No abstract

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.

Objective: To assess pathological, biochemical and clinical parameters in HCC patients with low, normal and high AFP levels. Methodology: This comparative analytical study was conducted in Liver and Gastric Clinic, Holy Family Hospital, Rawalpindi from June 2019-June 2020.Sample size was calculated as 225 by WHO sample size calculator .  Non randomized convenient sampling was used. Patients were divided into three groups according to AFP values; <200 ng/ml, 200-400ng/ml and >400 ng/ml. Patients demographic details, medical history, clinical symptoms and signs, biochemical parameters and pathological findings on ultrasonography and CECT were assessed. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical   variable.  p Value less than 0.05 was considered significant. Results: Out of 256 patients, 161 (62.9%) were males and 95 (37.1%) were females.The mean age of patients was 60.5 years ±  10.5. 94.4% of patients with HCC had Hepatitis C. Anorexia, jaundice and abdominal distension, hepatomegaly and splenomegaly were more frequent in patients having high AFP level. Serum bilirubin, tumor size, number of lesions, BCLC staging and other pathological parameters associated with HCC worsens as AFP levels increase. Conclusion: Alpha-fetoprotein levels  are  significantly associated with clinical and pathological parameters of hepatocellular carcinoma thus can be used as a better diagnostic and prognostic tool.

INTRODUCTION:                              Diabetes is characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and lipid metabolism. Disorders of lipid metabolism are common in diabetes causing greater cardiovascular risks. Leukocytosis is a major marker of metabolic syndrome. Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are related to subclinical inflammation worsening the glycemic control. HbA1c is used as a marker of blood glucose regulation. OBJECTIVE:  To investigate the association of  neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with blood glucose regulation in patients with type 2 diabetes mellitus.   METHODS: This comparative analytical study was conducted in Shifa  International Hospital on diabetic patients. Sample size was calculated as 62 by WHO sample size calculator .  Non randomized convenient sampling was used. Patients were divided into two groups according to HbA1c level taking 7% as cut off point. Full blood count, lipid profile and liver profile were carried out. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical   variables. For quantitative normal and dispersed variables, independent student t and Mann Whitney U test were applied respectively. P Value less than 0.05 was considered significant.   RESULTS: Out of total 93 patients,33 (35.4 %) were males and 60(64.5%) were females. The mean duration of disease was 8.26  ± 5.8 years. NLR and PLR were elevated in patients having poor glucose control but that difference was not significant. Significant difference between the groups was found with random blood glucose. LDL, triglycerides , cholesterol ratio, ALT and AST were raised in patients having poor glycemic control.                              CONCLUSION:  Patients having poor blood glucose regulation have increased levels of   haematological and serological parameters posing greater cardiovascular health risks to patients with type 2 diabetes