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Objective: To find out the differences in disease severity of Rheumatoid Arthritis (RA) depending on clinic-demographic variables and determine association between clinic-demographic variables and disease severity of RA. Study Design: Cross-sectional Analytical study. Setting: Department of Medicine & Allied at CMA Hospital, Azra Naheed Medical College, Superior University Lahore. Period: August 2021 to April 2022. Material & Methods: After IRB approval 266 patients, aged 21 to 80 years, of both sexes, diagnosed with RA were enrolled. DAS-28 score was employed to assess disease severity. Demographic information and medical records of the patients were assessed and recorded. SPSS version 21 was used for data analysis. Results: Among the 133 patients with active disease, 113 (85.0%) were females and 20 (15.0%) male having mean age 40.0+12.8 years. Mean duration of disease in years was 8.3+6.2 and mean DAS-28 score was 5.5+0.9. RA Factor was positive in 96 (72.2%) and Anti-CCP antibody was seen in 78 (58.8%). Mean Hemoglobin level was 11.7+1.1 g/dl and anemia was found in 47 (35.5%) patients. Mean TLC and platelet count were 8.8+2.2 ×109/L and 375.9+83.5 ×109/L respectively. Among the 133 patients with LDA/remission, 106 (79.7%) were females and 27 (20.3%) male having mean age 44.5+15.5 years. Mean duration of disease in years was 8.5+7.6 and Mean DAS-28 score was 2.5+0.5. RA Factor was positive in 106 (79.7%) and Anti-CCP antibody was seen in 94 (70.7%). Mean Hemoglobin level was 12.6+1.8 g/dl and anemia was found in 29 (21.8%) patients. Mean TLC and platelet count were 9.5+3.5 ×109/L and 333.7+109.1 ×109/L respectively. Conclusion: Anti-CCP antibody positive patients with anemja and having disease for more than 3 years are more likely to have active rheumatoid arthritis whereas there was no significant difference with regards to age, sex and RA Factor status.

Objective: To determine the frequency of hypothyroidism in patients with pulmonary hypertension. Study Design: Observational Cross-sectional study. Setting: Department of Medicine, Sandeman Provincial Hospital, Bolan University of Medical & Health Sciences Quetta Pakistan. Period: March 2020 to March 2021. Material & Methods: Pulmonary Hypertension was defined as mPASP of >25 mm Hg at rest on transthoracic echocardiogram and hypothyroidism was labeled when TSH was high with low Free T4 and/or Free T3. Patients with congestive cardiac failure, pulmonary malignancy or pulmonary metastasis assessed by history and examination were excluded from the study. Using non-probability consecutive sampling, 186 patients of both genders, aged 20-65 years with pulmonary hypertension were included. Demographic information along with clinical variables noted, echocardiography was done and thyroid profile was sent for each patient. Results: Mean age was 41.2+11.2 years with 56 (30.1%) males and 130 (69.9%) females. The mean height, weight and BMI were 1.6+0.2 meters, 56.5+14.4 kilograms and 21.8+3.6 kg/m2 respectively. The mean mPASP was 40.2+7.1 mmHg. The mean serum TSH, free T3 and free T4 levels were 6.6+4.8 IU/L, 2.5+1.0 pmol/L and 1.1+0.4 pmol/L respectively. In our study, hypothyroidism was seen in 46 (24.7%) and was not significantly associated with age, gender, BMI or mPASP. Conclusion: Hypothyroidism was noted in about a quarter of the patients with pulmonary hypertension in this study.

We present the case of a 27 year old woman who presented with paralysis of left-half of the body and inability to speak for 1 day. She was a diagnosed patient of Rheumatic heart disease since her childhood for which mitral valve replacement with metallic valves had been done 7 years ago. She had been taking warfarin regularly but INR had not been monitored. She had one child born through Cesarean section at 37 weeks of gestation 4 weeks prior to presentation. She had taken warfarin throughout her pregnancy, and discontinued it 2 days before her delivery. Her CT brain showed multiple bilateral asymmetrical hemorrhagic venous infarcts due to sinus thrombosis subsequently confirmed by Magnetic Resonance Venography. The final diagnosis was Rheumatic heart disease with hemorrhagic venous infarcts due to cortical venous thrombosis and a multidisciplinary management involving radiologist, cardiologist, neurologist and gynecologist was planned.

Objective: To find out the frequency of hiatal hernia among patients with dyspepsia undergoing esophagogastroscopy. Study Design: Descriptive, Cross-sectional study. Setting: Departments of Medicine and Gastroenterology, Services Hospital Lahore. Period: December 2018 to June 2019. Material & Methods: A total of 195 patients with dyspepsia aged 20 to 60 years of both sexes were enrolled. Patients with history of gastric or duodenal ulcer, pregnant women, Chronic Renal Failure and Chronic Liver Disease were excluded. After taking informed consent, esophagogastroscopy was done in each patient and presence or absence of hiatal hernia was noted. Results: Out of 195 patients enrolled 104 (53.3%) were male. Mean age was 41.3±8.8 years and mean duration of disease 6.3±2.0 months. Mean BMI was 27.5±3.0 kg/m2 and 101 (51.7%) had BMI

Objective: To determine frequency of hyponatremia in liver cirrhosis patients presenting with hepatic encephalopathy. Study Design: Descriptive Cross-sectional study. Setting: Department of Medicine, Sandeman Provincial Hospital, Bolan University of Medical and Health Sciences Quetta. Period: June 2020 to December 2020. Material & Methods: Cirrhosis was characterised on Ultrasound abdomen with altered liver parenchyma, shrunken liver and coarse echo texture. HE was defined as a spectrum of neuropsychiatric abnormalities diagnosed clinically with adequate history taking and physical examination. After taking informed consent from the patients’ attendants, 172 patients of liver cirrhosis presenting with HE were enrolled. Detailed clinical history and examination along with investigations were done. Hyponatremia was defined as serum sodium level 3 days was seen in 47 (27.3%) while 125 (72.7%) had stay of >3 days. It was observed that 14 (8.1%) patients expired. Hyponatremia was found in 69 (40.1%). Conclusion: Hyponatremia was a common feature in liver cirrhosis patients presenting with hepatic encephalopathy. Furthermore a significant association of hyponatremia was seen with hospital stay and all-cause mortality.