%) had duration of disease less than 10 years. Low bone mineral density at the spine and hip was found in 18(72%). Osteopenia was present in 9(36%) at hip and 8(32%)in spine, while osteoporosis was seen in 5(20%) at hip and 9(36%) in the spine. No significant association was found between bone mineral density and all the other parameters measured (p0.05 each).Majority of spondyloarthritis patients had decreased bone mineral density which could be observed in early stages of the disease.