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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.

Aim: To determine the frequency of recurrence of hepatic encephalopathy in patients treated with Rifaximin. Study design: Observational cross-sectional study. Setting & duration: Department of Medicine, Services institute of Medical Sciences Lahore for duration of 12 months. Methodology: Hepatic encephalopathy was diagnosed using West-Haven classification in patients of chronic liver disease. Recurrence was considered if a new episode of hepatic encephalopathy occurred within 3 months after initiation of treatment. A total 120 patients of chronic liver disease having had an episode of recent hepatic encephalopathy within the last 3 months, of both genders, above 20 years of age with hepatic encephalopathy were included in the study. The patients were followed for 3 months after initiation of therapy and any episode of recurrence of hepatic encephalopathy was recorded. Results: Mean age was 51.5±12.2 years and 52.3±12.8 years respectively in Rifaximin and Placebo groups. Fourteen (23.3%) patients in Rifaximin group and 17(28.3%) in placebo group were younger than 40 years of age. Thirty-three (55%) patients in Rifaximin group were male versus 29(48.3%) patients in Placebo group. Fifteen (25%) patients in Rifaximin Group developed hepatic encephalopathy by 3 months of follow up as compared to 31(51.7%) patients in Placebo Group Conclusion: Frequency of recurrence of hepatic encephalopathy is significantly lower in Rifaximin treated patients. Keywords: Hepatic Encephalopathy, Recurrence, Rifaximin.

Objective: Medical students have considerably higher prevalence rates of depression and suicidal thoughts as compared to their age-fellows from the general population. Only a limited number of studies have previously investigated the suicidal thinking/planning in Pakistani medical students. The aim of this study was to assess the prevalence rates of suicidal thoughts and planning in medical students studying at a private medical college in Lahore, Pakistan. Place and duration: Fourth year and final year medical students at Azra Naheed Medical College, Lahore were invited to voluntarily take part in this study. The study was conducted from 15th of June to the 15th of July 2022. Study design: Cross-sectional descriptive study Methodology: Suicide behavior questionnaire revised (SBQ-R) was used as the study instrument. Data collection was anonymous and the study was approved by the local institutional review board. The study was approved by the Institutional review board of Azra Naheed Medical College, Lahore. Descriptive statitstics were employed to report the findings and SPSS version 26 was used to store and analyze the data. Results: A total of 248 medical students (51.5% female) participated in the study. The prevalence of suicidal thoughts/plans in the past was 36.3% and the prevalence of suicidal thoughts in the past year was 31%. More than 16% of students communicated their intent to commit suicide to someone else in the past and 7% of the students reported that it was likely, rather likely or very likely that they will attempt suicide in the future. Conclusions: The prevalence of suicidal thoughts/ planning in medical students is worryingly high. Medical teachers should routinely assess their students for the presence of depressive symptoms/suicidal thoughts and offer support for students who screen positive for these. Key words: Suicide, Medical students, Prevalence

Background: Previous research on the prevalence of depression and anxiety disorders in patients with chronic kidney disease (CKD) has shown a high prevalence of both types of disorders. The aims of this study was to assess the prevalence of depression in anxiety disorders in CKD patients admitted at a tertiary care facility in Lahore, Pakistan. Materials and methods: All admitted patients at one of the medical wards at Jinnah hospital Lahore from December 2018 to December 2019 with a diagnosis of CKD were invited to participate in this study. Aga khan university anxiety and depression scale was used to assess the prevalence of anxiety and depressive disorders. Results: All patients scored above the cut-off points of 19 on the AKUADS. The mean score of study participants on AKUADS was 46 (range of possible scores from 0 to 75). There was no statistically significant difference between male and female study participants on AKUADS scores. Conclusions: The prevalence of depressive and anxiety disorders in patients with CKD is extremely high in the Pakistani population. The possible reasons for this high prevalence could be physical morbidities, lack of appropriate treatment facilities, financial burden, loss of bread winning roles as well as reduced quality of life associated with CKD. Keywords: Depression, Anxiety, Chronic kidney disease

Objectives: To determine the frequency of silent cardiac ischemia in type II diabetes mellitus patients presenting to tertiary care facility. Methodology: This cross-sectional study was conducted from 20th October 2017 to 20th April 2018 at Department of Medicine Jinnah Hospital Lahore. After a detailed history, measurement of height, blood pressure, weight, fasting blood sugar, body mass index of 237 patients were recorded, and electrocardiography (ECG) was done before and after exercise tolerance testing (ETT). Changes in ECG were assessed and person labeled as having silent cardiac ischemia or not depending on the outcome of the ECG. Results: Mean age was 54.9 ± 5.9 (range: 45 – 63) years. There were 144 male patients and 93 female patients The mean duration of type II diabetes mellitus in the study population was 10.0 ± 2.6 (range: 6 – 15) years. The frequency of silent cardiac ischemia was found to be 45.1%. Increasing age, prolonged duration of diabetes mellitus, history of smoking and hypertension, and increased body mass index were significantly related to silent cardiac ischemia (p-value< 0.05). Conclusion: Silent cardiac is quite prevalent in our population that demands urgent efforts to diagnose this condition earlier for better future outcomes.

