Background. Hyperammonemia resulting from chronic liver disease (CLD) can potentially challenge and damage any organ system of the body, particularly the brain. However, there is still some controversy regarding the diagnostic or prognostic values of serum ammonia in patients with over hepatic encephalopathy, especially in the setting of acute-on-chronic or chronic liver failure. Moreover, the association of serum ammonia with worsening Child-Pugh grade of liver cirrhosis has not been studied. Objective. This study was conducted to solve the controversy regarding the association between hyperammonemia and cirrhosis, especially hepatic encephalopathy in chronically failed liver. Material and Methods. In this study, 171 cirrhotic patients had their serum ammonia measured and analyzed by SPSS version 16. Chi-squared test and one-way ANOVA were applied. Results. The study had 110 male and 61 female participants. The mean age of all the participants in years was 42.33 ± 7.60. The mean duration (years) of CLD was 10.15 ± 3.53 while the mean Child-Pugh (CP) score was 8.84 ± 3.30. Chronic viral hepatitis alone was responsible for 71.3% of the cases. Moreover, 86.5% of participants had hepatic encephalopathy (HE). The frequency of hyperammonemia was 67.3%, more frequent in males (N = 81, z-score = 2.4, and P < 0.05) than in females (N = 34, z-score = 2.4, and P < 0.05), and had a statistically significant relationship with increasing CP grade of cirrhosis (χ 2(2) = 27.46, P < 0.001, Phi = 0.40, and P < 0.001). Furthermore, serum ammonia level was higher in patients with hepatic encephalopathy than in those without it; P < 0.001. Conclusion. Hyperammonemia is associated with both increasing Child-Pugh grade of liver cirrhosis and hepatic encephalopathy.

Spontaneous Bacterial Peritonitis (SBP), a known complication of cirrhosis Liver is an acute bacterial infection of the peritoneum. Usually no source of infection is easily identifiable. Objective: To compare the efficacy of Ciprofloxacin and Cefotaxime in Cirrhosis Liver patients with SBP. Material and Methods: This prospective, comparative, single center study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar from 1st October 2017 to 31st December 2018. A total of 300 admitted patients having Cirrhosis Liver with SBP were included in this study. The patients were randomized into Group A and Group B. Group A was treated with Intravenous Ciprofloxacin and Group B was treated with Intravenous Cefotaxime given twice daily for a period of 5 days. Diagnostic peritoneal paracentesis was done before the start of the treatment and repeated after 5 days therapy. Patients who were either non cirrhotic or had secondary bacterial peritonitis were excluded from the study. Results: A total of 300 Cirrhosis Liver patients with SBP were studied in two equal randomized groups. Out of these 168 were male and 132 were female. The mean age of patients in study was 51.14±11.9 years. The age ranged between 15-75 years. In Group A, 82 percent responded to ciprofloxacin and in group B, 86 percent responded to cefotaxime. Conclusion: Both intravenous ciprofloxacin and cefotaxime are effective in treating spontaneous bacterial peritonitis in patients with Cirrhosis Liver. Key Words: Ciprofloxacin, Cefotaxime, Spontaneous bacterial peritonitis, Efficacy.

Objectives: To determine the frequency of Escherichia coli (E. Coli) with multi-drug resistance and sensitivity to oral Fosfomycin in urinary tract infections in a public sector hospital of Peshawar Pakistan. Material and Methods: A descriptive cross-sectional study with a convenient consecutive sampling technique at the Department of Medicine Khyber Teaching Hospital Peshawar. A total of 179 patients were recruited in the current study. Detailed history and examination were carried out followed by routine baseline investigations. Under rigorous aseptic settings, two clean midstream urine samples from patients exhibiting symptoms of a urinary tract infection were collected. These samples were then promptly transferred to the hospital laboratory for routine evaluation and E.Coli inoculation on culture media. Once E.Coli was detected, it was tested for antibiotic sensitivity and resistance against the antibiotics mentioned. The multi-drug resistant (MDR) strains were isolated and their sensitivity was checked against oral fosfomycin. All the variables of data were recorded in SPSS version 20. Descriptive and inferential statistics will be utilized to elaborate study findings.   Results: The mean age in this study was 37 years with a standard deviation was ±11.27.Seventy-three (41%) patients were males and 106 (59%) patients were females. One hundred and eleven (62%) patients had multidrug-resistant E.Coli among which oral Fosfomycin was sensitive in 108(97%) patients and was resistant in 3(3%) patients presenting with urinary tract infection. Conclusion: The multidrug-resistant E. coli strains are common in our setup. However, oral fosfomycin has documented sensitivity against these MDR strains of E. coli in the majority of UTI cases.  Keywords: Multidrug-resistant Escherichia coli, Drug Sensitivity, Fosfomycin, urinary tract infection