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Objective: To evaluate the quality of colonoscopy procedure and assess characteristics of polyps/adenomas and their detection rate. Study Design: Cross Sectional Study. Place and Duration of Study: Department of Gastroenterology, Combined Military Hospital, Rawalpindi Pakistan, from Jan 22 to Dec 23. Methodology: Patients aged 15 to 92 years were included through non-probability consecutive sampling in which 387 colonoscopies were performed. Quality metrics addressed included indication, bowel preparation, caecal intubation rate, withdrawal time, polyp/adenoma detection rate and adverse events. Polyp/adenoma characteristics included site, morphology, size and histology-dysplasia. Results were analyzed using SPSS. Results: Out of 387 colonoscopies, bowel preparation was adequate in 80.6% and caecal intubation rate was 85.3%. The overall polyp detection rate (PDR) was 21.2% and adenoma detection rate (ADR) was 9.3%. The PDR and ADR in patients > 50 years old were 23.7%, and 13.9%. ADR in patients >50 years old was statistically significant (p<0.001). Bowel preparation also showed significance with PDR (p=0.041) and ADR (p=0.025). There was no significant difference of PDR in patients >50 years old and PDR/ADR with gender.  The most common polyp morphology was sessile 0-Is 64.6%. Polyps of size ≥10 mm, 13.3% were more likely to be adenomas and harbor higher grade dysplasia (p<0.001). Conclusion: PDR and ADR increase with better preparation. Increase in polyp size was associated with adenomas of advanced features. The quality indicators of colonoscopy, PDR and ADR merit further evaluation large scale multicenter validation studies are needed to define baseline characteristics and PDR, ADR in our population.

Objective: To determine the comparison between vitamin D deficiency and Autoimmune Thyroid Disease, especially Hashimoto's Thyroiditis. Study Design: Cross-sectional Study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Rawalpindi Pakistan, from June 2022 to July 2023. Methodology: In this study, 400 subjects of both genders, between the age of 20-70 years, were enrolled. All the patients who reported for thyroid evaluation at medical Outpatient Department, Combined Military Hospital, Rawalpindi were included in this research. Individuals with renal or hepatic diseases, primary hyperparathyroidism, metabolic bone diseases, epilepsy, subacute thyroiditis, transitory thyroid dysfunction with negative thyroid autoantibodies, and missing lab data were excluded. All the individuals were tested for serum vitamin D, phosphorus, parathyroid hormone, calcium, thyroid function tests including antithyroid antibodies. Vitamin D deficiency and insufficiency were indicated as serum 25(OH)D level <25nmol/L and 25-75nmol/L, respectively. Results: When compared to 110(27.5%) individuals without autoimmune thyroid disease, 290(72.5%) /patients with Autoimmune Thyroid Disease had a higher rate of vitamin D insufficiency (85.3% vs. 55.5%, p=0.001). There was a significant inverse correlation between serum vitamin D levels and serum thyroid-stimulating hormone levels when gender, BMI, age, and sample season were taken into consideration. Conclusion: Deficiency of vitamin D has a strong correlation with Hashimoto's Thyroiditis and Autoimmune Thyroid diseases. High blood serum levels of Thyroid stimulating hormone have an independent correlation with decreased levels of vitamin D.

Objective: To evaluate how SGLT2 inhibitors, in comparison to a placebo and the maximum dose of Metformin, affect the levels of serum potassium and sodium in individuals with Type II Diabetes. Study Design: Quasi- Experimental study Place and Duration of Study: Department of Medicine (Endocrinology) in a tertiary care hospital, in Rawalpindi Pakistan from Oct 2022 to Mar 2023. Methodology: A total of 200 patients with type II diabetes were recruited and divided into two groups. 100 diabetic patients were placed in Group-A and were given SGLT-2 inhibitors (Dapagliflozin and Empagliflozin) while 100 diabetic patients were placed in Group-B, given a placebo in addition to a maximum dose of 2000mg/day of Metformin they were already taking. Patients were observed over 24 weeks and the levels of serum potassium and sodium were assessed at the end of this period. Results: Mean sodium levels of patients receiving SGLT-2 inhibitors were 139.3±3.18 mmol/L while of those who received placebo were 138.94±3.5 mmol/L with a p-value of 0.44. The mean potassium levels of patients who received SGLT-2 inhibitors were 3.96±0.33 mmol/L while of those who received placebo were 3.97±0.38 mmol/L with a p-value of 0.8. There was statistically no difference in serum sodium and potassium levels of the two groups. Conclusion: SGLT-2 inhibitors (Dapagliflozin and Empagliflozin) do not affect serum sodium and potassium levels when compared to patients who were given placebo as there was statistically no significant difference among the two groups.

