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Objective: To determine the frequency of cirrhotic cardiomyopathy in decompensated liver cirrhosis patients. Study Design: Descriptive, Cross-sectional. Setting: Department of Medicine, Bahawal Victoria Hospital, Bahawalpur. Period: February 2022 to August 2022. Material & Methods: Patients of either gender having age between 25-65 years with decompensated liver cirrhosis (duration >6 months) were analyzed. Demographic and clinical characteristics of each patient were recorded at the time of the inclusion. Then, echocardiography was done in each patient by consultant cardiologist and presence or absence of cirrhotic cardiomyopathy was noted. Results: In a total of 92 patients, 54 (58.7%) were male and 38 (41.3%) were female with male to female ratio as 1.4:1. The mean age was 42.92±8.72 years while 57 (61.96%) patients were aged between 25 to 45 years. The mean duration of disease was 8.52±2.48 months. The mean body mass index was 27.46±2.97 kg/m2. Diabetes was noted in 28 (30.4%) patients while 35 (38.0%) had hypertension. Frequency of cirrhotic cardiomyopathy in patients with decompensated liver cirrhosis was found in 38 (41.3%). Conclusion: This study concluded that the frequency of cirrhotic cardiomyopathy in decompensated liver cirrhosis patients is quite high. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequencies of different vascular etiologies and clinical presentations in postpartum women with suspected stroke. Study Design: Cross-sectional study. Setting: Department of Medicine, Bahawal Victoria Hospital, Bahawalpur. Period: November 2022 to May 2023. Material & Methods: A total of 117 female patients aged between 18-45 years in post-partum period of 30 days after delivery having clinical diagnosis of suspected stroke were included. All patients were evaluated and clinical presentation and frequency of different vascular etiologies were noted. Results: In 117 women, the mean age was 32.01±5.67 years while 59 (50.4%) women were aged ≤35 years of age. Headache was found in 61 (52.1%), seizures 56 (47.9%), altered consciousness 26 (22.2%) and weakness in 16 (13.7%) patients. Frequencies of different vascular etiologies in post-partum women with suspected stroke were cerebral venous sinus thrombosis in 21 (17.9%), arterial thrombosis 7 (6.0%) and hemorrhagic stroke in 89 (76.1%) patients. Conclusion: Hemorrhagic stroke was the most common vascular etiology whereas headache was the commonest clinical presentation in post-partum women with suspected stroke. [ABSTRACT FROM AUTHOR]

Objectives: To find the frequency of hyponatremia in decompensated chronic liver disease patients. Study Design: Descriptive, Cross-sectional study. Setting: Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan. Period: October 2022 to March 2023. Material & Methods: A total of 118 patients of either gender aged 40-70 years having decompensated chronic liver disease were analyzed. Five ml blood was drawn under aseptic environment and was properly preserved, and sent to the hospital laboratory for analysis of sodium levels. Frequency of hyponatremia was determined and hyponatremia was labeled as serum sodium level < 130 mEq/liter. Results: In a total of 118 patients, the mean age was 53.69 ±7.11 years (ranging between 40-70 years) while 69 (58.5%) patients were aged between 41 to 55 years of age. There were 64 (54.2%) male and 54 (45.8%) female patients. The mean duration of chronic liver disease was 10.49±3.48 months whereas the mean BMI was 30.26±2.50 kg/m2. The mean serum bilirubin, serum globulin, serum albumin, mean albumin to globulin ratio, PT, child Pugh score and serum sodium levels were 5.43±2.41 mg/dl, 4.87±1.89 g/dl, 2.13±0.87 g/dl, 1.65±0.73, 11.33±3.41 seconds, 8.12 ± 2.68 and 118.67±9.87 mEq/liter respectively. The frequency of hyponatremia in patients with decompensated liver cirrhosis was found in 39 (33.1%) patients. Conclusion: This study concluded that frequency of hyponatremia in decompensated chronic liver disease patients is quite high. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of metformin versus Sitagliptin among treatment naïve patients of type-2 diabetes mellitus (T2DM). Study Design: Randomized Controlled Trial. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: September 2021 to August 2022. Material & Methods: During the study period, a total of 320 treatment naïve T2DM patients (160 in each group) were randomly enrolled and followed up. Baseline demographics of all patients including gender, age, BMI (kg/m²), fasting plasma glucose (FPG) and baseline HbA1c were recorded. Patients of Group-A were given oral Sitagliptin 100mg once daily whereas patient in Group-B were prescribed oral metformin as 500-2000 mg per day aiming achievement of glycemic goals. Repeat HbA1c and FPG levels were tested at the end of 12th and 24th weeks therapy among both study groups. Side effects related to studied drugs were also observed and recorded. Results: Out of a total of 320 patients, 57 patients (27 in Group-A and 30 in Group-B) lost follow up so 263 patients were included in the final analysis. Majority of the patients, 134 (51.0%) were male. Mean age, BMI and duration of diabetes among study participants were 53.07+9.62 years, 29.44+4.74 kg/m² and 1.96+2.3 years respectively. No statistically significant difference was noted at zero, 12 or 24 weeks in between both study groups (p>0.05) in terms of reduction in HbA1c or FPG levels during the study period (p>0.05). Conclusion: Both metformin and Sitagliptin effectively reduce HbA1c and FPG levels among treatment naïve T2DM patients with relatively good tolerability and safety. Both study drugs can be used as initial monotherapy among T2DM patients with relatively mild-to-moderate disease. [ABSTRACT FROM AUTHOR]

