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Background: Hepatitis virus C (HCV) infection is affecting millions of people globally with an estimated prevalence in Pakistan ranging from 4.5 to 8%. Advent of oral direct acting antiviral agents (DAAs) in combination therapy has made possible the treatment of decompensated cirrhosis secondary to hepatitis C (HCV) infection. Therefore, this study focused to evaluate safety and efficacy of direct antiviral agents (DAAs) in compensated and decompensated cirrhotic patients. Materials and Methods: This cross sectional study was conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT) Karachi, from 1st September 2017 to 30th June 2018. Patients diagnosed with HCV, presenting in outpatient department were enrolled. All patients received Daclatasavir, Sofosbuvir and Ribavirin combination. Patient without cirrhosis and with cirrhosis received treatment for 12 and 24 weeks, respectively. End of treatment response was taken as primary end point. Statistical analysis was performed by SPSS version 20.0. Results: Out of 180 patients, 88(48.9%) were male and 92(51.1%) were female, with mean age of 44.59±11.29 years. Majority had genotype 3 i.e., 145(80.6%). In this study population, 97(53.9%) patients were non-cirrhotic and received 3 months treatment while 83(46.1%) cirrhotic patient got 6 months treatment. Post- stratification observed that young patients have better treatment response rate than older individuals (p-=0.031) On the other hand, statistical insignificant association was observed between end of treatment response with regards to gender, duration of treatment, history of hepatic encephalopathy and ascites. Conclusion: This study concluded that treatment with direct antiviral agents of Hepatitis C virus related chronic liver disease is effectual and has shown equivalent response in cirrhotic and non-cirrhotic patients. Age is an important factor affecting treatment response i.e, better response achieved in patient with less than 45 years.

INTRODUCTION: It has been postulated that the vasoconstriction at the level of renal arcuate artery plays a key role in the development of Hepatorenal syndrome(HRS). However, the measure of renal resistive index at the level of renal arcuate artery can provide a direct measure of renal hemodynamics among cirrhotics. The aim of this study is to determine the difference in the renal resistive index amongst both compensated as well as decompensated cirrhotics and to evaluate its association with natriuresis. METHODS: This prospective study included all consecutive cirrhotic patients visited gastroenterology clinic of our hospital from May 2018 to May 2019. After obtaining informed consent, the demographic parameters were noted along with a detailed drug history (Dose and duration of diuretics and beta blocker). Later on an ultrasound abdomen was also performed for documenting the features of chronic liver disease and the renal resistive index was noted. These patients were then stratified into two groups i.e. compensated cirrhosis and decompensated cirrhosis. Chi square test was applied and P value was calculated. RESULTS: A total of 60 patients were included in the study. The mean age of the patients was 40.3 ± 18.1, and were predominantly males 31(51.7%). Hepatitis C was the most common etiology for liver disease seen in 22 patients (36.7%).The mean CTP score, MELD and MELD sodium score were as follows: 7.9 ± 1.93, 15.2 ± 6.6 and 13.3 ± 4.2 respectively. Compensated liver disease was present in 16(26.7%) patients, while decompensated liver disease was present in 44(73.3%) patients. Mean renal resistive index of patient with compensated cirrhosis was 0.59 ± 0.04, while with decompensated cirrhosis was 0.62 ± 0.04. Patients with a higher RI had poor natriuresis as manifested by low urinary sodium potassium ratio < 1.0 and AROC is 0.775. At the cut off value of RI = 0.615 sensitivity, specificity, positive predictive value and negative predictive value for nartriuresis was 65.0%, 70.0%, 73.3% and 60.1% respectively. Patient with higher RI value were having decompensated cirrhosis (P = 0.06, 0.62 vs 0.59) CONCLUSION: The renal resistive index at the level of arcuate artery were found to be higher among patients with decompensated cirrhosis. At a higher RI value ( >0.615) patients had poor natriuresis. Therefore, RI can be used to predictor of natriuresis among cirrhotic patients. Key words:

Objective: Gastroesophageal reflux disease (GERD) prevalence ranges from 24% to 35% in Pakistani population. Studies have demonstrated GERD frequency is directly proportional to increasing weight. Thus, the frequency of obesity among gastro esophageal reflux disease patients was determined. Methodology: This cross-sectional study was conducted on outpatients with GERD visiting Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi; from December 2017 to June 2018. Clinical and demographic parameters of study population were recorded. Body mass index (BMI) more than 27 was labeled as obese. Patients with history of ischemic heart disease, pregnancy, ascites and/or Patients on NSAIDS, bisphosphonates or steroids were excluded. Results: One hundred and fifty patients with mean age of 43.3±11.5 years were included in study. Eighty-seven patients (63.3%) had age more than 40 years. Majority of study population were males 95 (63.3%). Mean height and weight of study population were 163.09±9.56 cm and 72.92±15.13 kg, respectively. Mean BMI were 27.55±6.02 in which 71 (47.3%) were obese i.e., BMI >27. Majority were Urdu speaking i.e., 57 (38%) followed by Sindhi 31 (20%) Diabetes mellitus was documented in 22 (14.7%) and hypertension in 16 (10.7%) patients. Statistically significant association of GERD was seen in obese females (p-value: 0.018) Conclusion: Increase frequency of obesity is significantly associated with GERD. More proportion of obese females has GERD. Keywords: Gastro esophageal reflux disease; Body mass index; Weight; height