Objectives: To determine the frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients. Setting: Department of Medicine at LUMHS hospital Hyderabad/Jamshoro. Study Design: Descriptive Cross sectional study.          Duration of Study: 6 months from 01-03-2019 to 31-08-2019. Methods: A total of 232 patients with severe acute exacerbation of COPD were included in this study. A 12 lead ECG was performed. QT intervals were measured on a resting ECG tracing in lead II. The QT interval was measured manually from the starting point of the QRS complex to the terminal point of the down slope of the T wave. Results: A total of 232 patients with COPD were included in this study. Most of the cases were above 50 years of age. The average age of the patients was 53.74±4.35 years. There were 92.67% (215/232) male and 7.33% (17/232) female. Out of 232 patients, 21.14% were current smoker and 75.86% were ex-smoker. A QTc interval >0.44 seconds was considered abnormally prolonged. Frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients was 31.47% (73/232). Rate of altered cardiac repolarization was not significant among different age groups (p=0.641). Rate of altered cardiac repolarization was significantly high in male as compare to female (33.5% vs. 5.9%; p=0.018). This was not significant between obese and non-obese groups (p=0.100). Rate of altered cardiac repolarization was significantly high in former smoker (p=0.0005) and those patients whose duration of COPD was above 15 years (p=0.0005). Conclusion: Patients with hypoxic chronic obstructive pulmonary disease (COPD) have evidence of a subclinical parasympathetic autonomic neuropathy, with apparent preservation of sympathetic function. Measuring heart rate corrected QT interval (QTc) test is repeatable, easy to perform and a sensitive indicator for autonomic dysfunction in breathlessness individuals with COPD.

Objectives: To evaluate the frequency of autoimmune cutaneous disorders in patients with celiac disease. Study Design: This descriptive cross sectional study. Setting: conducted at Dermatological Department of Liaquat University Hospital Hyderabad/ Jamshoro. Period: From 1st March 2015 to 31st August 2015. Material & Methods: Total 352 patients of age 15 to 45 years & either gender having celiac disease were enrolled consecutively. Patients with history of abnormal serological test results and already on gluten free diet, known cases of diabetes mellitus, tuberculosis, systemic lupus erythematosus (SLE), secondary syphilis, hyper or hypothyroidism, iron deficiency anemia, pernicious anemia, Addison disease and pituitary insufficiency were excluded. The data was analyzed using SPSS version 16. The frequency/ percentage were calculated for autoimmune cutaneous disorders i-e; Dermatitis herpetiformis, Alopecia areata, vitiligo & psoriasis & for gender. The mean and standard deviation (SD) were calculated for age, duration of celiac disease and duration of cutaneous disorders. Stratified analysis was done followed by applying chi-square with a p value <0.05 taken as significant. Results: The mean age was 29.83 ± 8.91 years (Range 15-45). The mean duration of celiac disease was 5.99 ± 2.30 years (Range: 1-10 years). The Mean duration of cutaneous manifestation was 7.55 ± 3.30 months (Range: 3 to 15). Slight less than half of all patients were females 46.3%. More than two third patients i-e; 69% (n= 243) in this study were from rural areas. About 10.2% patients had dermatitis herpatiformis, 6.3% patients had alopecia areata, 2.6% patients had Vitiligo while 16.5% had psoriasis. The gender, age of patients, duration of CD & duration of development of skin symptoms were non-significant effect modifiers for the frequency of cutaneous manifestations among CD patients. Conclusions: Therefore, it concludes that psoriasis, dermatitis herpatiformis & alopecia areata are quite prevalent in CD patients. Vitiligo is rare condition. Screening for such autoimmune cutaneous manifestations and proper treatment of all such patients should be carried out routinely.

