Background: Caregiving to substance-use disorder patients had a significant impact on mental and physical health which needs some modalities to be developed to support the caregiver’s self-care. Objectives: To determine the frequency of depression among caregivers of patients with Substance use disorder Setting: Department of psychiatry, Ganga Ram Hospital, Lahore Material and Methods: Total 100 caregivers of either gender of age 20 to 50 years old, of patients with substance use disorder. All those with significant physical, surgical, or psychiatric illness and/or mental retardation, dependence of more than one drug simultaneously, intravenous drug users, history of any past psychiatric illness in caregivers, care givers with medical problems (Diabetes, Hypertension, Asthma and COPD) that may mask depressive symptoms were excluded. For Substance use disorder DSM5 criterion was applied to the patient. Conclusion: We concluded that frequency of depression is higher among caregivers of patients with Substance use disorder which needs early intervention to reduce their mental health.

Tachyarrhythmiasare dangerous heart rhythms that can disturb the hemodynamics of the patient leading to cardiac arrest and death. Knowing the exact burden of AVRT and AVNRT in our population can help in early diagnosis and management with radiofrequency ablation.Aim of this study was to determine the frequency AVNRT and AVRT in relation with concealed and manifested types of accessory pathways, in patients with previous history of Narrow Complex Tachycardia (NCT). Methods: In this retrospective study, 160 patients were enrolled from Punjab Institute of Cardiology, Lahore, Electrophysiology Department. All patients who had experienced two or more episodes of narrow complex tachycardia (NCT) were included. Main outcome variable was primary etiology of NCT as seen on EP study. Age, gender, co-morbid conditions like diabetes and hypertension were documented for each patient. Results: Mean age of the patients was 38.25 SD 13.6 years, 60% were females and only 8 patients had diabetes (5%) all were above 50 years of age, 24 patients had hypertension (15%) with majority of case of age 31-50 years. On electrophysiological (EP) study, patients of NCT were later diagnosed to be AVNRT in 60% (n: 96) cases and ORT in 40% cases (n: 64), (24 of 64 cases of manifested type and 40 of 64 cases of concealed type). Among the factors like diabetes, hypertension, old age, old age with hypertension and old age with diabetes, old age alone was a significant risk factor, p=0.03. Conclusion: Narrow complex tachycardia (NCT) patients should be follow-up for EP study to determine the cause and manage using catheter ablation. The percentages and statistics concluded in our study are more or less in coherence with international studies. We have not been able to identify any significant differences which could initiate the basis and lead us to another study. Keywords: AVNRT, ORT, SVT, Re-entery tachycardia, Arrhythmia, Electrohysiology, EP

Objectives: record the rate of thrombocytopenia in cases presenting with chronic liver disease(CLD) due to Hepatitis C virus. Methodology: A total of 300 patients who were diagnosed with CLD caused by HCV and were over the age of 18 were part of this trial. The enroleld cases were admitted from Deptt. of Medicine, Rawalpindi Medical University. All patients diagnosed using AST, ALT levels of liver function test and reported by the radiologist was labeled as havign CLD. A thrombocyte count and an ELISA test for HCV were performed on the blood sample that was supplied to the laboratory from patients who had been diagnosed with CLD to determine presence/absence of thrombocytopenia. Results: Patients were in majority in age group 41-60 yrs i.e. 62%(n=186), mean age 42.63+8.57 yrs, 60 percent males (n=180) and there are 40 percent female subjects (n=120). Thrombocytopenia was found in 26 percent of CLD patients (n=78), while 74 percent of CLD patients (n=222) did not have any signs of thrombocytopenia. Conclusion: Higher rate of thrombocytopenia was observed in CLD cases due to hepatitis C virus. It needs attention for its early detection and management. Keywords: Chronic liver disease, hepatitis C virus, thrombocytopenia, HCV, CLD

In underdeveloped nations, TB in children is a major public health issue, with tubercular meningitis being a devastating consequence with high death rate. Tuberculous Meningitis (TBM) is caused by the spread of main or secondary pulmonary illness through the bloodstream. One of the most dangerous clinical symptoms of TB is infection of the central nervous system. The advanced stage of TBM may have a negative impact on the result. Objective: To determine frequency of different spectrum of clinical presentation of tuberculosis meningitis in children at tertiary care hospital Material and Methods: This was a cross sectional study carried out at the Children hospital and Institute of child health from May, 2018 to Nov, 2018. About 364 patients were employed in the research. Patients' or attendants' informed written consent was attained, and their demographic information (including name, age, gender, residence, and duration of pain) was recorded. All newly diagnosed cases were taken in this study for further investigation about their stages of the disease. All stages were labeled as per operational definition. Results: The patients' normal age was 6.56 SD 3.46 years, with the lowest and highest ages being 1 and 12 years, respectively. There were 200 male cases (54.9%) and 164 female cases (45.1%), with a larger male to female ratio. With a minimum and highest GCS score of 5 and 15, the mean GCS is 11.76 2.77. According to the operational definition, 30 patients (8.2%) had stage I TBM, 150 cases (41.2%) had stage II TBM, and 184 instances (50.5%) had stage III TBM. Conclusion: The outcomes of this study revealed that about half of the cases had stage III TBM, implying that patients with TBM should be managed properly if this stage is remembered. With aggressive and selective treatment plan the prognosis can be increased and rate of mortality may be decreased. Keywords: Children, developing country, meningitis, mortality, Tuberculosis

Objective: evaluate the diagnostic accuracy of serum C-reactive protein levels in acute appendicitis (AA) Methodology: Two hundred suspicious cases of AA presenting with pain in right iliac fossa in addition to nausea/vomiting, direct tenderness in right iliac fossa of either gender in adult population were included. Intravenous blood sample was drawn for CRP evaluation. Appendectomy was performed in all these cases, and histopathological examination was done to confirm presence/absence of AA. Both the reports were evaluated and AA was considered positive if CRP levels are >6 μg/dl. A 2x2 table was drawn to analyze diagnostic accuracy of CRP. Results: The mean age was 27.11+10.42 years, 80.5% (n=161) cases were diagnosed as acute appendicitis on histopathology. The diagnostic accuracy of serum C-Reactive Protein levels shows 81.63% for sensitivity, 73.58% for specificity, 89.55% had positive predictive value, 50.09% negative predictive value while 79.50% had accuracy rate. Conclusion: serum C-reactive protein levels is a useful marker for diagnosing acute appendicitis and may be used in rural areas where USG and CT scan facility is not available. Keywords: Acute appendicitis, diagnosis, serum C-reactive protein, diagnostic accuracy