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Objective: To compare serum visfatin levels in obese and non-obese individuals. Study Design: Cross-sectional study. Setting: District Head Quarter Hospital, Gujrat. Period: July 2020 to May 2021. Material & Methods: A total of 52 subjects were included fulfilling the inclusion criteria. They were divided in two groups, 26 non-obese subjects were placed in Group A and 26 obese subjects in Group B. The serum visfatin level, Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL), triglycerides (TG) were calculated in both groups. The statistical analysis was carried out using SPSS version 22.0. Results: The obese subjects had higher serum visfatin levels than the non-obese i.e. 3.87 ± 0.90ng/mL vs. 1.08 ± 0.56 ng/mL (p=0.001). A significant elevation was observed in the serum LDL level among obese subjects, 224.6 ± 55.0 mg/dl compared to 114.2 ± 22.9 mg/dl among non-obese subjects. Similarly, the serum TG levels were also significantly high among obese subjects (p=0.001). The intergroup comparison showed that the serum visfatin levels were higher among obese subjects with dyslipidemia (3.97 ± 0.93 ng/dl) than non-obese (3.46 ± 0.86 ng/dl). Conclusion: It is concluded that the serum visfatin levels are significantly high among obese individuals than non-obese counterparts.

Objective: To compare the effectiveness of the combination of Lactulose and Polyethylene glycol (PEG) versus Lactulose alone in improving the grade of hepatic encephalopathy (HE) within 24 hours of hospital admission in patients with hepatic encephalopathy due to decompensated liver cirrhosis precipitated by constipation. Study Design: Randomized controlled trial. Place and Duration: The Department of Gastroenterology, Hepatology and GI Endoscopy, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan from 07-05-2020 to 06-05-2021. Methodology: One hundred and sixteen patients (58 in each group) of either gender aged 20-70 years having decompensated liver cirrhosis with HE grade 2 to 4 secondary to constipation were enrolled. Patients were randomly and equally divided into either Lactulose and PEG (Group-1) or Lactulose alone (Group-2) by lottery method. West Haven Criteria was used for labeling HE grades at the baseline and after 24 hours of treatment in both study groups. A one-grade improvement in HE after 24 hours of treatment from the baseline was considered as effectiveness of treatment. Results: Treatment was found effective (at least one HE grade improvement) in 43 (74.1%) patients treated with PEG+Lactulose, while it was 32 (55.2%) in patients who were treated with Lactulose alone (p=0.033). When stratified for age and gender, PEG+Lactulose was significantly effective in improving HE grades in younger age group (p=0.007) and males (p=0.040). Practical Implications: Combination treatment with PEG+Lactulose can be a preferred option for improvement in HE grades in comparison to treatment with lactulose alone Conclusions: Combination treatment with PEG+Lactulose was found to be more effective in improving HE grades when compared to treatment with lactulose alone within 24 hours of hospital admission among patients who had decompensated liver cirrhosis precipitated by constipation. Keywords: Constipation, decompensated liver disease, Hepatic encephalopathy, Lactulose, Polyethylene glycol.

Objective: To compare the efficacy of dual therapy (rifaximin and lactulose) and lactulose monotherapy in the treatment of porto-systemic encephalopathy. Study Design: Randomized control trial. Place and Duration of Study: Department of Gastroenterology, PIMS Hospital, Islamabad from 1st July 2020 to 31st December 2020. Methodology: One hundred and fifty patients of both genders age ranges from 18-65 years with liver cirrhosis having hepatic encephalopathy grade II or above were included. They were divided in two groups; each group comprised 75 patients. Group A took lactulose and rifaximin, while lactulose alone was given to Group B. All patients were monitored for 5 days on the basis of Child Pugh Criteria. Results: The mean age was 40.02+24.4 years. One hundred twenty six (85.1%) of patients were above 50 years. Males were 60%, majority of patients were from the emergency department, while 17 were from OPD. HCV was identified as the major cause of cirrhosis (72.6%), while HBV (14.6%), alcohol (4%) and others (8.6%) contributed nominally. Constipation was major precipitating factor in 83 patients while sepsis and UGI Bleed was culprit in 31 and 19 patients respectively. Sixty patients (80%) of group A of both genders showed improvement in five days, while 42 patients (56%) of group B showed improvement in the same period of time (p=0.006). It was found more in males and elder patients. Practical implication: Dual therapy will reduce the morbidity, hospital stay and cost of treatment. It may also help in making local guidelines for treatment of hepatic encephalopathy. Conclusion: Rifaximin plus lactulose therapy was far superior to lactulose monotherapy in every age group and either gender. Keywords: Porto systemic encephalopathy, Decompensated chronic liver disease, Rifaximin lactulose therapy, Lactulose monotherapy

Objective: To find out the frequency of corrected QT interval (QTc) prolongation in patients with liver cirrhosis. Study Design: Cross-sectional study. Place and Duration: The department of medicine, “Aziz Bhatti Shaheed Teaching Hospital”, Gujrat from April 2021 to October 2021. Methodology: A total of 150 patients of both genders aged 18-65 years having liver cirrhosis were included. Proper medical history and clinical examination were performed while electrocardiogram (ECG) was obtained to find out QT interval in all the patients. The frequency of QTc prolongation was recorded. Results: In a total of 150 patients, 66 (44.0%) were males and 84 (56.0%) females. The mean age was 48.67±16.67 years while the mean duration of cirrhosis was 4.71±1.18 years. Frequency of QTc prolongation was noted in 44 (29.3%) patients. Among ninty patients of liver cirrhosis with age more than 40 years, 31 (70.5%) had corrected QT interval prolongation (p=0.040). Among 84 female patients, there were 25 (56.8%) cases of corrected QT interval prolongation (p=0.047). Practical Implications: Potential cases of liver transplantation may be prioritized as per their risk of prolongation of QTc but further research is required in this regard. Conclusion: The frequency of QTc prolongation was quite high among patients of liver cirrhosis. Keywords: Cardiovascular disease, Electrocardiogram, liver cirrhosis, mortality, QT prolongation.