Background: One of the leading cancers worldwide is the hepatocellular carcinoma, ranked as the 6th most common cancers. Aim: To evaluate the co-relation between BCLC staging of HCC and alpha fetoprotein levels. Study design: Cross-sectional study. Methodology: Patients (n=90) of either gender irrespective of age who were diagnosed with hepatocellular carcinoma were included into the study. Clinical examination was performed and findings were noted. Eastern cooperative oncology group ECOG scoring system was used to identify the functional performance status of the patients. Hepatocellular carcinoma staging was done using the BCLC scoring system. Complete blood counts, Liver function tests (LFTS), INR, alpha fetoprotein levels, viral serology for hepatits and ultrasonography of abdomen were performed for all the patients. Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: Mean AFP levels were 400.7±305.4 IU/ml with a range of 8.50- 1015 IU/ml. 3(3.3%) patients were in BCLC stage 0, 23(25.6%) were in stage A, 33(36.7%) in stage B, 15(16.7%) in stage C and 16 (17.8%) in stage D. Results showed significant positive correlation between BCLC staging and AFP levels (r=o.834, p=0.001). Conclusion: It was concluded that Hep C followed by Hep B was the main cause of HCC. AFP has a significant diagnostic and prognostic value with positive co-relation with HCC. Keywords: Alpha-Fetoprotein, BCLC Staging, HCC and Liver Disease.

Defects in insulin secretion or its metabolic functionality results in increased levels of glucose causing metabolic disorders. Aims: To check the Co- relation of HbA1c level with diabetic retinopathy on fundoscopy in patients suffering from Type II DM for more than 10 years duration. Study Design: Cross sectional study. Methodology: Patients (n=61) who were diagnosed cases of diabetes mellitus type II according to American diabetes association guidelines for the past 10 years were included into the study. HbA1c was assessed on autoanalyzer from Roche and NGSP certified using turbidimetric inhibition immunoassay (TINIA) method of hemolyzed blood samples. Eye examination of patients were carried out by expert ophthalmologist after proper pupillary dialatation was carried out. After proper fundoscopy patients were classified into four stages of diabetic retinopathy based on ETDRS levels. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: Out of 61 patients 38 (62.3%) were male and 23 (37.7%) were female. HbA1c levels and diabetic retinopathy showed a statistically significant association when assessed using chi square test (p=0.001). Comparison of HbA1c levels among various groups based on diabetic retinopathy grading revealed a statistically significant difference (p=0.001). Conclusion: It was concluded that HbA1c levels and diabetic retinopathy were significantly associated. Higher levels of HbA1c which reflected the poor glycemic control that can be used as a predictor for the severity of developing retinopathy. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Fundoscopy, Microvascular Complication and Type-II Diabetes Mellitus

Background: Around one and half years ago in the December of 2019 a flu like disease emerged in the city Wuhan located in China. This was termed by WHO as a global pandemic due to its rapid widespread. Aim: To compare the efficacy of high dose dexamethasone (8 mgx tds) vs low dose methylprednisoslone (100 mgx bd) therapy for two weeks, in resolution of acute inflammatory markers in patients with covid pneumonia. Study Design: Quasi experimental study. Methodology: Patients (n=72) with an age range of 18-70 years with Covid 19 PCR positive having Covid associated pneumonia were enrolled. Group 1 containing 36 patients receiving high dose dexamethasone (8 mgx TDS) and group 2 with 36 participants receiving low dose methylprednisolone (100 mgx BD). Inflammatory markers (CRP, ESR and Ferritin) were recorded on Day 1 (T1) on day 7 (T2) and day 14 (T3). Patients who required ventillatory support and those who died was also recorded.All this information was recorded on Performa. Data was analyzed using SPSS version 26. Results: Mean age of the patients was 50.11±11.7 years. When we compared the inflammatory markers among group 1 and group 2 at T1, T2 and T3 no statistically significant difference was obtained. Conclusion: It was concluded that high dose dexamethasone and low dose methylprednisoslone therapy for two weeks were equally effective in resolution of acute inflammatory markers in patients with covid pneumonia. Keywords: Covid, Pneumonia, High Dose Steroids and Inflammatory Markers.

Objective: To study association between spontaneous bacterial peritonitis and clinical symptoms in liver cirrhosis. Study Design: cross-sectional study. Place and Duration of Study: Combined Military Hospital Kharian, from Jul 2019 to Apr 2020. Methodology: A total of 122 patients of liver cirrhosis (irrespective of aetiology), presented with various clinical symptoms such as fever, pain abdomen and hepatic encephalopathy were randomly selected. Patients between 18-80 years of age, were included in the study. Asymptomatic patients, with ascites other than liver cirrhosis were excluded. Spontaneous Bacterial Peritonitis was defined as positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥250 cells/mm3 in ascitic fluid. Results: Of the 122 randomly selected patients, the mean age was 56.5 ± 20.2 years. Forty-Five (46.8%) were male and 67 (54.2%) patients were female. Chronic Hepatitis C was the commonest cause of liver cirrhosis (92%). The frequency of spontaneous bacterial peritonitis was 37.7%. Majority, (83%) of the culture positive ascitic isolate was Gram negative bacilli and E.coli (72%) being the commonest organism isolated. Severe ascites, high International Normalized Ratio (INR), hepatic encephalopathy, fever, low ascetic fluid protein count, high serum bilirubin and creatinine were considered to be independent predictor of Spontaneous Bacterial Peritonitis. Conclusion: Clinical symptoms of fever, hepatic encephalopathy, severe ascites, International Normalized ratio high and deranged renal profile was highly suggestive of Spontaneous Bacterial Peritonitis in cirrhotic patients.