Objective: The aim of this study is to determine the frequency of portal vein thrombosis in patients with liver cirrhosis. Study Design: Retrospective/Case-control Place and Duration: Medicine and Gastroenterology department of Peshawar Institute of Medical Sciences, Peshawar and DHQ Teaching Hospital, Charsadda for six months duration from August 2020 to January 2021. Methods: Total 100 patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking written consent, Patients were aged between 20-75 years. Patients who had liver cirrhosis were included in this study. Complete patients were undergone for Doppler ultrasonography for observation of portal vein thrombosis. Complete data was analyzed by SPSS 24.0 version. Results: Out of 100 patients, 60 (60%) were males and 40 (40%) patients were females. Mean age of the patients were 47.08±7.42 years with mean BMI 28.22±9.61kg/m2. We found that 60 (60%) patients had hepatitis C, 29 (29%) patients had hepatitis B, 7 (7%) had chronic liver disease, 3 (3%) patients had autoimmune hepatitis and 1 (1%) patient had other disease (Wilson’s). Among hundred patients frequency of portal vein thrombosis (PVT) was 15 (15%) and majority of them were males 12 (80%). Conclusion: We concluded that the frequency of portal vein thrombosis was high among patients of liver cirrhosis and mostly patients of hepatitis C were affected. Keywords: Liver cirrhosis, Portal vein, Thrombosis

Objective:To determine the effectiveness of prone positioning in patients of covid-19 deisease presented with respiratory failure. Study Design: Retrospective/Observational study Place and Duration: Medicine department of BKMC/MMC, Mardan and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from August 2020 to January 2021. Methods: Total 100 patients of respiratory failure admitted to ICU were included in this study. Patients detailed demographics age,sex and body mass index were recorded after taking informed written consent. Patients were aged between 25-80years.Patients were divided in to two groups I and II. Group A had 50 COVID-19 patients underwent prone position and group Bwith50 patients taken as control. Chest X-ray of both groups were taken. Patients of group A were kept in prone position whilegroup B received invasive ventilation and follow up was taken in duration of 15-days. Reduction of intubation rate, mortality, hospital stay and complications were identified among both groups. Complete data was analyzed by SPSS 22.0 version. Results:Majority of the patients was males 76% and the rest were females 24%. Mean age of the patients in prone positioning group was 52.42±13.18 years with mean BMI 26.14±7.13 kg/m2 and in control group A itwas 50.44±14.65 years with mean BMI 26.41±7.13 kg/m2. 55% patients had moderate and 45% had severe covid-19 disease. Mean duration of prone position was 5.14±6.31 hours. Most of the patients 81% had bilateral lung involvementinterstitial infiltrates. Fever, cough and dyspnea were the most common symptom found in both groups. Mean PF ratio was increases in prone group as compared to controlled group. Mean hospital stay in group A was 12.9±4.76 days and in group B mean hospital stay was 17.32±10.24 days. Mortality in group A was 3 (3%) and in group Bmortality was found in 7 (7%). No any severe complications were observed among both groups. Conclusion:We concludedin this study that the use of prone position among patients of COVID-19 was effective and safe method to reduce intubation, mortality and hospital stay. There was no any complication were found after this treatment. Keywords: Prone Position, Covid-19, Respiratory Failure, Mortality

Notable researchers tell us about acute pain management in opioid users and how it works and which drug group works effectively in them. The purpose of our study is to manage pain in opioid users during detox without the use of Analgesics. An experimental study is conducted among 36 male patients in the age group of 25 to 55 from Punjab, Pakistan. The purposive sampling technique was used in the collection of samples due to limited resources. We divided these samples into 3 different groups (medication, placebo, and physiotherapy) and after doing treatment according to their group we get the results through a self-report inventory. Most rehabilitation centers used analgesics to relieve symptomatic pain management but the problem is the drug-seeking behavior of opioid users. Data was analyzed by using SPSS version 26. Of 12 patients in the placebo group only 25% feel better through a placebo treatment plan and in the analgesic group 75% of patients feel relieved and in the physiotherapy group, 66% of patients feel relieved. As a result of this, we concluded that physiotherapy can also play role in the rehabilitation process of opioid users and helps to minimize their drug-seeking behavior. Our research concludes that a positive but weak association between placebo in opioid pain management is present while strong but less association between physiotherapy in opioid users then analgesics.