Objective: To compare the frequency of post-stroke seizure between acute ischemic and haemorrhagic stroke patients. Study Design: Comparative, prospective study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Oct 2022. Methodology: A total of 180 patients with acute stroke, were included in the study. CT brain and/or MRI brain were performed to diagnose all patients. Patients were divided into haemorrhagic and ischemic stroke groups. Patients were followed for four weeks. Results: The mean age of the patients was 48.92±7.80 years. The majority were males 127(70.5%),125(69.4%) patients had an ischemic stroke, while 55(30.6%) had haemorrhagic. Post-stroke seizures were seen in 12(7.07%). In haemorrhagic stroke patients, the frequency was 5/55(9.09%), while 7/125(5.6%) in ischemic ones. The difference in frequencies was 4.03%. There was no significant difference in seizure frequencies between the two groups (p=0.298). Conclusion: This study concluded that there is no significant statistical difference in frequencies of post-stroke seizure in haemorrhagic stroke compared to ischemic stroke patients.

Objective: To assess the degree of impact the pandemic had on the Oncology Department regarding patient visits and elective procedures. Study Design: Comparative pre-post analysis study. Place and Duration of Study: Medical Oncology Department of Combined Military Hospital, Lahore Pakistan, from Oct to Dec 2019 before the pandemic, and then 2020 during the pandemic. Methodology: Data was collected from the Department regarding the number of outpatient visits, indoor admissions, new cases diagnosed, chemotherapies administered, blood transfusions, and various procedures like lumbar puncture, ascitic fluid paracentesis, pleural fluid drainage, etc. Results: Our study showed an overall decrease in all the study parameters. The average monthly Outpatient visits fell by 395 patients (55.6%). The new cases decreased by 25 patients (36.2%). The indoor admissions also came down by 17 patients (42.5%). Furthermore, the procedures performed in the Oncology department were also observed to have decreased. Conclusion: Oncology has suffered dramatically in the face of the COVID-19 pandemic, with fewer patients visiting the hospital for their consultations, follow-ups, as well as treatments. This has resulted in a delay in diagnosis and treatment and has had a severe adverse psychological impact on the patients.Keywords: COVID-19, Elective procedures, Pandemic, Oncology.

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019. Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals. Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP. While passive external rotation was 70.275.26 at six weeks and 82.304.84 at 12 weeks with PRP versus 61.35.28 at six weeks and 71.806.99 with corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP. Conclusion: There was a significant improvement in mean resting pain relief and passive external rotation after platelet-rich plasma injection in the shoulder joint adhesive capsulitis compared to intra-articular Steroids.

Objective: To determine the frequency of Hyperhomocysteinemia in patients of essential hypertension presenting with acute ischemic stroke. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Internal Medicine, Combined Military Hospital, Quetta Pakistan, from Feb 2018 to Jan 2019. Methodology: The patients of essential hypertension presenting with acute ischemic stroke between 20-70 years of age of either gender were evaluated for the serum homocysteine level. Results: A total 195 patients of essential hypertension presenting with acute ischemic stroke for ≥24 hours duration, of age between 20-70 years, of both genders were included in the study by non-probability consecutive sampling. Majority of patients were between 50-59 year of age (34.3%) with majority of them were male (66.4%). Out of 195, 70.3% were smokers, 56.4% were diabetics, 60.5% were obese and 71.7% had hyperhomocysteinemia respectively. The statistical significance was also observed for hyperhomocysteinemia in accordance with age (p=0.04), gender (p=0.02), obesity (p=0.03) smoking (p=0.01) and diabetes mellitus (p=0.03). Conclusion: Hyperhomocysteinemia is more prevalent in patients of essential hypertension with acute ischemic stroke.

