Background: Hypoalbuminemia ‎ is a strong predictor for assessing acute and chronic illness conditions. The condition of hypoalbuminemia ‎is associated with the low synthesis of albumin resulting from cachexia and wasting. Aim: To find out the frequency of 30 Day in-hospital mortality among patients with hypoalbuminemia admitted at a tertiary care hospital of Karachi. Study design: Cross-sectional study. Place and duration of study: Data was collected from the Department of Medicine Department, Government Tertiary Care Hospital of Karachi during a period of six months from Feb 2022 to August 2022. Methodology: One hundred and seven patients who met the investigative criteria were included. A short history was taken and demographic details were recorded after taking informed written consent. 5 ml of blood from a peripheral vein and collected in a specific tube to measure serum albumin level at admission. Patients with serum albumin < 3.5 mg/dl were labelled hypoalbuminemia. Patients were followed throughout the admission, and those expiring within the 30 days of admission were labelled as having 30 Day in-hospital mortality. Results: The measurements of mean age, height, albumin, ‎and weight were 49.87±12.41 years, 159.00±7.28 cm,‎1.89±0.33 mg/dl‎, and 78.7±9.87 kg, respectively. Sixty-five (60.7%) were male, and 42 (39.3%) were female. In this study, we found that the in-hospital death rate was 14%. A significant association was found between in-hospital mortality and gender, age group, diabetes mellitus, hypertension, anemia, smoking status, and family income status. Conclusion: Hypoalbuminemia ‎ is a strong predictor for assessing acute and chronic illness conditions. The plasma albumin levels were reduced during mortality and extended hospital stay. Hence, the measurement of plasma albumin should be considered during the assessment of patients with cardiogenic shock. Keywords:‎ 30 Day in-hospital mortality, ‎Hypoalbuminemia, Length of hospital stay

Objective: This research aimed to evaluate the relative benefits of intravenous ciprofloxacin and ceftriaxone for the treatment of bacterial peritonitis in cirrhotic liver patients. Study Design: Randomized control trial Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital Lahore in the period from March, 2022 to August, 2022. Methods: Total 130 patients of bacterial peritonitis in liver cirrhosis were included. Patients were undergone for abdomen ultrasound to diagnose liver cirrhosis. Following the acquisition of written informed consent, participants' personal information (such as age, sex, and residence) was meticulously documented. Patients were equally divided in two groups. Group I received intravenous ceftriaxone 1g 12 hourly among 65 patients and 65 cases of group II received ciprofloxacin 200mg 12 hourly for 6 days. Effectiveness among both groups were assessed. Results: There were 44 (67.7%) males and 21 (32.3%) females in group I and in group II 52 (80%) males and 13 (20%) females. Patients mean age in group I was 39.10±6.29 years and in group II mean age was 41.7±3.50 years. We found that majority of the cases were from urban areas 37 (56.9%) in group I and 39 (60%) cases in group II. Frequency of effectiveness in group I was 49 (75.4%) and in group II efficacy found in 47 (72.3%) cases. Post-treatment complications in group I was 7 (10.8%) and in group II found in 6 (9.2%) cases. Satisfaction rate among patients was almost equal 46 (70.8%) and 45 (62.9%) in group I and II. Conclusion: The findings of this research indicate that the administration of ciprofloxacin intravenously is just as effective as the administration of ceftriaxone intravenously for the treatment of spontaneous bacterial peritonitis in cirrhotic cases.

Objective: The outcomes of individuals who were admitted to a hepatobiliary unit suffering from acute severe necrotizing pancreatitis will be the focus of this research. Study Design: Observational/ Prospective study Place and Duration: Conducted at Department of Gastroenterology Hayatabad Medical Complex Peshawar, during from the period Jan, 2021 to June, 2021. Methods: There were 85 patients of both genders were presented in this study. Included patients were aged between 20-70 years. All the patients had severe necrotizing pancreatitis were included. Detailed demographics of enrolled cases included age,sex, body mass index, etiology and comorbidities were recorded after taking informed written consent. Outcomes were calculated in terms of complications, hospital stay, number of drains inserted and nutritional support among all cases. SPSS 22.0 was used to analyze all data. Results: Among 85 patients, majority of the cases were males 62 (72.9%) and the rest of the patients were females 23 (27.1%). Included patients had mean age 47.12±8.39 years and had mean BMI 26.2±6.25 kg/m2. Most common comorbidity was diabetes mellitus found in 18 (21.2%),followed by hypertension in 17 (20%) and ischemic heart disease in 9 (10.6%) cases. Gall stones were the most common etiology found in 35 (41.2%) followed by idiopathic in 16 (18.8%) and cigarette smoking in 13 (15.3%) patients. NG feed was the most common nutrition in 19 (22.4%) cases. 10 was the most common CTSI score in 43 (50.6%) cases. Mean hospital stay was 31.9±11.82 days and infected necrosis / peri-pancreatic collections was the most common complication.13 (15.3%) cases received EUS drainage and surgical necrosectomy was given to 8 (9.4%) cases. Frequency of deaths was 10 (11.8%). Conclusion: A specialized hepato-biliary unit with a multidisciplinary team approach improves survival with acute severe necrotizing pancreatitis. Percutaneous and EUS-guided draining of pancreatic collections helps prevent necrosectomy for infected pancreatic necrosis. Keywords: Disease outcome, Acute pancreatitis, Infected pancreatic necrosis, Necrosectomy Acute Necrotizing Pancreatitis

