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Objective: To identify the fears and concerns regarding HCV amongst people presenting to a free screening camp and to identify the barriers preventing patients from linkage to care (seeking medical care for HCV). Study Design: Cross Sectional study. Setting: Gajrakh District, Gujranwala. Period: 15th February to 14th March 2019. Material & Methods: Questionnaire was filled by all the participants attending free screening and treatment camp. Questionnaire explored sociodemographic features, financial status, knowledge regarding awareness of disease e.g. risk factors for transmission of disease, possible complications of disease, fears regarding diagnosis & treatment of HCV and possible concerns of female population. Results: This study included 100 participants, 58% were females and 42% were males with a mean age of 46.23±12.36. Fifty seven percent of the participants were laborer, 15 were salary based, 6 were shopkeepers and 7 were housewives. Majority of participants have a sound knowledge about transmission of HCV i.e 95% said yes to the question about spread via ear/nose piercing by unsterilized needles, however, 49% and 61% think that hugging the patient and eating and drinking with patient also caused viral spread respectively. Most important factors contributing to inability to start treatment were inability to bear cost, missing of daily wages, lack of transport, fear of side effects and fear of being outcast in 75, 66, 41, 26 and 25% respectively. Conclusion: Socioeconomic factors like costly treatment, missing of daily wages, lack of transport, fear of side effects and being outcast are real hindrance in getting HCV treatment. [ABSTRACT FROM AUTHOR]

Background & aim: Hepatitis B and C infections are global issues that are associated with a massive financial burden in developing countries where vertical transmission is the major mode and remains high. This cross-sectional study was designed to investigate the seroepidemiology and associated risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among 375 pregnant women attending antenatal care health facilities at Bacha Khan Medical Complex (BKMC) Shahmansoor and District Head Quarter (DHQ) Hospital Swabi, Khyber Pakhtunkhwa, Pakistan. Methodology: From a total of 375 pregnant women selected using systematic random sampling from both hospitals, 10 ml of blood samples were collected and alienated serum was examined for indicators identification through the Immuno-Chromatographic Test (ICT) and 3rd Generation Enzyme-Linked Immunosorbent Assay (ELISA). A pre-structured questionnaire was used to collect the socio-demographic data and possible risk factors. The data was analyzed via SPSS 23.0 statistical software. A chi-square analysis was performed to determine the association between variables. P-value < 0.05 was set statistically significant. Results: The overall frequency of HBV and HCV among 375 pregnant women involved in the study was 3.7% and 2.1% respectively. None of the pregnant women were co-infected with HBV and HCV. Dental extraction (P = 0.001) and blood transfusion (P = 0.0005) were significantly allied with HBV infection while surgical procedure (P = 0.0001) was significantly associated with HCV infection. Moreover the sociodemographic characteristics: residential status (P = 0.017) and educational level (P = 0.048) were found significant risk factors of HBsAg and maternal age (P = 0.033) of anti-HCV, respectively. Conclusion & recommendation: HBV and HCV infections are intermediary endemic in the study area. A higher prevalence of HBV was detected among pregnant mothers with a history of dental extraction, history of blood transfusion, resident to the urban area and low educational level. The age and surgical procedures were the potential risk factors found significantly associated with HCV positivity among pregnant mothers in our setup. Future negotiations to control vertical transmission should include routine antenatal screening for these infections early in pregnancy and the requirement of efficient preventive tools including the birth dose of the hepatitis B vaccine in combination with hepatitis B immune globulins to the neonate. [ABSTRACT FROM AUTHOR]