The most frequent cause of chronic liver disease globally is non-alcoholic fatty liver disease (NAFLD). Potential risk factors for NAFLD have not received enough attention in Pakistan even though NAFLD has received substantial research. Objective: To assess risk factors for Non-alcoholic fatty liver disease. This study was conducted at the Department of Medicine Liaquat University, Hospital Jamshoro from 7th September 2020 to 6th March 2021. Methods: This research was cross-sectional. The study recruited a total of 195 patients via nonprobability sequential sampling. The ultrasound of all the patients was done by a sonologist for detecting NAFLD. Results: The stratification of NAFLD according to smoking, hypertension, obesity, hyperlipidaemia, uncontrolled diabetes mellitus, vitamin D deficiency was done. The statistical significance was observed for NAFLD in accordance with smoking, (p=0.00), hypertension (p=0.04), obesity (p=0.04), hyperlipidaemia (p=0.03), uncontrolled diabetes mellitus (p=0.04), vitamin D deficiency (p=0.04). Conclusions: This study has shown that the percentage of NAFLD was highest in age group (40-49 years). Males were more affected as compared to females. Smokers, hypertensives, hyperlipidemics and diabetics were more prone to develop NAFLD.

Objectives: To predict the frequency of rebleeding by pre-endoscopic clinicalRockall scoring system in patients presenting with upper gastrointestinal hemorrhage. StudyDesign: Descriptive Case series study. Period: six months. Settings: Departments of Medicine,Liaquat University of Medical and Health sciences Jamshoro/Hyderabad. Material & Methods:The source of data was 187 patients who reported with the presenting complaint of hematemesisin ER and were then transferred to Medical Unit for further management. At the time of inclusionthe concerned Physician collected the demographic data, vital and relevant information for thepresence of co morbidities. After admission patients were shifted to endoscopy suite (situatedin Medical Unit) for the endoscopic diagnosis of the underlying condition. Any new episode ofhematemesis was considered as a re-bleed (within 120 hours of time zero). Rockall scoringwas calculated as per operational definition in the specifically designed proforma for the study.Mortality was noticed in the time the patient stayed in the hospital. Rebleeding was the endpoint of this study. Results: A total of 187 patients were selected for this study. Out of these 119were males (63.64%) and 68 (36.36%) were females. The mean age of patients was 59.25 years± 10.3 SD. Mean systolic BP was 107.08 ± 13.3, heart rate was 90.3 ± 11.9 and clinical Rockallscore of 3.5 ± 0.8 SD. A total of 111 (59.4%) patients presented with bleeding esophagealvarices, 36 (19.3%) presented with bleeding gastric varices, together chronic liver diseasewas responsible for 78.4% (147) of patients. Gastric erosions were seen to be the cause ofupper gastrointestinal hemorrhage in 18 (9.6%) of patients, whereas peptic ulcer disease wasthe cause responsible in 20 (10.7%). Lastly gastric carcinoma was seen in only 2 (1.1%) ofpatients. A total of 35 (18.7%) of patients experienced rebleeding episodes during the hospitalstay. Mortality was seen in 31 patients (16.6%). Conclusion: Clinical Rockall score is a goodpredictor of rebleeding and mortality. However, application of this score for the purpose oftriage of patients reporting with bleeding esophageal varices is problematic because this grouphas the presentation of liver failure along with hematemesis so getting low Rockall scores (andpredicting survival without endoscopic intervention) is not possible in this group of patients.

Introduction: Epilepsy is among most frequent disorders visiting for neurology consultations while depression is documented as comorbidity with epilepsy that further disturbs the social life of such patients. Objectives: To find out the frequency of depression and difference in severity, age and gender among known epileptic patients visiting for neurology consultations at tertiary care hospital. Material and Methods: This cross sectional study was conducted in neurology outpatient clinic and neurology ward LUMHS from August 2017 to January 2018. Epileptic patients (129) fitting into the inclusion criteria were selected for study under informed consent on proforma using SSDS (Siddiqui Shah Depression Scale). Results: Mean age of study population was 26.2 ±11.1 (range15 to 60) years and Male, Female ratio was 1.6: 1. Depression was found in 77 (59.7%) patients with 34 (44.1%) mild21 (27.3%) moderate and 22 (28.6%) had severe depression. Conclusion: High prevalence of depression is seen in epileptic patients. There was male preponderance distribution in the study. There is no significant difference among the genders and age groups regarding severity depression.