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Aim: To determine the frequency and spectrum of thyroid dysfunction in patients with metabolic syndrome. Study design: Observational and descriptive study Place and duration of Study: Department of Medicine, Dr. Ruth Kum Pafu Civil Hospital Karachi from 1st January 2020 to 31st December 2020. Methodology: Four hundred and sixty eight patients were enrolled. Every patient was thoroughly examined and anthropometric measurement done (height, weight, waist circumference) and body mass index was calculated. Fasting blood samples were collected to measure fasting blood glucose, lipid profile and thyroid profile (Thyroid stimulating hormone, Free T4 and Free T3). Results: There were 186 (39.65%) males and 282 (60.34%) females. Patients aged between 30 to 69 years mean age was 48 years, mean BMI was 30.07. Thyroid profile including TSH, FT3, FT4 were normal in 246 (52.58%) patients, hyperthyroidism in 48 (10.34%) patients, subclinical hypothyroidism in 105 (22.41 %) and hypothyroidism in 69 (14.65%) patients. Results suggest positive correlation between BMI, TG, and thyroid profile while negative correlation between HDL cholesterol and thyroid profile. Conclusion: The positive correlation between thyroid dysfunction and metabolic syndrome. So it is suggested that patients with metabolic syndrome may require a thyroid profile which results in early detection of disease and timely treatment. Keywords: Thyroid dysfunction, Body mass index, Metabolic syndrome, Hypothyroidism, hyperthyroidism

Objective: To evaluate Hepatitis C treatment by directly acting antiviral agents and its impact on glycemic control. Study Design: This is an observational study. Setting: This study was conducted in Medicine department Civil Hospital Karachi from March 2018 to December 2019. Materials and Methods: Patients visiting the outpatient department of the hospital having documented HCV infection having type 2 diabetes mellitus were included in the study. All participants were given directly acting antiviral treatment for 12 weeks. After treatment they were assessed for achievement of sustained virological response (SVR). Pre-treatment and post treatment fasting blood glucose levels and HbA1c levels were checked. SVR is defined as serum HCV RNA which is undetectable (

Objective: To evaluate the association of vitamin D deficiency with hepatitis B and C virus Infection. Study Design: This is a prospective study. Setting: Study carried out at Medicine department Civil Hospital Karachi, from March, 2018 to December, 2019. Materials and Methods: 266 Participants of the study included patients with active hepatitis B or hepatitis C infection visiting OPD of the hospital. Vitamin D levels of 14-30 ng/ml have been described as insufficient and levels 30 nm/ml have been defined as sufficient according to our study. Diagnosis of Hepatitis B is confirmed by HBV DNA and HBsAg serum levels and of Hepatitis C by HCV RNA levels. Results: We received 70.6% (n=266) males and 29.3% females. After serological tests 34.9% (n=93) patients were positive for HBV DNA whereas 47.7% (n=127) patients were positive for HCV DNA. Coinfection with hepatitis B and C was present in 17.2% (n=46) of patients. Amongst total 266 participants 54.31% patients have been vitamin D deficient and 32.7% have insufficient vitamin D levels. Conclusion: Genetic and metabolic factors linked to hepatitis B and C with vitamin D deficiency should be studied on large scale. In our study patients infected with HBV and HCV have been vitamin D deficient, supplementation needs to be added to the treatment regimen.

Objective: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. Methodology: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. Results: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p

Objective: To determine frequency of thrombocytopenia in patients with Chronic Hepatitis C infection. Methods: A 6 months cross sectional study was carried out to determine frequency of thrombocytopenia in all patients admitted with chronic hepatitis c infection in all medical units at Civil Hospital Karachi, from April 2, 2012 to October 1, 2012. Patients with platelet count 9 in Grade C. Results: Out of 141 patients, 46(32.6%) were male and 65(46%) were female with 1.17:1 male to female ratio. The average age of patients was 47.25 ± 11.52 years (95%CI: 45.33 to 49.17). Similarly average duration of illness was 3.06 ± 1.78 Years (Range 8 months to 9 Years) and average platelet count was 165156.74± 176324.9. Seventy five patients (53%) had thrombocytopenia (platelet count

Objective: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. Methods: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. Results: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p

Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC < 80% of Predicted, (b) FEV1 < 80% Predicted, (c) FEV1/FVC ≥ 70. Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p

Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC

Objective: To determine frequency of Minimal Hepatic Encephalopathy in illiterate patients with compensated cirrhosis. Methods: Illiterate patients with compensated cirrhosis with F4 Score on Shear-wave Elastography were selected for study after informed consent. Sample size was estimated at 106. Selected patients were subjected to two tests for detection of MHE, Number Connection Test A and Block Design Test. Patients taking ≥ 30 seconds were labelled as Positive for MHE. Result: Out of 110 selected patients 10.9% were alcoholics and in 8.2% of patients no hepatic virus infection was detected. HCV was positive in 48.2% patients while HBV was positive in 13.6% of patients. MHE was detected in 72 (65.5%) of patients. Major differences were found in MHE Stage II & III by two tests. Over all BDT detected more cases and gave higher Staging in Stage II & III as compared to NCT-A test. Conclusion: Minimal Hepatic Encephalopathy (MHE) could be detected in illiterate patients using NCT-A and BDT Tests.

Background This study was conducted primarily to determine the prevalence and incidence of intra-abdominal hypertension (IAH) in a mixed ICU (medical & surgical) population and, secondarily, to compare outcomes between patients with and without IAH. Methods The prospective cohort study was conducted from April to July 2011 on adult patients admitted in ICU, on mechanical ventilation and with an indwelling urinary catheter. Intra-vesicular pressure was measured. Primary endpoint was IAH and it was defined as Intra-abdominal pressure>12 mm Hg on two consecutive readings 6 h apart. Results Total 83 patients were enrolled in the study; 61% from medical services and 39% from surgical services. Mean age in years±SD was 47 ± 17.5 with male preponderance (66%). IAH was detected in 23/83 (28%) at the time of admission, while six out of remaining 60 patients (10%) developed the condition during their ICU stay; the incidence and prevalence was 10% and 35%, respectively. Secondary end points of the study comparing outcomes between patients with and without IAH, though different in the two groups, did not achieve statistical significance. In-hospital mortality 65.5% vs. 44.4% p-value 0.054. New onset renal failure 34.5% vs. 16.7% p-value 0.054%. Difficulty in weaning from mechanical ventilation 37.9% vs. 25.9% p-value 0.008. Conclusion IAH is a poorly recognized clinical entity with potentially devastating impact on patient outcomes. Since majority of patients had IAH at the time of admission, all ICU patients especially on ventilator should have baseline intra-abdominal pressures measured at the time of admission and subjected to appropriate management to prevent them from developing abdominal compartment syndrome.