Objective: To find out the efficiency of leukocyte esterase reagent strip (LERS) testing for the diagnosis of spontaneous bacterial peritonitis (SBP). Study Design: Cross Sectional, Validation study. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: January-December 2019. Material & Methods: A total of 235 patients of both gender, aged 18-60 years, having CLD with ascites, with any child pugh class and duration of CLD between 6-12 months were enrolled. Ascitic fluid was obtained at bedside and immediately dispatched for testing in a clean and dry test tube with reagent strip Multistix® 10 SG. Screening tests were calculated for accuracy of LERS test with respect to confirmed cytology testing. Results: Majority, 152 (64.7%) were male, 94 (40.0%) between 51-60 years age group and 146 (62.1%) had child pugh class C. Overall, mean age was noted to be 46.82+9.45 years. LERS testing turned out to be positive among 138 (5837%) cases. Confirmation of SBP through cytology was noted among 141 (60.0%). Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of LERS for the diagnosis of SBP with respect to cytology confirmation was calculated to be 90.8%, 89.4%, 92.8%, 86.6% and 90.2% respectively. Conclusion: The LERS testing was found to have high SE, SP, PPV, NPV and diagnostic accuracy in diagnosing SBP among patients of CLD with ascites. LERS can be used at bedside while it very simple and easy to perform. [ABSTRACT FROM AUTHOR]

Objective: To find out the efficiency of leukocyte esterase reagent strip (LERS) testing for the diagnosis of spontaneous bacterial peritonitis (SBP). Study Design: Cross Sectional, Validation study. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: January-December 2019. Material & Methods: A total of 235 patients of both gender, aged 18-60 years, having CLD with ascites, with any child pugh class and duration of CLD between 6-12 months were enrolled. Ascitic fluid was obtained at bedside and immediately dispatched for testing in a clean and dry test tube with reagent strip Multistix® 10 SG. Screening tests were calculated for accuracy of LERS test with respect to confirmed cytology testing. Results: Majority, 152 (64.7%) were male, 94 (40.0%) between 51-60 years age group and 146 (62.1%) had child pugh class C. Overall, mean age was noted to be 46.82+9.45 years. LERS testing turned out to be positive among 138 (5837%) cases. Confirmation of SBP through cytology was noted among 141 (60.0%). Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of LERS for the diagnosis of SBP with respect to cytology confirmation was calculated to be 90.8%, 89.4%, 92.8%, 86.6% and 90.2% respectively. Conclusion: The LERS testing was found to have high SE, SP, PPV, NPV and diagnostic accuracy in diagnosing SBP among patients of CLD with ascites. LERS can be used at bedside while it very simple and easy to perform. [ABSTRACT FROM AUTHOR]