Objective: To find the association of Child-Pugh’s Class with oesophagal varices and portal hypertensive gastropathy in cirrhotic patients at CMH Lahore. Study Design: Cross sectional study Place and Duration of Study: Department of Gastroenterology and Department of Pathology, Combined Military Hospital Lahore Pakistan, from Feb to May 2021. Methodology: All patients with cirrhosis of the liver, irrespective of aetiology, who underwent upper gastrointestinal endoscopy, were included in the study. Lab data was retrieved from the Pathology Department to calculate Child Pugh’s score. Endoscopic findings of oesophagal varices and portal gastropathy were recorded and their correlation/association with Child-Pugh’s Class was calculated separately by using Pearson’s coefficient. Results: A total of 148 patients were included in the study. Male patients were 90(60.8%) and female were 58(39.2%). The age range was 27-85 years, with the mean of patients being 55.93±13.19 years. Association of Child Pugh’s Class with oesophagal varices and portal hypertensive gastropathy revealed that higher grades of oesophagal varices (Grade-lll) and severe portal hypertensive gastropathy were found in Child Pugh’s Class-B (13.51%, 14.18%) and C (15.54%, 16.2%) as compared to Class- A (4.72 %, 1.35%). Child-Pugh’s Class positively correlates with both oesophagal varices and portal hypertensive gastropathy by Pearson’s coefficient r=0.594 and 0.035, respectively; both have significant p values (p <0.05). Conclusion: Child-Pugh’s Class has a positive correlation with both oesophagal varices and portal hypertensive gastropathy in patients with cirrhosis

Objective: To determine the frequency of dyslipidaemia in type-2 diabetic patients and to compare the frequency of dyslipidaemia in patients with and without microalbuminuria in type 2 diabetes. Study Design: cross-sectional study. Place and Duration of Study: Department of General Medicine, Combined Military Hospital Quetta Pakistan, from Dec 2018 to Jun 2019. Methodology: All patients who fulfilled the inclusion criteria and visited General Medicine department of Combined Military Hospital Quetta with type II diabetes mellitus were included in the study. Blood sample following an 8-12 hours fasting over the last night and 24 hour urine sample for microalbuminuria was collected to assess the outcome i.e. frequency of dyslipidaemia and also its frequency with and without microalbuminuria. Result: A total of 165 patients with type 2 diabetes mellitus were included. Ninety nine (60%) were males and 66 (40%) were females with the mean age of 48.08 ± 7.63 years. Overall, dyslipidaemia was found in 48 (29.1%) patients, dyslipidaemia was noted in 29 (17.6%) with microalbuminuria and 19 (11.5%) without microalbuminuria. Chi-square test revealed that dyslipidaemia was significantly more in patients of diabetes mellites having microalbuminuria than those not having it (p-value=0.01). Conclusion: Abnormal lipid metabolism was present in significantly more in patients with microalbuminuria as compared to those without microalbuminuria suffering from type II diabetes mellitus.

Objective: To assess the frequency of stress hyperglycemia and mortality in patients with hyperglycemia admitted in medical Intensive Care Unit. Study Design: Cross-sectional study. Place and Duration of Study: Medical Intensive Care Unit, Combined Military Hospital Quetta, from Nov 2018 to Jun 2019. Methodology: A total of 150 adult patients of age between 18-80 years, of both genders, with Intensive Care Unit stay >24 hours, who were treated in medical Intensive Care Unit during study period, were included in the study. Those patients with duration of stay <24 hours, paediatric patients, surgical and pregnant patients and those who were on chronic steroid therapy and those who were given TPN and dextrose infusions were excluded. The blood sugar fasting was measured daily and blood sugar random was measured on admission and twice daily. The patients were segregated into three groups: Normoglycemia, Diabetes mellitus and Stress hyperglycaemia. The frequency of patients and outcome of patients in terms of death was observed in all groups. Results: The mean age of study population was 55.02 ± 18.14 years, with 99 (66%) were males while 51 (34%) were females. Among study population 77 (51.3%) had normoglycemia, 46 (30.7%) had Diabetes Mellitus while 27 (18%) had stress hyperglycaemia. Out of 77 patients with normoglycemia 10 (12.9%) died, while number of deaths in patients with diabetes mellitus and stress hyperglycaemia was 21 (45.6%) and 15 (55.5%) respectively. The mean maximum blood glucose in those who survived and died was 214.39 ± 100.69 mg/dl and 295.26 ± 122.60...