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Aim: The purpose of this study is to look at the link among a family history of cancer, coping style, also emotional suffering. Methods: The self-reporting questionnaire, coping style scale, also effect of occasion scale-revised were also used to assess 85 individuals through the family history of cancer also 74 normal patients. Results: There have been substantial variations in nervousness, despair, cancer-exact distress, and psychological adjustment here between two groups of patients. Psychological discomfort (anxiety, sadness, and cancer-specific distress) was regarded as a negative coping style and the family history of cancer. In the family history and psychological discomfort, an undesirable coping style served as an intermediate. Conclusion: People through the family history of cancer are now extra probable to have a negative coping style, which predisposes them to more severe psychological discomfort.

Background: Acute upper gastrointestinal bleeding is a serious complication in cirrhotic patients. Without recommended management, recurrent bleeding happens in 30–40% within the next 2–3 days, and up to 60% within 1 week. Aim was to determine predictors of re-bleeding after oesophageal variceal banding in cirrhotic patients for 4 weeks. It was a descriptive study, conducted at the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Six months from June 21 to December 21, 2021. Methods: A total of 93 patients with active oesophageal variceal bleeding were included in this study. Upper gastrointestinal (UGI) endoscopy was performed to look for bendable varices (grades 1–4) and band ligation was applied. Patients were followed for 4 weeks for the history of hematemesis or Malena, fall in haemoglobin of 2 grams per decilitre or more and endoscopic rebleeding findings. Results: Out of 93 patients, 67(72.0%) were males, while 26(28.0%) were females. The Mean age of the patients was 45.66±16.61 years. According to Child-Pugh Classification, the majority of the patients 45(48.4%) had Child-Pugh Class-A, while 33 (35.5%) were Child B and 15 (16.1%) patients belonged to Child-Pugh Class C. Red wale sign was noted in 22 patients (23.7%). Among 93 cirrhotic patients who presented with variceal bleeding, 9 (9.7%) had re-bleeding within 4 weeks. Amongst 9 patients, 8 patients (88.9%) had red wale sign, grade II or above oesophageal varices and belonged to severe liver disease with child class B or C. Conclusion: Endoscopic variceal band Ligation is an effective treatment modality for the control of oesophageal variceal bleeding. Re-bleeding after band ligation was 9.7%. The major contributing factors to re-bleeding were the severity of cirrhosis, grades and columns of oesophageal varices, number of bands ligation and findings of red wale sign. Increasing age and duration of cirrhosis were contributing predictors of increased re-bleeding risk

Objective: To study the outcome of oral vitamin D therapy on symptoms of PDP Nin T2DM patients Methods: This randomized double blind placebo controlled trial comprised 120 T2DMpatients with vitamin D deficiency and symptoms of PDPN on the basis of neuropathy symptoms score (NSS) and neuropathy disability score (NDS). Patients were randomly divided in to two groups. Patients in group A were given capsule vitamin D2, 00000IU/month over while patients in group B were given capsule placebo for a period of 03 months duration. The study outcomes of PDPN were assessed by NSS and NDS as primary endpoint while glycemic control and vitamin D level were secondary end point of study from baseline. Results: After 12 weeks therapy of vitamin D, significant improvements were recorded in primary end points NSS score (from 5.9±2.0 to 4.7±1.5 ) vs placebo (6.5 ±2.0 to 6.4 ±3.2) with p-value (0.002) and NDS score (from 7.8±2.0 to 6.5± 2.5) vs placebo (7.7±1.8 to 7.9±2.5) with p-value (0.001). Similarly secondary endpoints were also improved significantly from baseline to end point after 12 weeks of vitamin D therapy vitamin D value ( from 25.8±14 to 44.5±12.5) vs placebo group ( from 28.5±14.5 to30.0±15.5) with p-value (0.002), HbA1c from 9.0±2.8 to 7.8±3.5) vs Placebo ( from 9.8±2.0 to 9.5±2.2) with p-value 0.001 (table 2). Conclusion: Vitamin D therapy attenuates symptoms of PDPN in T2DM patients Keywords: Vitamin D, T2DM, PDPN, HbA1c

Cisplatin is a platinum-containing drug that inhibits DNA synthesis by inhibiting cross-linking, denaturing DNA strands. It is used in combination with other chemotherapeutic agents to treat several types of cancers. Numerous adverse effects have been reported with this compound. However, it is considered a safe medication in terms of cardiotoxicity. In this report, we discuss the case of two patients who experienced bradycardia while receiving cisplatin as part of combination therapy. A workup was undertaken to rule out other possible causes of bradycardia, and the diagnosis of cisplatin-induced bradycardia was made.

To study the use of the self-expanding Covera covered stent for the treatment of stenotic lesions at the venous anastomosis of hemodialysis arteriovenous grafts (AVGs).A total of 110 patients with AVG venous anastomotic stenosis of ≥50% and access dysfunction were treated at 14 centers in the United States using percutaneous transluminal angioplasty followed by covered stent placement. The primary end points were 30-day safety and 6-month target lesion primary patency (TLPP). The secondary measures included access circuit primary patency, circuit cumulative patency, and the number of reinterventions through 24 months.Freedom from a primary safety event at 30 days was 96.4% while the 6-month TLPP rate was 70.3%. Seventy-five patients completed 24-month follow-up (68.2%). The TLPP rates were 54.2% at 365 days and 36.9% at 730 days while the access circuit primary patency rates were 16.7% at 365 days and 7.8% at 730 days (Kaplan-Meier analysis). The access circuit cumulative patency rates were 85.4% at 12 months and 73.6% at 24 months. The number of reinterventions to maintain the patency of the access circuit was 3.6 ± 3.1 at 24 months (1.6 ± 1.9 at the target lesion).Use of the Covera covered stent for hemodialysis graft-vein anastomotic stenosis provided a safe treatment option with a TLPP rate of 70.3% at 6 months and TLPP and cumulative access circuit patency rates of 36.9% and 73.6% at 2 years.

