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Background: Proton pump inhibitors (PPIs) are in routine widely prescribed to hemodialysis patients. Recent studies have reported the association of PPIs use with hypomagnesemia in patients with long term hemodialysis. This study aims to determine the frequency of hypomagnesemia in patients of hemodialysis taking proton pump inhibitors. Patients and methods: This cross-sectional study was conducted in the Department of Nephrology of Sandman Provincial Hospital Quetta from 01-6-2019 till 01-9-2019. A total of 120 patients (52 PPI users and 68 non-PPI users) who were on HD for more than 06 months were included. Data regarding age, gender, duration of hemodialysis and taking PPIs were collected. Determination of serum magnesium was made by taking 3 different samples at 2 weeks’ interval and the mean value of serum magnesium was calculated. Serum Mg2+ levels <2.0 mg/dL was taken as hypomagnesemia. A Chi-square test was applied to determine the association of PPI use with hypomagnesemia. Results: Demographic variables such as age and gender were not significantly different between the groups. There was female dominance in both groups (73% in PPI groups and 66.1% in the non-PPI group (p-value 0.65). The mean duration of dialysis was 45.3±13.8 months in PPI users versus 48.9±12.9 months in non-PPI users (p-value 0.14). There was a significantly higher frequency of hypomagnesemia in PPI users; 36 (69.3%) versus 27 (39.7%) in non-PPI users (p-value 0.001). Conclusion: The use of PPI is associated with a significant reduction in serum magnesium levels. So serum magnesium levels should be advised as routine monitoring in patients of hemodialysis taking PPIs.

Background and Aim: Ascitic fluid infection is pre-existing ascites infection of both symptomatic and asymptomatic types without abdominal source in chronic liver disease patients. Culture negative ascites are common infections in patients with chronic liver disease. The aim of the recent study was to determine the prevalence of culture-negative ascitic fluid infection among chronic liver disease patients. Methodology: This cross-sectional study was conducted on 134 patients with ascitic fluid infection due to chronic liver disease in the Department of Medicine and Gastroenterology, Pak International Medical College, Peshawar for six months duration from December 2020 to May 2021. All the ascitic infectious patients due to chronic liver disease regardless of their age and gender showing ascitic fluid infection symptoms such as tenderness, fever, and abdominal pain were admitted and underwent laboratory culture examination. Based on bacterial growth, all the chronic liver disease patients were grouped into two; Group-I of no bacterial growth and Group-II of positive bacterial growth. All the patients having an intra-abdominal infection or taking antibiotics were excluded. Results: Of the total 134 patients, 84 (62.7%) were male and 50 (37.3%) were females. Overall mean age was 47.56±19.8 years with an age range of 20 years to 80 years. Of the total 134 cases, the prevalence of positive and negative culture ascites were 30 (22.4%) and 104 (77.6%) respectively. out of 104 culture-negative patients, 65 (62.5%) were male patients whereas 39 (37.5%) were females. Chronic liver disease means duration was 8.9±2.6 months with a range of 6 months to 18 months. For all the patients above 40 years, the prevalence of culture-positive and negative ascitic infection was 20 (66.7%) and 77 (74.1%) respectively. The prevalence of male patients was higher (62.5%) among culture-negative patients due to chronic liver disease. Conclusion: Our study found that the prevalence of culture-negative ascitic fluid was higher at 77.6% among male patients. Also, ascitic fluid infection due to chronic liver disease was higher in patients of age above 40 years. Keywords: Ascitic fluid, Culture-negative ascitic fluid infections, Chronic liver disease

Background and Aim: Ulcerative colitis (UC) is a subtype of inflammatory bowel disease that can develop extra-intestinal manifestations (EIMs) in a subgroup of patients. There is a scarcity of data on the prevalence of extra-intestinal manifestations (EIMs) in inflammatory bowel disease and their risk factors analyses. The present study aimed to evaluate the prevalence of extra-intestinal manifestations in ulcer colitis and its associated risk factors. Methodology: This prospective study was conducted on 334 inflammatory bowel disease patients who were followed for identification of EIMs associated risk factors in the Department of Medicine and Pulmonology, Ghulam Muhammad Medical College and Hospital (GMMCH)/ Civil Hospital, Sukkur for the duration of six months; from April 2021to September 2021. All the patients above 16 years and who had ulcerative colitis and Crohn’s disease (CD) were enrolled. Patient’s demographic and clinical details such as gender, education, age, smoking history, diagnosis of EMIs, age at IBD, different IBDs, surgical, and treatment details were recorded. Results: Out of 334 IBD patients, the prevalence of ulcerative colitis (UC) and Crohn’s disease (CD) was 38.9% (n=130) and 61.1% (n=204) respectively. The overall mean age of UC and CD patients was 38.6±6.8 and 42.7±8.5 years respectively. Of the total 130 CD patients, the prevalence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis and psoriasis was 20.8% (n=27), 3.8% (n=5) 4.6% (n= 6), 3.1% (n=4) , 2.3% (n=3), 3.8% (n=5), and 1.5% (n=2) respectively. Out of 204 CD patients, the incidence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis, and psoriasis was 32.8% (n=67), , 9.8% (n=20) , 5.9% (n=12) , , 6.4% (n=13) , 2% (n=4) , 1% (n=2) and 2% (n=4) respectively. Risk factors for EMIs were identified using multiple logistic regression. In ulcerative colitis patients, no risk factors were identified. Conclusion: Our study concluded that extra-intestinal manifestations are a major issue in ulcerative colitis and Crohn’s disease patients. Moreover, the ongoing EIMs in Crohn’s disease patients are significantly associated with inflammatory bowel disease positive family history, and active disease. Therapeutic management and diagnostic facilities can be improved with the determination of extra-intestinal manifestation prevalence and related risk factors. Keywords: Crohn’s Disease, Extra-intestinal Manifestation, Inflammatory Bowel Disease