ABSTRACT… Objectives: To assess the SBP in patients with Hepatic Encephalopathy and its association with grades of hepatic encephalopathy. Study Design: Cross sectional study. Setting: Department of Medicine, Medina Teaching Hospital. Period: January 2017 to June 2017. Material and Methods: Total 143 patients of HE having age range from 18-65 years either male or female selected. SBP was assessed in these selected patients. SBP defined as positive when ascetic fluid neutrophil count > 250/ml. West heaven criteria was used for grading of HE. Results: In present study, mean age of patients was 37.45 ± 10.63 years. Out of 143 patients, SBP was found in 77 (54%) patients. HBsAg was found positive in 58 (40.56%) patients followed by Anti-HCV was found positive in 77 (53.85%) patients and Both Anti-HCV & HBsAg was found positive in 8 (5.59%) patients. Total 51 (35.66%) patients were found with grade I HE followed by 60 (41.96%) patients grade II, 23 (16.08%) patients grade III and 9 (6.29%) patients found with grade IV HE. SBP was found in 36 (70.59%) patients, 32 (53.33%) patients, 5 (21.74%) patients and 4 (44.44%) patients respectively. Statistically significant association between grade of HE and SBP was noted with p value 0.001. Conclusion: Results of present revels that frequency of SBP is very high in cases of HE. Hepatitis C was found positive in most of the patients. Statistically insignificant association of SBP with gender was observed. But highly significant association of SBP with grade of HE was seen. Key words:Hepatic encephalopathy, Cirrhosis, Spontaneous bacterial peritonitis, Ascites Article Citation: Ghafoor A, Ahmed I, Javid RA. Spontaneous bacterial peritonitis (SBP); Assessment of spontaneous bacterial peritonitis (SBP) in patients of hepatic encephalopathy and its association with grades of HE.

Background: Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non–ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. Case presentation: We present a case of 36 years female who visited cardiac OPD with continuous left arm pain. She was then referred to nuclear cardiology for screening of CAD. Pharmacological stess study was planned but rest study was done instead due to patient having persistent pain in left arm. Rest study showed a large perfusion defect in LAD territory. As patient was not having any previous history of CAD except for positive family history of premature CAD. She was immediately referred to interventional cardiologist where her primary PCI to LAD (3xDES) got done and she was saved from impending myocardial infarction. Conclusion: Regular follow up and monitoring should be fine in young adults with positive family history of premature CAD. This may help in early detection leading to timely management and acute coronary events in young adults may be avoided. This will eventually reduce mortality and morbidity.

ABSTRACT… Objectives: To find out the frequency of hyponatremia in cases of hepatic encephalopathy. Study Design: Cross-sectional study. Setting: Department of Medicine DG Khan Hospital, DG Khan. Period: July 2016 to December 2016. Material and Methods: Total 80 patients with hepatic encephalopathy either male or female were selected for this study. Hyponatremia was assessed in these selected patients. Results: Mean age of the patients was 38.34 ± 11.140 years. Hyponatremia was found in 31 (39%) patients. Hyponatremia was noted in 13 (41.94%) patients of age group 18-36 years and 18 (36.73%) patients of age group 37-55 years. Statistically insignificant association of hyponatremia with age was seen with p value 0.6467. Hyponatremia was found in 21 (40.38%) male patients and 10 (35.71%) female patients. But the difference of frequency of hyponatremia between male and female patients was statistically insignificant with p value 0.8109. Conclusion: Results of this study showed a higher percentage of hyponatremia in patients with HE. Male were more victim of HE as compared to female but insignificant association of hyponatremia with gender is noted. Findings of present study showed that there is insignificant association of hyponatremia with grade of HE, socioeconomic status, area of residence and age.

Objectives: To assess the SBP in patients with Hepatic Encephalopathy andits association with grades of hepatic encephalopathy. Study Design: Cross sectional study.Setting: Department of Medicine, Medina Teaching Hospital. Period: January 2017 to June2017. Material and Methods: Total 143 patients of HE having age range from 18-65 years eithermale or female selected. SBP was assessed in these selected patients. SBP defined as positivewhen ascetic fluid neutrophil count > 250/ml. West heaven criteria was used for grading of HE.Results: In present study, mean age of patients was 37.45 ± 10.63 years. Out of 143 patients,SBP was found in 77 (54%) patients. HBsAg was found positive in 58 (40.56%) patients followedby Anti-HCV was found positive in 77 (53.85%) patients and Both Anti-HCV & HBsAg was foundpositive in 8 (5.59%) patients. Total 51 (35.66%) patients were found with grade I HE followed by60 (41.96%) patients grade II, 23 (16.08%) patients grade III and 9 (6.29%) patients found withgrade IV HE. SBP was found in 36 (70.59%) patients, 32 (53.33%) patients, 5 (21.74%) patientsand 4 (44.44%) patients respectively. Statistically significant association between grade of HEand SBP was noted with p value 0.001. Conclusion: Results of present revels that frequencyof SBP is very high in cases of HE. Hepatitis C was found positive in most of the patients.Statistically insignificant association of SBP with gender was observed. But highly significantassociation of SBP with grade of HE was seen.