Introduction: Peptic ulcer disease (PUD) is very common in both developing and developed countries. Osteoporosis, a disease with decreased bone mineral density is a complication of this PUD, though mechanisms are not well understood. Objective. To determine the frequency of osteoporosis in cases with peptic ulcer disease. Methods; It was a descriptive, cross sectional study that was conducted at Department of Medicine, from July 2019 to December 2019. The cases presenting with history of epigastric pain with age range of 20 to 60 years of both gender were considered. These cases then underwent upper GI endoscopy and finally the 100 cases of peptic ulcer were considered. The detailed data was collected. The cases with previous history of bone trauma, metabolic disorders, end stage renal or liver disease and those with diabetes mellitus were excluded. The cases with diagnosed PUD then underwent DEXA scan and score less than 2.5 was labeled with osteoporosis. Results; In this study there were total 100 cases out of which 56 were males and 44 females. The mean age was 35.44±5.35 years. Osteoporosis was seen in 10 (10%) of cases. Osteoporosis was more seen in females affecting 7 and 3 males out of their respective groups (p= 0.12). It was also more common in cases with age group more than 40 years where 8 cases were seen with p value of 0.04. There was no significant difference in terms of duration of PUD with osteoporosis (p= 0.78). Conclusion: Osteoporosis is not uncommon in cases of peptic ulcer disease. Higher age is significantly associated with this. Key words. PUD, Osteoporosis, DEXA scan, T score

Objective: Frequency of diastolic dysfunction in cases of Diabetes Mellitus. Methodology; This cross-sectional study was conducted during July 2019 to December 2019 at department of cardiology and Medicine. Hundred cases of diabetes mellitus of both gender i.e. male/female with age more than 40 years and duration of DM of at least 2 years and of type II DM were included. The cases with previous history of acute coronary syndrome, valvular disease, liver or renal disease were excluded. The cases were labelled as Diastolic dysfunction where E/A ratio was Results; In this study, out of 100cases there were 61 (61%) males and 39 (39%) females with mean age of 54.34±9.41 years. There were 36 (36%) cases had HTN. Diastolic dysfunction was observed in 49 (49%) of cases. There was no significant difference in terms of gender in both groups with p= 0.79. Diastolic dysfunction was more in cases that had HTN where it was seen in 25 (69.44%) of cases with p= 0.001. There was significant difference in cases that had BMI more than 30 where it was seen in 30 (62.50%) of cases with p= 0.001. Conclusion: Diastolic dysfunction is seen in almost half of the cases with DM and it is significantly high in cases that had HTN and BMI more than 30. Key words: Diastolic dysfunction, Diabetes Mellitus

Recent advances in technology show promise in providing greater vascular access options for hemodialysis patients. This review discusses novel methods for creating an anastomosis for arteriovenous (AV) fistulas and new materials for prosthetic AV grafts. Two technologies for endovascular arteriovenous fistula creation, the Ellipsys and WavelinQ endovascular systems, are discussed. When an AV fistula is not possible, an AV graft or devices to augment the AV fistula may be appropriate. New materials that have been developed that show promise as an alternative to the expanded polytetrafluoroethylene graft are discussed. Such potential conduits include bioengineered vessels and both allogenic or xenogenic biologic grafts. Devices designed to optimize blood flow to reduce maturation failure and improve AV fistula outcomes are explored.

To evaluate safety and efficacy of arteriovenous fistulas (AVFs) created with a thermal resistance anastomosis device.A prospective single-arm trial at 5 sites enrolled 107 patients. Patients underwent ultrasound (US)-guided anastomosis creation between the proximal radial artery and perforating vein with the Ellipsys Vascular Access System (Avenu Medical, Inc, San Juan Capistrano, California) followed by separate maturation procedures. Primary endpoints were brachial artery flow volume ≥ 500 mL/min and target vein diameter ≥ 4 mm in49% of patients and absence of device-related complications at 90 days.AVFs with fused anastomoses were created in 95% (102/107) of patients. Maturation procedures included anastomotic balloon dilation in 72% (77/107), brachial vein embolization in 32% (34/107), cubital vein ligation in 31% (33/107), and surgical transposition in 26% (28/107) of patients. Primary flow and diameter endpoints were achieved in 86.0% (92/107) of patients, exceeding performance goal of 49% (P.0001). No major adverse events were attributed to the device. Cumulative patency was 91.6%, 89.3%, and 86.7% at 90 days, 180 days, and 360 days. Target dialysis veins were cephalic, basilic, and brachial veins in 74% (73/99), 24% (24/99), and 2% (2/99) of patients. Two-needle dialysis was achieved in 88% (71/81) of patients on hemodialysis at a mean 114.3 days ± 66.2. Functional patency was 98.4%, 98.4%, and 92.3% at 90 days, 180 days, and 360 days.The Ellipsys