Aflatoxin occurrence in poultry feed causes aflatoxicosis in birds and poses health hazards to the consumers. Aflatoxin B1 (AfB1) is the most predominant and toxic metabolite that is controlled through addition of argillaceous clays as non-nutritive additives. Non-smectitic indigenous clay reserves need testing as AfB1 adsorbent. With detailed mineral and adsorption characteristics, three indigenous non-smectitic clays: (i) palygorskite, (ii) palygorskite-smectite mix, and (iii) interstratified smectite with hydroxy interlayered smectite were tested against 250 μg kg-1 AfB1 contamination in a poultry feeding trial with three replications at 1% and 2% (w/w) with positive and negative controls. A total of 330 Ross-308 male broiler chicks, initially reared on clean feed under controlled conditions of light and humidity, were distributed into eleven treatment combinations in a completely randomized design with 30 birds in each treatment on an equal weight basis with three replications at day 14 and fed on experimental feeds for three weeks. Three birds from each pen were randomly slaughtered at day 35 and for each replicated treatment, body weight gain, feed intake, and internal organs weight and morphology were recorded. AfB1 contamination reduced weight gain (p 0.0001), feed conversion ratio (p 0.0001) and feed intake (p 0.0001) while clays addition in the toxin feed effectively controlled AfB1 toxicity as suggested by improved body weight, weight gain rate and feed consumption compared to the toxin fed birds. The liver morphology was comparatively better in palygorskite-smectite mix treatment when applied at 1% and the darkish colour was also improved with addition of the clay in the toxin feed. AfB1 feeding caused a 75% reduction in weight gain compared to the clean feed. Palygorskite and palygorskite-smectite mix clays were better than interstratified clay in increasing weight gain and caused a 60% and 65% increase over toxin feed treatment when applied at 1% and 2%, respectively. In conclusion, the indigenous clay sources overall and palygorskite-smectite mix in particular has the potential for use as a mycotoxin binder for controlling AfB1 incidence in poultry. [ABSTRACT FROM AUTHOR]

In alkaline soils, most of the plant nutrients are either lost or become unavailable. Current study investigated the role of bacterial isolates for enhancing nutrients bioavailability in soil along with improvement in the plant growth characters under greenhouse conditions. Bacterial strains were characterized on the basis of morphological and biochemical features. Sequence analysis of 16S rRNA regions confirmed the bacterial identity as Thiobacillus thiooxidans, Thiobacillus ferrooxidans and Desulfovibrio vulgaris, and sequences were submitted to GenBank (Accessions: MK123808, MK123809, MK123680, MK123681, MK123861). Pot experiment was performed with 10 treatments including; T1 (½ N fertilizer), T2 (Full N fertilizer), T3 (NPK fertilizers @ 100-50-30 mg kg‒1 soil), T4 (½ N + T. thiooxidans), T5 (½ N + T. ferrooxidans), T6 (½ N + D. vulgaris), T7 (½ N + T. thiooxidans + T. ferrooxidans), T8 (½ N + T. thiooxidans + D. vulgaris), T9 (½ N + T. ferrooxidans + D. vulgaris), T10 (½ N + T. thiooxidans + T. ferrooxidans + D. vulgaris). Among all the treatments, T7 enhanced the bioavailability of macro- and micro-nutrients in soil and maize plants; while T10 significantly improved the plant growth attributes. Study concludes that development and application of bacterial consortium based biofertilizers could help in improving the plant growth characters and nutrients bioavailability in plants and soil. [ABSTRACT FROM AUTHOR]

Utilization of organic matter and synthetic fertilizers in soil generally influences the diversity and dynamics of microbial mass bearing the amino acids, which contain carbon as well as nitrogen being stable components of soil organic matter. This long-term field study initiated in 1989 compared the sole and collective use of compost and NPK fertilizers for exploring microbial amino acids as signatures of carbon turnover in soil exhibited by macro-aggregates formation. Treatments in quadruplicated randomized complete block design experiment were: whole N from organic manure (OM); half N from organic manure + half N from inorganic fertilizer (HOM); mineral NPK fertilizers (NPK), NP, NK, PK, and no fertilizer (control) applied to raise wheat and maize continuously. Classified as calcareous Fluvo-aquic soil (Aquic Inceptisol) and located in Fengqiu County, Henan province, North China Plain, it has sandy loam texture and average pH 8.2. After 23 years of fertilization treatments (in 2012), randomly drawn soil samples from 0-20 cm profile were subjected to various physicochemical and biochemical determinations. Contents of majority amino acids, viz., arginine, asparagine, aspartic acid, cystine, glutamic acid, leucine, lysine, methionine, proline, and tyrosine were statistically higher under OM and HOM compared to NPK and control treatments. Among the mineral fertilizers, N and P addition but not K mainly contributed to amino acid synthesis / residues in soil; more importantly the cysteine, phenylalanine and serine. Quantitatively increased amino acids positively correlated with improved SOC content that promoted the formation and count of macro-aggregates in soil. These results suggest that accrual of organic and microbial residues largely the amino acids associated with soil micro-aggregates enhance the carbon sequestration in surface soil concurrent with an increased formation and stability of macro-aggregates. [ABSTRACT FROM AUTHOR]