Objective: The aim of this study is to determine the prevalence of diabetes mellitus and impaired glucose tolerance in patients with COVID-19. Study Design:Cross-sectional study Place and Duration:Conducted at department of Medicine, Khyber Teaching Hospital (KTH),Peshawer and Avicenna Teaching Hospital, Lahorefor the duration from July 2020 to December 2020. Methods: There were one hundred and fifteen patients of both genders had coronavirus disease were included in this study.Patients ranged in age from 25 to 80 years.After obtaining informed written permission, we collected detailed demographic information on all of the registered patients, including their age, gender, BMI, educational attainment and place of residence. All of the patients had their blood tested for corona disease using RT-PCR. After screening positive (fasting capillary glucose >100 mg/dl and 200 mg/dl) and each sixth consecutive negative (fasting capillary glucose <100 mg/dl) subjects, the 75-g oral glucose tolerance test was administered. The SPSS 23.0 software was used for analyzing of data. Results:Included patients had mean age 59.4±12.55 years with mean body mass index 29.12±11.76 kg/m2. There were 70 (60.9%) male patients and 45 (38.1%) females. Majority of the patients were illiterate 65 (56.5%) and 49 (42.6%) patients were from urban areas. Most common co-morbidities were hypertension, hyperlipidemia, chronic kidney disease and coronary artery disease. We found 62 (53.9%) patients had diabetes mellitus in which majority of the cases were pre-existing. Frequency of impaired glucose tolerance was found among 26 (22.6%) cases in which majority of the cases had pancreatic cancer. 28 (24.4%) cases had intubation. Overall mortality was found among 18 (15.3%) cases. Conclusion:This research found that people with diabetes and poor glucose metabolism are more likely to have severe Covid-19. A previously undiagnosed symptom of primary infection has been linked to a disorder in glucose metabolism. Pathways through which SARS-CoV-2 affects glucose metabolism must be investigated if disease aetiology is to be fully understood. Keywords:Coronavirus, DM, IGT, Co-morbidities, Mortality

Background and Aim: Globally public health has been drastically affected by the Coronavirus disease (COVID-19) pandemic. There is a scarcity of data regarding risk factors, cardiac injury, and the treatment of cardiovascular disease associated with coronavirus disease. The present study aimed to assess the pattern of cardiovascular disease in COVID-19 patients referred to Tertiary Care Hospital. Methodology: This retrospective study was conducted on 446 adult patients with new-onset or existing cardiovascular disease patients at the department of Cardiology, PNS Shifa hospital Karachi during the period from February 2021 to July 2021.Demographic details, physical examination, comorbid conditions, and laboratory findings were used for data collection from the patient’s admission file. All the patients above 18 years and positively diagnosed with COVID-19 infections through rapid antigen test were enrolled and admitted with cardiovascular disease. The clinical features, chest X-ray, echocardiography, biochemical parameters, and electrocardiogram (ECG) were analyzed for each individual. Congenital heart disease,coronary artery disease, cardiomyopathy, heart failure, arrhythmias, peripheral arterial disease, and myocarditis were different cardiovascular diseases. Statistical analysis was carried out in SPSS version 23. Results: Of the total 446 cardiovascular disease patients, about 334 (74.9%) were male and 112 (25.1%) were females. The overall mean age was 52.82±10.62 years. Out of 446 CVDs patients, the incidence of preexisting and new cardiovascular disease was 225 (50.4%) and 221 (49.5%) respectively. Acute coronary syndrome was the prevalent (50.7%) cardiovascular manifestation followed by elevation myocardial infarction. The incidence of myocarditis, Rhythm and conduction abnormalities was 45 (10.1%) and 126 (28.3%) respectively. QT prolongation and hospital mortality was seen in 45 (10.1%) and 85 (19.1%) respectively. The prevalence of pre-existing cardiovascular disease, atrial fibrillation, cardiogenic shock, and renal failure were predominantly higher in mortality group compared to survival group. Conclusion: Our study found acute coronary syndrome was the prevalent cardiovascular disease. Elevated serum ferritin, lymphopenia, advanced age, cardiogenic shock, lower haemoglobin, renal failure, pre-existing heart failure, and leukocytosis were significantly related to cardiovascular disease increased mortality.