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 and Aim: Gastroesophageal reflux disease (GERD) is a physiological passage of stomach contents into the esophagus. It is basically the pathological complications and symptoms. Endoscopy is a gold standard investigation tool that eliminates the gastroesophageal reflux disease co-morbidities such as malignancy and Barret’s esophagus. The present study was carried out to evaluate the correlation between endoscopic findings and symptoms of gastroesophageal reflux disease. Materials and Methods: This intervention cross-sectional study was carried out on 109 gastro esophageal reflux disease patients in Gastroenterology department of Isra University Hospital, Hyderabad for six months duration from January 2021 to June 2021. Suspected gastroesophageal reflux disease patients were assessed thoroughly by physical examination, history, and endoscopy for gastrointestinal symptoms. Severity, symptom type, duration, and frequency were assessed as clinical symptoms. The upper gastrointestinal endoscopy findings were evaluated in terms of esophageal erosions, and their grades such as Grade A, Grade B, Grade C, and Grade D. The endoscopy abnormal findings such as hernia, esophagus, malignancy, and Barret’s esophagus were correlated with gastroesophageal reflux disease. Result: Out of 109 patients, 78 (71.5%) were females while 31 (28.5%) were male. The mean age of the patients was 43.54 ± 7.3 years with an age range between 25 and 67 years and the mean BMI was 43.34 ± 5.76 kg/m2. Gastro esophageal reflux disease symptoms such as malignancy and Barrett’s esophagus shown no evidence on pre-operative endoscopy. About 29 (26.6%) patients had normal endoscopy. The symptomatic patients were 80 (73.4%) which were categorized based on LA classifications into Grade A 62 (77.5%), Grade B 13 (16.3%), Grade C 3 (3.8%) and Grade D 2 (2.5%). Based on the reflux score system, patients were distributed as mild 43 (53.8%), moderate 11 (13.8%), severe 5 (6.3%), and very severe 21 (26.3%). Conclusion: Our study found a significant correlation between gastro esophageal reflux disease and endoscopy esophagitis findings. Pre-operative endoscopy should be carried for abnormal endoscopy in both symptomatic and asymptomatic patients. Keywords: Gastro-oesophageal reflux disease, Endoscopy, Esophagitis

Background: Asthma is a non-curable but preventable disease that can be controlled by a proper approach. Inhalational route is considered to be one of the fastest, non-invasive course for the management of asthma. Despite its importance, compliance towards proper inhalational technique remains quite low. Thus, United Kingdom guidelines and Global Strategy for Asthma Management and Prevention (GINA) recommend regular assessment of inhaler techniques in all asthma patients. Objective: To evaluate the inhalational technique of asthma patients visiting outpatient departments of public sector tertiary care hospitals of Rawalpindi and correlate with various demographic factors. Methods: A cross-sectional study was conducted on a total of 209 respondents visiting the outpatient department of public sector hospitals in Rawalpindi. Asthmatic patients were included via a non-probability consecutive sampling technique and were assessed for inhaler techniques via a structured checklist. Statistical data were analyzed using IBM Statistical Package for Social Sciences (SPSS®), version 25.0 (IBM Corp., Armonk, NY, USA). Results: Two hundred and nine asthma patients were included. Only 10% of patients demonstrated the correct inhaler technique. Continuing inhaling till lungs are full, holding breath for five to 10 seconds, and breathing out slowly after using the inhaler were most poorly followed. Conclusion: Most asthma patients are using poor inhalation technique, risking sub-optimal drug delivery and inadequate effects. Hence, it is the need of the hour to focus on patient training and education.

Background: COVID-19 pandemic or coronavirus is a systemic disease taken into consideration for vascular system-specific tropism where microcirculation alteration has a significant pathogenic role. The coronavirus affects the gastrointestinal tract, abdominal manifestation, and hepatobiliary system. Aim: the aim of the present study was to evaluate the association of gastrointestinal symptoms with unfavorable prognosis of coronavirus patients. Materials and Methods: This single-center cross-sectional study was carried out on 486 patients with or without gastrointestinal symptoms and was conducted for six months duration from January to June 2021 at Gastroenterology department, Isra University Hospital, Hyderabad. All these patients were categorized into two main groups; group-I patients exposed to coronavirus with gastrointestinal symptoms while group-II patients exposed to COVID-19 without gastrointestinal symptoms. Gastrointestinal symptoms were associated with acute respiratory distress syndrome (ARDS), continuous renal replacement therapy (CRRT), non-invasive ventilator treatment, tracheotomy, and tracheal intubation. Multivariable and unilateral regression models were utilized for data analysis. Results: Of the total 486 patients, 157 (32.3%) were with gastrointestinal symptom patients while 329 (67.7%) were without GI symptoms. Propensity scores were analyzed in both groups. Both groups were equally susceptible to higher mortality risks but COVID-19 patients with gastrointestinal symptoms were at high risk of acute respiratory distress syndrome. Of the 157 patients with GI symptoms, 44 (28.03%) were initially diagnosed and 113 (71.97%) were diagnosed in hospital. The prevalence of vomiting or nausea, diarrhea, abdominal distention, and abdominal pain were 30 (19.1%), 83 (52.9%), 18 (11.5%), and 26 (16.6%) respectively. Dyspnea, fatigue, fever, chest tightness, and cough were common COVID-19 symptomatic patients. The prevalence of GI symptoms patients had dyspnea 23 (14.6%), fatigue 45 (28.7%), fever 128 (81.5%), chest tightness 25 (15.9%), and cough 72 (45.9%) were statistically significant and higher compared to the no symptoms of gastrointestinal disease patients. Conclusion: Our study found the high prevalence of COVID-19 patients with gastrointestinal symptoms compared to without gastrointestinal symptoms in COVID-19 patients and associated with non-invasive mechanical ventilation and risks of acute respiratory distress syndrome. Hence, COVID-19 patients with gastrointestinal symptoms should be taken care of in healthcare protection. Keywords: COVID-19, Gastrointestinal symptoms, ARDS or acute respiratory distress syndrome