HCV infects nearly 10 million patients in Pakistan, genotype 3 is the predominant genotype. Liver transplant used to be the only option in patients with decompensated cirrhosis before the emerging role of DAAs. Clinical trials have suggested that successful treatment of HCV in this group results in early improvement in liver function although long term benefit is not yet known. Objectives: To measure clinical and laboratory parameter improvement after successful eradication of hepatitis C in cirrhotics. To study any events of decompensation while on treatment. To measure incidence of HCC on/after treatment. Study Design: A retrospective, observational study. Setting: Fatima Memorial Hospital, Lahore. Period: July 2015-April 2017. Material & Methods: We included patients with compensated and decompensated cirrhosis with a CTP score ranging from A5 to C12, treated with sofosbuvir and ribavirin or pegylated interferon sofosbuvir and ribavirin. Data analyzed at the initiation, at the end, 12 weeks and 24 weeks post treatment. Results: A total of 191 (98 male and 93 female) patients were included in our study. There was statistically significant improvement in albumin, bilirubin, AFP, platelet count, CTP and MELD scores but not in INR. One patient developed ascites and another developed hepatic encephalopathy. Four patients developed HCC during follow up after completion of antiviral therapy. Conclusions: 1) Successful treatment of cirrhotic patients leads to improvement in clinical and laboratory parameters. 2) Need for continued surveillance for HCC in patients with cirrhosis remains after successful antiviral treatment. [ABSTRACT FROM AUTHOR]

Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan. [ABSTRACT FROM AUTHOR]

Temperature is the main climatic factor that influences the yield just as entire development of farming crops. All periods of phenology of crops are temperature sensitive. Hence, information on appropriate temperature for best yield is significant so as to get maximum production. In current examination, a field test was directed to evaluate the phenology, relative development, ideal sowing time, comparative growth just as yield execution of three cultivars of Bacillus thuringiensis Cotton (Bt. Cotton) at different sowing systems during summer 2015 at cotton research station Regional Agriculture Research Institute Bahawalpur (RARI) Pakistan. The test was directed in an irregular complete block design (RCBD) with a split-plot course of action comprising of three replications. One factor comprised of six planting dates (for example April15 and 30, 15 and 30 May, 14 and29 June) and other factor comprising of three Bt. cotton cultivars (BH-184, MNH-886 and CIM-598). The after effects of the test indicated that both sowing dates and cultivars fluctuated fundamentally for development, phenology and yield. Highst leaf area index (LAI) 4.38, total dry matter (TDM) 1033 g m-2, leaf area duration (LAD) 275.6 days and mean harvest development rate 6.51g m-2 day-1 were recorded on April 30 sowing. Yield contributing boundaries like opened boll, average boll weight and 100-seed weight altogether shifted and highest seed cotton yield 3847 kg ha-1 was acquired by cv. MNH-886 when it was planted on April 30. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is the most common acid-related disorder encountered during clinical practice in Pakistan and is associated with significant impairment of health-related quality of life. A number of guidelines and recommendations for the diagnosis and management of GERD have been published in different countries, but a Pakistani accepted directive by the standards of evidence-based medicine is still lacking. Our aim was to create an understanding of the natural history and presentations of reflux disease; evaluating possible treatment options available for the patients with complex and uncomplicated reflux ailments with the development of current and up to date evidence based endorsement, relevant to the needs of Pakistani health care providers in order to treat oesophageal manifestations of GERD. In order to make such guidelines, a comprehensive literature search was conducted with pertinent evidence reviewed, and quality of relevant data assessed. The resultant conclusions were based on the best available evidence and expert opinion of the authors of technical review panel.

Objective: To assess the utility of liver function tests (LFTs) for early recognition and prediction of severity of Dengue fever in hospitalized patients., Study Design: An analytical study., Place and Duration of Study: Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September - December 2010., Methodology: Admitted cases of Dengue fever were divided into 3 groups; mild, moderate and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. (survival or complication free stay) or (death or complications). RESULTS were analyzed in SPSS version 18., Results: Out of the 353 patients with mean age of 37.12 ± 15.45 years, 245 (69.4%) were males and 108 (30.6%) were females. Seventy five patients (21.2%) had mild elevation of aminotransferases (2 fold increases), 265 patients (75.1%) had moderate increases (3 to 4 fold) and 13 (3.7%) had severe (> 4 fold increase). ALT was statistically higher in patients with septicemia, hepatic and renal failure (p-value ² 0.05). AST was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT., Conclusion: AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases.