Objective: To determine the frequency of autonomic cardiovascular dysfunction in patents with decompensated cirrhosis. Methodology: This cross-sectional study was conducted from august 2018 to January 2019 at department of medicine, Abbassi Shaheed hospital. A total of 187 diagnosed patients of decompensated chronic liver disease were consecutively included. Lying and standing BP were taken for orthostatic hypotension while 1 minute ECG was recorded for decrease in HRV during breathing. Results: Out of 187, 72.7% had autonomic cardiovascular dysfunction. Conclusion: Almost two thirds of cirrhotic were found to have hemodynamic alterations. Treatment is largely supportive and empiric. Further studies are needed to recognize the burden of autonomic dysfunction.

Background: Ammonia is detoxified in the liver, and hepatic insufficiency due to cirrhosis leads to raised ammonia, causing symptoms of Hepatic Encephalopathy (HE). Studies proclaim that Helicobacter pylori (H. pylori) accelerate ammonia production. The study objective was to establish the frequency of H. pylori in liver cirrhosis patients with overt HE. Methodology: This cross-sectional study was conducted in Medical Unit-I Abbasi Shaheed Hospital, Karachi, from May to November 2018. Liver Cirrhosis patients between the ages of 31-60 years were selected via non-probability sampling. Patients of any sex suffering from liver cirrhosis for six months, as proved by ultrasound and overt HE diagnosed using West Haven Criteria, were included in the study. Stool samples were collected from patients in a sterile manner. Results of stool for H. pylori antigen were recorded. Data were analyzed using SPSS version 16.0. Results: Out of 135 patients with Liver Cirrhosis with overt HE, 42 (31.1%) suffered from H. pylori infection while 93 (68.9%) patients did not. The mean age of patients was 44.14 ± 8.49 years. Stratification of the age of patients with H. pylori infection showed significant results (p=0.00). The mean disease duration was 4.72 ± 1.24 years. Stratification based on disease duration with H. pylori infection revealed significant results (p=0.00). Stratified findings based on Child-Pugh classification and H. pylori infection were insignificant (p=0.50). Conclusion: Our study reveals there is less frequency of H. pylori infection amongst liver cirrhotic patients. However, amongst those infected, many had a longer duration of disease. Our study indicates more cases of H. pylori infection with increasing age of liver cirrhosis patients. Furthermore, the relation between H. pylori infection and the Child-Pugh classification indicates that overt HE may be attributed to factors other than H. pylori infection.

Rhabdomyosarcoma is a rare and highly aggressive malignancy arising from the striated skeletal muscle fibre. It is commonly a childhood tumour and rarely seen in adults. The most predominant part commonly involved is head and neck. We are reporting a rare case of a 54 year old adult male with Rhabdomyosarcoma of nasopharynx with a non specific presentation of weight loss for past four months, fever, a perianal abscess and backache since 10 days. Continue

Objective: The aim of this study is to determine the effects of drinking water with high fluoride level on liver functions. Method: This is a descriptive comparative cross-sectional study conducted at Sammu rind village where the drinking water has increase fluoride content. The comparative area was Gadap town where the drinking water has normal fluoride level. Sampling was done randomly and sample size was calculated by WHO calculator and found to be 121 each for exposed and unexposed population. Blood samples taken for liver functions included bilirubin, AST, ALT, Alkaline phosphate, Gamma GT, total protein, albumin and globulin. SPSS version 16 was used for analysis. Mean and SD calculated for quantitative variable and the two comparative groups were cross-tabulated. To check the statistical significance t-test was applied.Results: There was no statistically significant difference with consideration to serum bilirubin, ALT, and AST. However, statistically significant difference was established with respect to alkaline phosphatase, Gamma GT total proteins and A/G ratio between two groups. Conclusion: In our study, there was no evidence of impaired liver function tests in subjects drinking water with high fluoride content.