Background and aim For years, interferon-based treatment has been offered to patients with chronic hepatitis C virus (HCV) infection; however, the complexity of the treatment, efficacy, and adverse effects were the primary concerns. All these concerns were addressed with the introduction of directly acting antivirals (DAAs) to treat chronic HCV. Sofosbuvir and velpatasvir are second-generation DAAs used in combination for the treatment of chronic HCV infection. The aim of our study was to determine and compare the efficacy and safety profile of the sofosbuvir and velpatasvir combination in treating patients with chronic hepatitis C with or without cirrhosis. Materials and methods This descriptive study was conducted at the Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 15th to September 15th, 2021 after approval from the Institution Research and Ethical Review Board (IREB). Diagnosis of HCV was based on the detection of hepatitis C ribonucleic acid (RNA) fragments by reverse transcription-polymerase chain reaction (RT-PCR). Liver status was assessed with liver function tests and imaging. Sofosbuvir (400 mg) and velpatasvir (100 mg) were administered once daily for 12 weeks, followed by polymerase chain reaction (PCR) for HCV RNA after 12 weeks of completion of treatment for determination of sustained virologic response at 12 weeks (SVR12). Patients with cirrhosis also received weight-based ribavirin. Adverse events experienced by the study participants during the course of treatment were recorded. Data were collected regarding patients' demographics, laboratory parameters, SVR12, and adverse events, and were then analyzed using SPSS, version 22 (IBM SPSS Statistics, Armonk, NY). Results A total of 58 patients with cirrhosis and 58 patients without cirrhosis with chronic HCV were enrolled. The rate of SVR12 in patients with cirrhosis was 89.7% (52 patients achieved SVR12), compared to 98.3% in patients without cirrhosis (57 patients achieved SVR12). Subgroup analysis of patients with cirrhosis revealed that patients who have failed to achieve SVR12 were mostly males, had prolonged disease duration, and low hemoglobin at baseline; however, the association of these factors with SVR12 was not significant. The incidence of adverse events among all study participants was 46.5%. Among the cirrhotic cohort, 37 (63.8%) patients experienced adverse events, while only 17 (29.3%) patients among the non-cirrhotic cohort had adverse events. A total of 24 patients with cirrhosis (41.37%) reported mild complaints. The most commonly reported adverse event was gastrointestinal (GI) upsets (46.2%), followed by fatigue (33.9%), while 19.9% developed miscellaneous adverse events such as headaches, rash, and insomnia. Conclusion The combination of sofosbuvir and velpatasvir is highly effective and safe in patients with HCV with or without cirrhosis. However, this combination's efficacy was slightly higher in non-cirrhotic patient...

Background and aimsPeripheral neuropathy is a frequent complication of long-standing diabetes mellitus that adversely affects the quality of life. Pregabalin (anticonvulsant) and duloxetine (antidepressant) are often prescribed for diabetic peripheral neuropathic pain. This study aimed to determine and compare the efficacy and safety of pregabalin and duloxetine in patients with diabetic peripheral neuropathic pain. Materials and methodsThis prospective observational study was conducted at District Headquarter (DHQ) Hospital, Daggar, Buner district, Pakistan, from February 15 to July 15, 2022, after approval from the Institutional Research and Ethical Review Board. Confirmation of diabetic peripheral neuropathy was based on the history of diabetes mellitus and vibration perception threshold (VPT) using a biothesiometer. The cut-off was set at 15 volts. VPT of more than 15 volts was considered confirmatory for peripheral neuropathy. Patients were divided equally into two groups. Baseline visual analog scale (VAS) score was recorded for all patients. Tablet pregabalin 300 mg daily was administered for four weeks to one group, while tablet duloxetine in 60 mg strength daily was administered to the other group. VAS score after four-week treatment was recorded and compared. Adverse events experienced by the patient were also noted. ResultsA total of 86 patients were enrolled. The patient ages ranged from 30 to 80 years. Baseline characteristics, including mean age, mean BMI, and mean disease duration of duloxetine versus pregabalin group, were 50.30 ± 8.55 versus 48.20 ± 8.99 years, 23.47 ± 1.23 versus 23.10 ± 1.59 kg/m2 and 21.64 ±7.41 versus 20.04±6.37 months respectively. Duloxetine effectively controlled peripheral neuropathic pain in 81.4% of patients compared to pregabalin in 74.4% of patients. Severe drug-related adverse reactions were observed in 4.6% of patients with duloxetine compared to 0% with pregabalin. ConclusionDuloxetine and pregabalin effectively reduce diabetes-related peripheral neuropathic pain. However, duloxetine has slightly better outcomes than pregabalin. The safety profile of pregabalin is better than duloxetine.