Objective: To determine the elevation of AST/ALT ratio in association with severity of esophageal varices in patients with hepatic cirrhosis. Study Design: Cross sectional survey Place and Duration of Study: Medical Unit II, Jinnah Hospital Lahore from November 2018 to April 2019 Methodology: One hundred and ten subjects were enrolled. The complete history, physical examination and appropriate investigations were done like liver functions test to see the ratio of AST/ALT and upper GI Endoscopy to confirm the presence or absence of esophageal varices. Results: The mean age of the patients was 45.6±5.2 years with 77.27% males and 22.73% females. Paquet grading system showed that esophageal varices were presented in 20.9% grade II. Within the 65 cases of esophageal varices 30 patients of liver cirrhosis were having a 27% high risk of esophageal varices. ALT and AST were significantly higher in high risk esophageal varices. Conclusion: The elevated level of ALT and AST are significantly associated with the severity of esophageal varices in hepatic cirrhosispatients. Key words: Elevation, AST/ALT ratio, Association, Esophageal varices, Hepatic cirrhosis

Objective: To determine efficacy of Daclatasvir with sofosbuvir in treating patients of chronic hepatitis C genotype 3. Study Design: Interventional case-series study Place and Duration of Study: Hepatitis Clinic, Medical Unit–II, Jinnah Hospital, Lahore from January 2019 to June 2019. Methodology: One hundred and thirty five patients of chronic hepatitis C Genotype 3 were enrolled. All patients were givendaclatasvir60mg and sofosbuvir 400mg once-daily for 12 weeks. HCV-RNA-PCR was done at end of 12 weeks of treatment (ETR) and 12 weeks after end of treatment (SVR). Results: The mean age of the patients was 49.8 ±2.3 years. There were 57.7% males while 42.2% females with 22.2% frequency of cirrhosis in them.The mean value of AST and ALT was calculated as 57.07 ± 48.69 and 51.02 ± 44.17 IU/ml respectively in hepatitis C patients having genotype 3.The treatment follow up showed that on reassessing the hepatitis C status through quantitative analysis of genotype 3 through PCR it was seen that 91.1% patients reached SVR with no viral detection in them. Conclusion: Daclatasvir in combination to sofosbuvir is an efficient way of treating hepatitis C patients suffering from genotype 3. Keywords: Viral load, Sofosbuvir, HCV, Genotype 3

Anton's syndrome implies the situation when affected patient contradicts blindness in spite of objective documentation of loss of vision, and often confabulate to assert their bearing. It is an infrequent sequel of cortical blindness affecting both occipital cortex and other cortical centers, while patients genuinely act as if they are sighted. Our case report is of a lady, 55 years old, who presented to us with history of uncontrolled diabetes, hypertension and visual loss as a consequence of occipital lobe infarction bilaterally. In patients with evidence of occipital lobe injury and atypical visual loss, an assessment for cortical blindness and Anton's syndrome must be included. Anton's syndrome is most frequently caused by cerebrovascular disease. Any condition that causes cortical blindness may, however, lead to Anton's syndrome. Improvement in visual function after occipital lobe infarction due to cerebrovascular events is limited. Therefore, the management should be focused on rehabilitation and secondaryprevention. Keywords: Anton’s syndrome, Occipital lobe infarct, Diabetes mellitus, Hypertension.

Objective: To determine the frequency of anaemia among patients with human immune-deficiency virus / acquire immunodeficiency syndrome. Methods: The descriptive cross-sectional single-blind study was conducted at Jinnah Hospital, Lahore, Pakistan, from June 25 to December 25, 2016, and comprised human immune-deficiency virus / acquire immunodeficiency syndrome patients diagnosed at least 3 months earlier.. Demographic information was obtained along with sample of patient’s blood for haemoglobin level estimation. Anaemia was defined as haemoglobin 12g/dl. Overall, 152(66.1%) patients were anaemic and 78(33.9%) were normal. Age and socioeconomic status were significantly associated with anaemia status (p

Objective To compare the efficacy of lactulose plus rifaximin with efficacy of lactulose alone in the treatment of hepatic encephalopathy. Study design A randomized controlled trial. Place and duration of study Department of Medicine, Jinnah Hospital, Lahore, from December 2014 to June 2015. Methodology All patients who presented with hepatic encephalopathy due to decompensated chronic liver disease were randomly divided into two groups of 65 patients each. One group was given 30 ml thrice daily lactulose alone and the other lactulose plus rifaximin 550 mg twice daily for 10 days. Informed consents were taken from the participants' attendants. Grades II-IV hepatic encephalopathy was noted according to West-Haven Classification. All subjects were followed until 10 days after admission. Results The mean age of patients was 56.06 +11.2 years, among which 46.9% were females and 53.1% were males. After ten days of follow-up, reversal was seen in 58.46% in lactulose alone group and 67.69% in lactulose plus rifaximin group (Chi-square p=0.276). Conclusion There was no difference in effectiveness of lactulose plus rifaximin and lactulose alone in treatment of hepatic encephalopathy.