Objectives: To compare the efficacy of Vonoprazan based dual treatment versus PPI based treatment for the eradication of Helicobacter pylori infection. Methods: A randomized controlled trial was conducted in Department of Medicine/Gastroenterology Ruth KM Pfau Civil Hospital, DMC during the period of 22 June to 21 September 2021. Sample size was calculated as 96 in each Group. All patients of age 18-75 years with Helicobacter Pylori Infection were inducted and randomly allocated to two groups. Group-A: were given Capsule Amoxicillin 1 gm; Tablet Clarithromycin 500 mg; Capsule Omeprazole 20 mg all medications were given twice daily for two weeks. Group-B were given Capsule Amoxicillin 1 gm; Tablet Vonoprazan 20 mg (Vonozon©, m/s Getz Pharma, Pakistan) twice daily for two weeks. Confirmation of Hp eradication was done by stool Hp antigen test four weeks after completion of treatment. Nine and four patients were lost to follow-up in Group-A & B respectively. Analysis was conducted on 87 patients in Group-A and 92 patients in Group-B. Results: Out of eighty-seven patients in Group-A and ninety-two patients in Group-B, 73 (83.9%) patients in Group-A and 86 (93.5%) patients in Group-B had negative H pylori result respectively after treatment (p = .042). Significantly higher frequencies of adverse events were observed in Group-A as compared to Group-B in nausea/vomiting (p = .035) and bloating (p = .045). Conclusion: VA-dual provides an acceptable eradication rate with fewer adverse events. doi: https://doi.org/10.12669/pjms.38.4.5436 How to cite this:Zuberi BF, Ali FS, Rasheed T, Bader N, Hussain SM, Saleem A. Comparison of Vonoprazan and Amoxicillin Dual Therapy with Standard Triple Therapy with Proton Pump Inhibitor for Helicobacter Pylori eradication: A Randomized Control Trial . Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5436 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To determine level and factors of job satisfaction among doctors working in tertiary care hospitals in Pakistan. Methods: This is a multi-center cross-sectional survey conducted among Post graduate trainees, medical officers, consultants and faculty doctors. Job satisfaction was measured using 35 specific questions about sources of work-related stress and sources of work-related satisfaction. Satisfaction was defined if mean score of a factor was ≥3.0, where factors were rated using a 5-point Linkert scale ranging from 1 (completely dissatisfied) to 5 (completely satisfied). Results: In this study 373 doctors participated, out of which 215(57.6%) were males. Over all mean satisfaction score was of 2.69±0.37. Departmental mean satisfaction scores were Internal medicine 2.71±0.35, Medical subspecialties 2.63±0.38, Surgical and allied 2.73±0.45. Designation means were Consultant 2.87±0.38, Faculty 2.78±0.44, Medical officer/Registrar 2.50±0.32, Post graduate trainee 2.71±0.45. Public and private sector means satisfaction scores were 2.53±0.80 and 2.92 ±0.84 respectively. Conclusion: Job dissatisfaction was seen among doctors from all the tiers and departments. Public sector doctors were more dissatisfied than private sector doctors. Increasing age, duration of current posting and working experience, positively correlated with satisfaction level. How to cite this:Ali FS, Zuberi BF, Rasheed T, Shaikh MA. Why doctors are not satisfied with their job-current status in tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.72 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale. Methods: This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection. Results: In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection. Conclusion: The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness. doi: https://doi.org/10.12669/pjms.35.6.1031 How to cite this:Alvi H, Rasheed T, Shaikh MA, Ali FS, Zuberi BF, Samejo AA. Impact of bowel preparation on caecal intubation time during colonoscopy. Pak J Med Sci. 2019;35(6):1516-1519. doi: https://doi.org/10.12669/pjms.35.6.1031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To determine number of sessions of Endoscopic variceal band ligation required to obliterate the esophageal varices. Methods: This study was conducted at Civil Hospital Karachi between June 2018 to April 2019. All patients undergoing endoscopic Variceal Band Ligation (EVBL) were inducted. Number of sessions of band ligation required to obliterate the varices were recorded. Number of EVBL sessions were correlated with Child-Pugh’s Score and etiology of CLD by χ2 test, while it was compared with duration of Chronic Liver Disease (CLD) by One-way ANOVA test. Results: One hundred ninety-two patients fulfilling selection criteria were admitted after informed consent. These included 101 (52.6%) males and 91 (47.4%) females. Most common cause of cirrhosis was HCV (66.7%) in our patients. Most of the patients were in Child Class-B (71.9%). Majority of patients (52.6%) underwent 3 sessions of EVBL while 68 (35.4%) underwent 4 sessions of EVBL. Duration of CLD was analyzed with number of sessions of EVBL by One-Way ANOVA test and it showed significant more sessions of EVBL were done with longer duration of CLD (p <0.001). Conclusion: Most patients underwent 3-4 sessions of EVBL for obliteration of varices. Number of EVBL sessions increased significantly with duration of disease. doi: https://doi.org/10.12669/pjms.36.2.1144 How to cite this:Alvi H, Zuberi BF, Rasheed T, Ibrahim MA. Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices. Pak J Med Sci. 2020;36(2):37-41. doi: https://doi.org/10.12669/pjms.36.2.1144 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives This study was conducted to determine the impact of insulin resistance using Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR) score and BMI in non‐hypoxemic out‐patients with COPD on FEV1 using linear and polynomial regressions and to determine their correlation. Methods COPD patients of both genders were included after informed consent. Fasting blood sugar and serum insulin were done to calculate HOMA‐IR, which were segregated into two groups of ≥ 3 and < 3 labeled insulin resistance present and absent, these were compared with BMI. Patients were segregated into GOLD Grade 1–4 per GOLD Guidelines and compared with HOMA‐IR and BMI. Curve and linear regressions, multivariate and univariate analysis of HOMA‐IR with BMI, FVC, and FEV1 were done. Results A total of 273 subjects were inducted after informed consent. There was a linear correlation between HOMA‐IR and BMI (r2 0.498, P < 0.001) and nonlinear correlation between HOMA‐IR and FEV1 (r2 0. 617, P < 0.001) which showed little evidence of association above FEV1 > 60 predicted, but a clear negative association below that. Significant increase in HOMA‐IR was seen from GOLD‐2 to 3 and from GOLD‐3 to 4 classes. The impact of HOMA‐IR on FEV1 was 49.9% (P < 0.001) on FVC was 43.7%. Conclusions The results indicate that there is a high prevalence of IR in non‐hypoxemic COPD. A nonlinear association is present between FEV1 and HOMA‐IR which is most evident with FEV1 <60% predicted.