Aim: To study effectiveness of oral magnesium in improving in-hospital outcome in patients presenting with COPD exacerbation. Study Setting: It was conducted at Department of Medicine, Mayo Hospital, Lahore. Duration of study: Six month following approval of synopsis Study design: Comparative Cross-Sectional Methods: Total 160 patients who fulfilled the inclusion criteria were selected . All patients regardless of the group were given conventional management in the form of oxygen inhalation, anti-cholinergic and beta-2 agonist nebulization, intravenous steroids as well as steroid nebulization and intravenous antibiotics. In addition, Group-A was given magnesium in the form of 400 mg of magnesium oxide twice daily. Both groups were followed over their time of stay in the hospital to assess effect of oral magnesium. Data were entered and analyzed by SPSS v26.0. Means were compared by applying students t-test. Two groups were compared using Chi-square test. A p-value ≤0.05 was taken as statistically significant. Results: According to outcome distribution between groups, in group-A, 44(55%) patients were discharged, while 24(30%) needed assisted ventilation and 12(15%) expired. In group-B, 58(72.5%) patients were discharged, while 6(7.5%) needed assisted ventilation and 16(20%) expired with a p-value 0.178 ( for discharge), which is not statistically significant Conclusion: Oral magnesium does not effectively improve in-hospital outcome in those who presented with COPD exacerbation in comparison to those not receiving oral magnesium. Keywords: Chronic Obstructive Pulmonary Disease, Acute Exacerbation, Magnesium Sulphate.

Aim: To find frequency of large fiber sensory neuropathy in diabetes mellitus and to compare hand grip strength in patients of diabetes mellitus with and without large fiber sensory neuropathy Study setting: The study was conducted at Department of Medicine/ Diabetic Foot Care Clinic, Mayo Hospital, Lahore. Duration of study: August 25, 2020 to February 25, 2021 Study design: Cross-sectional study Methods: Total 100 patients with diabetes were enrolled. Patients had their handgrip checked. Handgrip strength of each participant was tested in morning after routine breakfast, with the help of Jammar hand dynamometer. Three readings were taken for each patient with dominant hand and average of these three was calculated for final analysis. Large fiber sensory neuropathy was assessed as per operational definition. Data were entered and analyzed by SPSS v25.0. Peripheral neuropathy was tested by Chi Square test. Data were stratified for age, gender, duration of DM and BMI. Hand grip was compared between groups by t-test. A p-value of ≤0.05 was taken as significant. Results: In this study, 100 patients presenting with diabetes mellitus were enrolled. Among these patients, 68(68.0%) were males, while 32(32.0%) were females. Age range in this study was from 18 to 60 years with mean age of 42.8±11.6 year. Frequency of large fiber sensory neuropathy was 42(42.0%) among cases presenting diabetes mellitus. Mean handgrip strength in patients with large fiber sensory neuropathy was 20.71±2.39 kg and 28.10±5.18 kg among cases without large fiber sensory neuropathy with p-value as 0.0001, which is statistically significant. Conclusion: Long-standing large fiber sensory neuropathy with type-II diabetes mellitus seems to result in a decrease in hand grip strength. This physical limitation may contribute to low productivity in people with large fiber sensory neuropathy among type-II diabetes mellitus. Keywords: Hand Grip Strength, Type-2 Diabetes Mellitus, Large Fiber Sensory Neuropathy.

Aim: To find the frequency of cirrhotic cardiomyopathy in patients of chronic liver disease. Study design: It was a pure cross sectional type of study. Duration: After approval of synopsis, it consisted of six months i.e., from 12/04/2018 to 11/10/2018. Methods: This study was consisted of 100 patients of both sex, having age range of 16-70 years & have cirrhosis of liver assessed at least half year previously. All of them underwent transthoracic echocardiography to look for cardiomyopathy to be assessed by looking at diastolic dysfunction (i.e. increase in ratio of E/A more than 1). Each individual enrolled in current study is asked for written consent. Results: Mean age of patients was found to be 51.9±9.8 years. There were 61 males (61%) & 39 females (39%) have man to woman ratio of 1.6:1. Mean BMI was 26.5± 3.7 Kg/m2 and mean duration of cirrhosis of liver was 22.0±10.9 months. Majority (n=49) of them (49%) were of Child Pugh Class C followed by 39% of Class B & then 12% of Class A. Cardiomyopathy with cirrhosis of liver was seen in 41%. No significant difference was seen statistically in frequency of cardiomyopathy with cirrhosis of liver across all groups based on age (p value less than 0.928), sex (p value less than 0.997), BMI (p valueless than 0.983) Practical implication: If all chronic liver disease patients are screened for cardiomyopathy by echocardiography early, then we can improve quality of life for these patients & hence can survive longer. Conclusion: Cardiomyopathy associated with cirrhosis of liver was seen in a large percentage of cirrhosis liver cases and was found to be more frequent in those with more severe illness which guide us for doing transthoracic echocardiography to screen all these to timely identify and manage this complication to improve case outcome. Keywords: Cirrhosis Liver, Cardiomyopathy, Child-Pugh Class

Objective: To compare lipid profile in thrombotic and haemorrhagic stroke patients. Place of Study: All general medical and neurology wards of Mayo Hospital Lahore. Patients and Methods: Study was conducted in 40 consecutive patients of stroke admitted in hospital. Serum lipid (total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio) were estimated in all selected patients within 7 days of onset of stroke and findings were entered on study proforma specifically designed for this purpose and analyzed statistically by student`s "t" test. Results: Out of 40 patients included in the study, 22(55%) were suffering from thrombotic stroke while 18(45%) suffered from haemorragic stroke. The difference in the values of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio was not statistically significant between the two groups of patients. Conclusion: It is concluded that serum lipids i.e., total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio does not have any differential effect in the causation of thrombotic or haemorrhagic strokes.

Aim: To find the frequency of hyperthyroidism in patients of atrial fibrillation admitted in Mayo hospital Lahore. Study setting: The study was conducted at Emergency Department, Cardiology Department and Department of Internal Medicine in Mayo Hospital Lahore\ Duration of study: It was from May 20, 2019 to November 20, 2019. Study design: It was Cross-Sectional study\ Methods: patients suffering with atrial fibrillation fulfilling the operational definition and inclusion criteria were enrolled. After aseptic measures, blood sample of 5 ml was drawn from left cubital vein with low sucking pressure. Sample was deposited to Center for Nuclear Medicine (CENUM) Laboratory at Mayo Hospital Lahore for thyroid function tests. Serum Thyroid Stimulating Hormone, Thyroxine and Triiodothyronine levels were noted and hyperthyroidism labeled as per the operational definition. Data was collected by the researcher himself noted on a specially designed proforma and presented in the form of tables and diagrams. Results: The mean value of age in our study was 55.13±14.01 year. In our study 40(42.6%) patients had hyperthyroidism. Conclusion: High frequency of hyperthyroidism in our study, suggests that routine thyroid function tests using sensitive thyroid-stimulating hormone assay with free T4 & free T3 levels is required in all those with acute atrial fibrillation. Keywords: Hyperthyroidism, Atrial Fibrillation.