Introduction Dengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in SouthEast Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count. Materials and methods This prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and ˃3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA). Results Out of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%)-dengue hemorrhagic fever, and six (3.3%)-dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity. Conclusion Gall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.

BACKGROUND & OBJECTIVE: The role of Velpatasvir/Sofosbuvir in the treatment of hepatitis C virus type 3 infection is evaluated in terms of virologic responses. i.e Rapid Virological Response (RVR) End of treatment response (ETR) and Sustained virological response (SVR 12). METHODOLOGY: This was a descriptive case study conducted in Liver OPD of Benazir Bhutto Hospital during 01 November 2018 to 30 April 2019 , in which 100 patients of HCV were enrolled, all of them had HCV genotype 3 infection. Every patient was treated with combination of Velpatasvir/Sofosbuvir 100mg/400 mg Once Daily as part of treatment regimen of HCV infection for 12 weeks. Pre-treatment HCV RNA QUANTITATIVE PCR was done, which was repeated on 4, 12 weeks of treatment and then 12 weeks post treatment. RESULTS: Among 100 patients, 51 (51%) were male and 49 (49%) were females. Mean age of patients was 43.2 ± 10.4 years (mean ± SD). Mean BMI of enrolled patients was 21.34 ± 2.40 kg/m2. 33% patients were cirrhotic while 67% were non cirrhotic. 53% patients were treatment experienced while 47% were treatment naïve. Rapid Virological Response (RVR) was achieved in 92%, End of treatment response (ETR) was achieved in 96%, while Sustained Virological response (SVR12) was achieved in 99% patients. The results were stratified according to age, gender and BMI. There was no effect of these parameters on the final results. CONCLUSION: Virological response (RVR, ETR, SVR12) of Velpatsvir /Sofosbuvir and Ribavirin is encouraging.

ABSTRACT BACKGROUND & OBJECTIVE: Overweight individuals have a greater tendency to develop gastroesophageal reflux disease (GERD). This study aims at comparing gastroesophageal reflux symptoms (frequency and severity) in females with different body mass index (BMI) categories. METHODOLOGY: This cross-sectional comparative research study was conducted over duration of 8 months. Both indoor and outdoor patients of medical unit – II Benazir Bhutto Hospital, Rawalpindi, fulfilling the inclusion criteria i.e. females 30-55 years of age with confirmed diagnosis of GERD and informed consent were included. Subjects with history of cigarette smoking, diabetes, use of postmenopausal hormone replacement therapy (HRT), anti-hypertensive or asthma medication were all excluded. Data were collected via proforma and analyzed on SPSS version 17. RESULTS: Among 360 enrolled women, 08 (2.2%) subjects were underweight, 109 (30.3%) had normal BMI, 151 (41.9%) were overweight, 88 (24.4%) subjects were obese and 04 (1.1%) belonged to morbidly obese group. Among 109 subjects with normal BMI, 53 (48.6%) had mild, 40 (36.69%) moderate, 13 (11.9%) severe and 03 (2.75%) very severe GERD. Among 151 overweight subjects, 37 (24.50%) were with mild severity, 64 (42.38%) with moderate, 35 (23.17%) severe and 15 (9.93%) had very severe GERD. Among 04 morbidly obese subjects, 02 (50%) had severe while remaining 02 (50%) had very severe GERD (p=0.000). CONCLUSION: Association of GERD symptoms and BMI were found in both normal and overweight women. Reflux symptoms may be exacerbated or even caused by moderate weight gain in people with normal weight.

Aim: To evaluate the histological spectrum of "celiac hepatitis" and the likelihood that these features will return after GFD. Methods: The laboratory tests, Clinical profile, liver and duodenal biopsy were studied with the patients with hepatic derangement and CD among 35 patients. Whenever possible, a histological comparison of before and after GFD treatmenton liver and duodenal biopsies were performed. Results: In the records of the pathology and gastroenterology departments of our institute, CD and ECM were found in 35 patients. There were twenty-four men and 11 women with a mean age of 24.3 (10-50 range). Twenty-four patients were primarily identified with celiac disease and later diagnosed with CLD. At diagnosis, this feature was currently associated with small bowel diarrhea in 13 (65%) and CD without diarrhea in the remaining seven patients (35%). 10 of these 20 patients had anemia. Antibodies to TTG were positive in 21 patients (87.5%), AGA in 17 patients (70.8%), and EMA in 4 patients. Severe villous abnormality (Marsh-Oberhuber type 3C) in eleven patients (45.8.3%) on duodenal biopsy, moderate villous abnormality (type 3B) in seven patients (29.2%), 5 patients (20.8%) have mild abnormality of the villi (type 3A). The clinical topographies indicating the progress of liver ailment in these 24 cases are as follows: 8 have ascites (33.3%), 6(25%) patients have jaundice, hepatomegaly in 5 (20.8%) and 5(20.8%) Patients have splenomegaly. Conclusion: There has been a problematic case of coeliac disease that has undergone an unnoticed distinction. This is one of the few researches that shows the full range of Coeliac Disease liver histopathology, from non-invasive to invasive hepatitis’. Experiment of a GFD may outcome in clinicopathological enhancement of ’coeliac hepatitis’. Keywords: Gluten-free diet, coeliac disease, duodenal biopsies, hepatomegaly.