Background and Aims: Rheumatologic disorders (RDs) can manifest as gastrointestinal (GI) symptoms. Patients with systemic sclerosis (SSc) frequently experience upper GI symptoms due to a lack of esophageal contractility (AC). GORD (gastro oesophageal reflux disease) is a common comorbidity in rheumatoid arthritis patients (RA).The aim of the present study was to evaluate the correlation between manifestation of rheumatoid arthritis and gastrooesophageal reflux disease. Materials and Methods: This cross-sectional study was carried out on 845 gastro-oesophageal reflux disease patients who presented to department of medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Lady Reading Hospital (LRH), Peshawar for period of six months i.e from January 2020 to June 2020. Consecutive patients with were premeditated subsequently taking written informed consent. Patients with prior history of Oesophageal surgery were excluded. The demographics characteristics such as age, BMI, gender, previous history, gastrointestinal symptoms severity, analgesics, and medication usage were recorded on a pre-designed questionnaire. Inflammatory marker’s results were taken in the forms of C - reactive protein (CRP), and Erythrocyte Sedimentation Rate (ESR). Ethical approval was taken from the respective institutional review board. SPSS version 20 was used for data analysis. Results: Out of 845 GORD patients, 110 (13%) had Rheumatologic disorders (mean age 49.5± 2.6 years, 71% females). The prevalence of rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and the most common systemic sclerosis (SSc) were 39 (36%), 24 (21.8%), and 47 (42.2%) respectively. Regurgitation, dysphagia, heartburn, and nausea were the most severe symptoms of gastrointestinal patients having rheumatoid disorder. The GI symptoms had no significant association with SLE, RA, and SSc severity. Upper GI symptom severity did not differentiate between RDs. Conclusion: Our study concluded that subsequent rheumatoid arthritis has a significant association with gastro-oesophageal reflux disease. Keywords: Gastro-oesophagealReflux Disease, Rheumatoid arthritis, Systemic sclerosis

Background: Diabetes is the common predisposing factor for Urinary Tract Infection. In diabetic patients, asymptomatic bacteriuria is more prevalent in females compared to male patients. Bacteria count for similar species over 10^5 per ml in urine specimen of mild stream clean catch without urinary infection is known as Asymptomatic bacteriuria (ASB). Asymptomatic bacteriuria appears to be incurable, recurring in diabetic patients. Aim: The current study aim to determine the outcomes of asymptomatic bacteriuria in patients with diabetes mellitus. Materials and Methods: This cross-sectional study was carried out on 85 women of diabetes mellitus in the department of General Medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Jinnah Medical College Peshawar for duration of six months from June 2020 to December 2020. Detailed and follow-up histories of all the patients were studied, compared, and reported. Individuals who met the inclusive criteria were enrolled in this study. Women on steroid therapy, with immunodeficiency, and incomplete follow-up history were excluded. The outcome of symptomatic and asymptomatic patients was followed for positive culture in a time span of 3 and 6 months. SPSS version 20 was used for data analysis purposes. Results: The mean age of the patients was 57+15.3. Of the total, 13 (15.3%) UTI were symptomatic women with diabetes, and UTI in asymptomatic patients was 72 (84.7%). In symptomatic cases, the prevalence of hypertension, Macroalbuminuria, and Microalbuminuria were 7 (53.4%), 3 (23.3%), and 3 (23.3%) respectively. HbA1C and eGFR (ml/min/1.732) level was 8.5+0.85 and 92.07+10.3 respectively. Conclusion: Our study concluded that urinary culture detected significant bacteriuria without symptoms such as fever, painful micturition, and urgency, frequent micturition, flank pain, burning micturition, and suprapubic pain. Symptomatic and asymptomatic bacteriuria is more common in females. Also, asymptomatic bacteriuria appears to be incurable, recurring in diabetic females. Keywords: Asymptomatic, Bacteriuria, Diabetes mellitus