There was no difference in effectiveness of lactulose plus rifaximin and lactulose alone in treatment of hepatic encephalopathy.

Objectives: To determine the frequency of silent cardiac ischemia in type II diabetes mellitus patients presenting to tertiary care facility. Methodology: This cross-sectional study was conducted from 20th October 2017 to 20th April 2018 at Department of Medicine Jinnah Hospital Lahore. After a detailed history, measurement of height, blood pressure, weight, fasting blood sugar, body mass index of 237 patients were recorded, and electrocardiography (ECG) was done before and after exercise tolerance testing (ETT). Changes in ECG were assessed and person labeled as having silent cardiac ischemia or not depending on the outcome of the ECG. Results: Mean age was 54.9 ± 5.9 (range: 45 – 63) years. There were 144 male patients and 93 female patients The mean duration of type II diabetes mellitus in the study population was 10.0 ± 2.6 (range: 6 – 15) years. The frequency of silent cardiac ischemia was found to be 45.1%. Increasing age, prolonged duration of diabetes mellitus, history of smoking and hypertension, and increased body mass index were significantly related to silent cardiac ischemia (p-value< 0.05). Conclusion: Silent cardiac is quite prevalent in our population that demands urgent efforts to diagnose this condition earlier for better future outcomes.

Objective and background: Previous studies have reported a high prevalence of depressive and anxiety disorders in medical students. The aim of the current study was to investigate the prevalence of PTSD symptoms among 1st to 3rd year MBBS students. Place and duration: The study was conducted at Azra Naheed Medical College, Superior University, Lahore, Pakistan from 15th of August o 15th of September 2022. Methodology: A Google form was developed by authors of the study that comprised demographic questions as well as items of post-traumatic stress disorder checklist-Civilian version (PCL-C). The form was posted in the official WhatsApp group of each class and the rationale and purpose of the study were communicated to students. Confidentiality of the data was ensured and anonymity of the participants maintained at all stages. The study was formally approved by the Institutional review board of Azra Naheed Medical College, Lahore. Descriptive statistics, independent samples T-test and the ANOVA test were employed to analyze and report the findings. SPSS version 26 was used for reporting and analyzing the data. Results: A total of 223 medical students (45.4% males) participated in the study. Nearly three quarters of medical students (73.4%) had either moderate, (29.1%) or severe (44.3%) PTSD symptoms. No significant difference was found between the students with regards to gender, age group and year of study. Students who belonged to a mixed rural/urban background had significantly higher PTSD symptoms as compared to students from a predominantly rural or urban background. Practical Implication Medical students should be routinely assessed for the presence of anxiety/depressive disorders, as successful treatment of these disorders may improve the quality of life as well as the academic performance of the students. Conclusions: The prevalence of PTSD symptoms in medical students participating in this study is very high. Future studies should investigate the reasons as well as the risk factors associated with PTSD in medical students. Keywords: Post Traumatic stress disorder, Medical students, Anxiety

Proteus syndrome is a rare disease manifested by progressive segmental overgrowth involving the skeletal, Cutaneous, subcutaneous, and nervous systems. We report the case of a 24-year-old female who was born with no obvious abnormality at birth. From the age of 1 year, she developed asymmetric enlargement of her left upper limb and bilateral lower limbs leading to enlargement of the right-hand phalanges with radial deviation, enlargement of the right big toe, lateral deviation of left foot, and discrepancy in the length of lower extremities and kyphoscoliosis. She had become bed-bound for the last few years due to increasing disability. She was diagnosed with Proteus syndrome based on clinical features of progressive course, mosaic distribution, and sporadic occurrence of the lesions.

Background: Chronic liver disease is a highly prevalent illness globally and in Pakistan as well. The current study was designed to investigate the prevalence of anxiety and depression in patients with chronic liver disease (CLD) in hospitalized patients. Methods and materials: Agha khan University anxiety and depression scale (AKUADS), a questionnaire developed natively in Urdu language, was the instrument used for the study. Admitted patients with the diagnosis of chronic liver disease at a tertiary care hospital in Lahore were invited to take part in the study. A total of 107 patients volunteered to take part in the study (29.9% females) from February 2018 to November 2018. Descriptive statistics was employed to report the prevalence of anxiety and depressive disorders in the study population and independent samples T-test was used to analyze the gender difference between the participants. Results: All study participants scored above the cut-off score of 20 on AKUADS. No significant gender difference was seen among the study participants on mean AKUADS scores. Conclusions: The prevalence of depressive and anxiety disorders is very high in patients with CLD. These patients should be assessed for the presence of depressive and anxiety symptoms on a frequent and routine basis. Recognition and treatment of depressive and anxiety symptoms at an early stage may lead to avoidance of many adverse outcomes related to CLD. Keywords: Depression, Anxiety, Chronic liver disease