Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41 ±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Aim: To know about the prevalence, characteristic and nature of near miss events and to relate the nature of near miss events with that of maternal mortality. Study design: Descriptive cross sectional study Place and duration of study: Department of Obstetrics & Gynecology Unit IV, LUMHS Jamshoro from 1st January 2020 to 31st December 2020 Methodology: Pregnancy outcomes segregated into maternal death, near-miss event, or live birth categories. Age, level of education, religion, and residence were socio demographic variables. Obstetrics characteristics and nature of maternal near-miss events also studied. Result: The prevalence of maternal near-miss event was 5.6%, and the maternal near-miss events were seen more in multigravida, pregnant women with the lack of antenatal care in referral cases. Live birth as fetal outcome was 75%. The maternal death to near-miss ratio in this study was 1:5. 44 (42.3%) postpartum haemorrhage and 28 (26.9%), hypertensive disorders cases were leading cause of maternal near-miss events. Conclusion: Every fifth women who survived life-threatening complications, one died. Maternal near-miss should be adopted as an indicator for evaluating maternal health services. Keywords: Maternal near-miss (MNM), Maternal mortality, Life-threatening complication

Objective: To determine the frequency of ethnicity and other etiological factors of hepatocellular carcinoma. Methodology: This cross-sectional study was conducted at the Liaquat University Hospital Hyderabad, Department of gastroenterology. The study occurred from March 2018 to February 2019 for a total period of one year. All the patients diagnosed as the cases of hepatocellular carcinoma; age more than 20 years of both genders were included. All the patients were assessed regarding their ethnicity and risk factors of hepatocellular carcinoma. A self-made study proforma was used for the data collection and data was analyzed by using the SPSS version 26. Results: A total of 80 patients of hepatocellular carcinoma were studied, their average age was 53.12+9.69 years, average CLD known duration was 05.40+3.90 years and the average known duration of HCC was 01.17+0.79 years. Males were in majority 76.3% and 40.0% of the cases had advanced disease. According to the ethnicity of the cases, Sindhi patients were 70.0%, followed by 6.3% were Punjabi, 1.3% were Pathan, 7.5% were Baloch and 15.0% were others. HCV was the most common cause 83.8%, 7.5% cases had HBV, followed by 2 cases had HBV+HDV and one case had HCV and HBV co-infection, while four cases were NBNC HCC patients. Tumor stage was statistically insignificant according to ethnicity (p-0.495). Conclusion: Sindhi and Punjabi population was observed to be mostly affected and HCV was concluded the most common causative factor of hepatocellular carcinoma. Keywords: Ethnicity, causes, HCC

Objective: To determine the liver function assessment in the patients presented with hepatocellular carcinoma. Methodology: This cross-sectional study was done at the gastroenterology departments of Liaquat University Hospital Hyderabad and Indus Medical College TM Khan. Patients with an age range of 20 to 70 years, both genders, and having hepatocellular carcinoma were included in the study. A 5 mL blood sample was taken from each participant and sent to the hospital diagnostic laboratory to assess the serum bilirubin level and albumin level. The albumin-bilirubin (ALBI) score was used for hepatic function. Data was collected using a self-made research proforma, and it was analyzed using SPSS 26. Results: A total of 58 cases having HCC were assessed regarding hepatic function. The mean age of the patients was 55.39+12.39 years. Males were in the majority 75.9%, and females were 24.1%. The majority of the patients (72.4%) had child Pugh class C, 12.1% had child Pugh class B, and 15.5% of the cases had child Pugh class A. Elevated bilirubin levels of albumin levels and Alpha-fetoprotein levels were significantly associated to the child Pugh class C (p= <0.05). Most of the cases, 67.3%, had an ALBI score > − 1.39, 10.3% cases had ALBI score − 2.59 to − 1.39, and 22.4% of patients had an   ALBI score ≤ − 2.60. Conclusion: Severe hepatic dysfunction was observed to be frequently high among patients having hepatocellular carcinoma, as most of the cases had Pugh class C and ALBI stage 3. Due to the extremely small sample size used in this study, the results are not trustworthy. Keywords: HCC, Hepatic function, Bilirubin, Albumin, ALBI

Aim: To determine the frequency of acute renal injury in patients with severe acute pancreatitis Methods: It is an observational research where patients coming at tertiary care hospital analyzed as severe acute pancreatitis of either gender were examined. Acute pancreatitis was determined when patients introducing to have pain in abdomen, ascend in serum amylase or potentially lipase > multiple times of ordinary reach and radiological discoveries reminiscent of acute pancreatitis. Acute kidney injury (AKI) was named when individuals with past ordinary renal capacity created decay of renal capacities with ascend in creatinine >2 mg/dl with decrease in urine output to under 0.5mg/kg/hr for 6 hours or more. Results: In our study out of fifty patients of severe acute pancreatitis 20 (40%) were males and 30 (60%) females, 15 women had history of gallstones while the history of alcohol was observed in 10 males and 02 females. The mean age ± SD for whole population is 58.85 ± 8.52. The pain abdomen was present in all patients followed by vomiting in 80%, jaundice was present in 30% cases and fever in 28%. The acute kidney injury has been detected in 32 (64%) of patients and 16 (32%) patients required renal haemodialysis (replacement therapy). The mean ± SD of hemoglobin (g/dl), WBC (x103 cells per cumm), serum potassium, urea, creatinine and bicarbonate for AKI population is 9.52±3.21, 27.85±10.95, 5.63±2.73, 268±20.85, 12.94±8.53 and 15.73±92.21. The mean ± SD of days of kidney insult and haemodialysis sessions for AKI population is 12.75±96.62 and 6.86±4.85 while the frequency (and %) of circulatory failure and deranged INR have been observed in 12 and 21 AKI patients. Conclusion: AKI is an incessant complication of acute pancreatitis and normally creates after the malfunction of different organs. Keywords: Acute renal injury, Acute renal failure and Acute pancreatitis.