Background and Aim: Acute Pancreatitis (AP) is a common disease requiring hospitalization. Though the mortality rate caused by pancreatitis decreased over the past few decades but patient’s organ failure causing mortality during acute pancreatitis is on the rise. The present study intended to assess the outcomes of acute pancreatitis in cirrhosis patients. Patients and Methods: This retrospective study was carried out on 180 acute pancreatitis patients admitted in the General Medicine and Gastroenterology Department of Central Hospital, Stadium Road Sargodha, Hayatabad Medical Complex Peshawar and Shaikh Khalifa bin Zayed Hospital, Muzaffarabad AJK for the duration from November 2021 to September 2022. Cirrhotic and non-cirrhotic patients were matched based on Propensity score matching (1:2). Inpatient mortality, systemic inflammatory response syndrome, length of hospital stay (LOS), and organ failure were the main outcomes. Model of End-stage Liver Disease (MELD) and Child-Pugh scores was used for cirrhotic patient’s subgroup analysis. Results: Of the total 180 AP patients, there were 60 cirrhotic (male 31 and females 29) and 120 (male 62 and females 58) non-cirrhotic patients. Based on Child-Pugh scores, the incidence of Child–Pugh scores A, B, and C was 17 (28.3%), 27 (45%), and 16 (26.7%) respectively. Based on cirrhosis etiology, the incidence of NAFLD (non-alcoholic fatty liver disease) , chronic hepatitis C, and autoimmune causes were 12 (20%), 42 (70%), and 6 (10%) respectively. Regarding diagnosis criteria, abdominal imaging diagnosed 56 (93.3%) patients whereas 4 (6.7%) were diagnosed based on liver biopsy. The mean BMI value in cirrhotic and non-cirrhotic groups was 28.4 and 26.8 kg/m2, p=0.51). Based on acute pancreatitis etiology, the incidence of gallstone-induced, idiopathic, and other in cirrhotic versus non-cirrhotic was 32 (53.3%) vs. 68 (56.7%), 12 (20%) vs. 30 (25%), and 16 (26.7%) and 22 (18.3%) respectively. Cirrhotic and non-cirrhotic patients’ outcomes such as inpatient mortality (6.8% vs. 1.7%), systemic inflammatory response syndrome (SIRS) (23.3% vs. 34.2%), and organ failure (13.3% vs 4.2%). Conclusion: The present study concluded the overall mortality and morbidity rates for cirrhotic and non-cirrhotic hospitalized with AP were similar. However, cirrhosis-related complications, portal hypertension and immunosuppression state such as sepsis, infections, and variceal bleed are likely to contribute to poorer outcomes and higher mortality compared to non-cirrhotic. Keywords: Acute pancreatitis, outcomes, acute liver injury

Background: The virulent pathogen SARS-CoV-2 first appeared in the Chinese province of Hubei in December 2019. Pregnant women were a high-risk population in the pandemic because immune system alterations that occur during pregnancy make them more vulnerable to foreign infections. Late-pregnancy cholestasis is a dangerous liver condition that can cause the foetus to experience potentially fatal problems like early birth and stillbirth. In the present study we were testing the Bile acid level during pregnancy patients after covid pandemic. Objectives: To evaluate the prevalence of intrahepatic cholestasis in pregnant patients after Covid -19 pandemic. Materials and Methods: This cross-sectional study was conducted at department of Dr.fida painless and General Hospital Peshawar from jan 2022 to Dec 2022. We enrolled 186 pregnant patients after fulfilling the inclusion criteria. 5 ml blood sample were also taken from the patients. Serum was extracted and Bile acid test were performed in clinical laboratory. Data were collected in predesign questionnaire. Results: Total 186 patients were enrolled in the study with mean age of 37.18±6.39 years (Range 18-45 years). The mean value of all enrolled patients was 31.38±5.79 with minimum and maximum value of bile acids 20 micromol/L and 40.6.00 micromol/L. In our study 95 (56.5%) of patients belongs to 36 to 45 years of age group followed by age group of 26 to 35 years in which 60 (35.7%) patients and 13 (7.7%) patients were belongs to age group of 18 to 25 years. Practical implication: This study will help the clinical practitioner to take care of pregnant patients in order to avoid the prevalence of intrahepatic cholestasis. Conclusion: It is concluded from this research study that prevalence of intrahepatic cholestasis in pregnancy has increased after Covid-19 pandemic. Keywords: COVID-19, cholestasis, pregnancy, elevated Liver Enzyme, Bile Acids.

Background and Aim: Malnutrition is a significant concern in inflammatory bowel disease with incidence varied from 18% to 62% among ulcerative colitis (UC) patients. The purpose of the present study was to investigate the ulcerative colitis patients for micronutrient status. Patients and Methods: This prospective study was conducted on 56 ulcerative colitis patients in the Endoscopic Unit of Dr. Fida Painless & General Hospital, Peshawar for the duration from April 2022 to April 2023. Newly diagnosed ulcerative patients confirmed by colonoscopy and histopathology were enrolled. All the patients were divided into three different categories based on disease severity: Group-I (mild), Group-II (moderate), and Group-III (severe). Each individual underwent complete physical examination, laboratory investigations, and colonoscopy. Serum was obtained and tested for selenium, iron, copper, and magnesium levels. SPSS version 27 was used for data analysis. Results: Of the total 56 UC patients, there were 21 (37.5%) male and 35 (62.5%) female. The overall mean age was 34 years. Based on histopathological examination, the grading of disease severity were as follows: Group-I (mild) 4 (7.1%), Group-II (moderate) 28 (50%), and Group-III (severe) 24 (42.9%). UC patients group and healthy group had similarity in terms of age and gender.