Efficacy of Natural Formulation Containing Activated Charcoal, Calcium Sennosides, Peppermint Oil, Fennel Oil, Rhubarb Extract, and Purified Sulfur (Nucarb®) in Relieving Constipation.

Introduction Long-term use of laxatives may have side effects such as bloating, allergic reaction, abdominal pain, metabolic disturbances, and hepatotoxicity. In this study, we have compared the efficacy of herbal medicine Nucarb, a combination of activated charcoal, calcium sennosides, peppermint oil, fennel oil, rhubarb extract, and purified sulfur, in relieving constipation. Methods This longitudinal study was conducted in multiple cities of Pakistan from April 2021 to June 2021. A total of 1000 patients, of either gender between age group 18 and 75 years, with complete spontaneous bowel movement of less than or equal to two times per week, were enrolled in the study. Participants were prescribed two tablets of Nucarb once daily (OD) at bedtime for the first seven days, followed by one tablet of Nucarb OD at bedtime for the following seven days. They were asked to return for follow-up after 14 days. Results There was a statistically significant improvement in all six components of constipation. After 14 days, the severity of constipation reduced by 80.70%, the sensation of straining was reduced by 72.69%, and the feeling of incomplete evacuation was reduced by 71.87%. There was no adverse event reported. Conclusion Nucarb is efficacious in reducing the severity of constipation, sensation of straining, bloating and abdominal pain, feeling of incomplete evacuation, and difficulty in passing gas. Since it is a herbal product, it can be safely used in all populations.

Peripheral Artery Disease as a Risk Factor for Myocardial Infarction.

INTRODUCTION:  Atherosclerosis contributes to the underlying pathophysiology for peripheral arterial disease (PAD), coronary artery disease (CAD), and cerebrovascular disease. Several studies have been conducted to demonstrate PAD as a major risk factor for cardiovascular (CV) events, however, the regional data are limited. This study aims to highlight PAD as a major risk factor in CV events in a local setting. METHODS:  In this longitudinal study, 400 hypertensive patients with a confirmed diagnosis of PAD were enrolled from the outpatient department of the cardiology unit. Diagnosis of PAD was made using the ankle brachial index (ABI). ABI less than 0.9 was labeled as participants with PAD. Another group of 400 without PAD was also enrolled as the control group from the outpatient department of cardiology unit. Patients were followed up for 12 months or for the development of myocardial infarction (MI). RESULT:  Participants with PAD had a significant increased risk of total MI events with a relative risk (RR) of 1.67 (confidence interval, CI 95%: 1.05-2.66; p-value: 0.02). The RR for fatal MI was 2.62 (CI 95%: 0.94-7.29; p-value: 0.06) compared to the participants without PAD, however, it was not significant. CONCLUSION:  This study has focused on the risk factors of PAD and has suggested that the patients who have any of the mentioned risk factors should be treated with caution under strict instructions given by doctors. A variety of treatment options is available, but the initial changes should be made in the lifestyle of these patients, making sure the risk factors are being treated.

Prevalence and Causes of Hyperuricemia in Children.

Introduction  There are various factors responsible for hyperuricemia in children, however, there is extremely limited local data available. In this study, we aim to determine the causes and risk factors associated with hyperuricemia. This study will assist pediatric consultants to identify children who might be at risk of hyperuricemia and manage them accordingly. Methods This study was conducted in pediatric outpatient departments of various tertiary care hospitals from January 2018 to December 2019. Five thousand (n = 5000) children of either gender between the age group of 1-14 years, were enrolled in the study after informed consent from their parents. Uric acid levels were assessed by using the UASure blood uric acid monitoring handheld device. Results  In our study, n = 1301 (26.02%) children had hyperuricemia. Hyperuricemia was more common in male compared to females (65.49% vs. 34.51%; p-value <0.00001) and in older children (9 ± 2 years vs. 7 ± 3; p-value <0.00001). In hyperuricemia patients, the most common disorder was gastroenteritis (23.98%), followed by respiratory infection (23.14%) and asthma (15.45%). Conclusion  Hyperuricemia in children is very prevalent in the local setting. Patients with pre-existing conditions like congenital heart disease, asthma, epilepsy, and cancers should routinely be screened for hyperuricemia and managed accordingly to avoid long-term complications associated with hyperuricemia.

Lumbar Disc Herniation: Comparing Pain Relief After Medical and Surgical Intervention.

Introduction The most common degenerative abnormality of the lumbar spine is lumbar disc herniation. There are two options of treatment, i.e. medical and surgical. Due to the scarcity of literature, it is a need of the hour to further study and evaluate the benefits and efficacy of early surgical intervention versus conservative management of lumbar disc herniation. Methods This study was conducted in the neurology unit of a tertiary care hospital in Pakistan from April 2019 to March 2021. After obtaining informed consent, 250 patients with a lumbar disc herniation, between the ages of 20 and 50 years, were enrolled in the study. Out of them, 81 participants chose surgical intervention while 169 participants chose medical intervention. Before the intervention, the patient's pain score was noted on the visual analog scale (VAS). The pain was assessed again 14 days after surgical intervention and 90 days after the start of medical intervention. Results There was a significant difference in the pain score in the post-intervention period in both the medical (7.01 ± 1.05 vs. 3.54 ± 0.51; p-value: <0.0001) and surgical intervention groups (6.92 ± 0.95 vs. 2.41 ± 0.42; p-value: <0.0001). Post-intervention, the VAS pain score was significantly lower in the surgical group as compared to the medical group (2.41 ± 0.42 vs. 3.54 ± 0.51; p-value: <0.0001). Conclusion In this study, there was a significant decline in pain in both groups; however, the reduction was more significant in the surgical group. Patients should be given both options for management of lumbar disc herniation and should be explained the pros and cons of each treatment option.

The Role of Vitamin C in Reducing Pain Associated With Diabetic Neuropathy.

INTRODUCTION: Neuropathic pain is a painful condition that arises after a lesion or an insult to the somatosensory nervous system, either in a central or peripheral location. The most common cause of neuropathic pain is diabetes. Controlled trials have been conducted on recent advancements in medicine to investigate the effect of vitamin C in the treatment of neuropathic pain. In this study, we aim to investigate the role of vitamin C in reducing pain associated with diabetic neuropathy. METHODS: This open-label, parallel-arm, interventional study was conducted in a public tertiary care hospital in Pakistan from April 2019 to March 2021. A total of 300 type II diabetic patients with newly diagnosed painful peripheral diabetic neuropathy, of either gender, were enrolled in the study. The intervention group received 60 mg duloxetine along with 200 mg oral vitamin C. The control group received 60 mg duloxetine without any additional intervention. Patients were asked to return for follow-up after 12 weeks. RESULTS: The mean visual analog score (VAS) was significantly lower in both, the intervention (5.54 ± 0.81 vs. 6.72 ± 0.90; p-value: <0.0001) and the control group (5.91 ± 0.80 vs. 6.79 ± 0.94; p-value: <0.0001), at week 12 compared to day 0. However, in comparison, VAS score in intervention at week 12 was significantly lower as compared to the control group (5.54 ± 0.81 vs. 5.91 ± 0.80; p-value: 0.0002). CONCLUSION: The use of vitamin C could be cost-effective and would be a safe and useful adjunctive therapy for pain associated with diabetic peripheral neuropathy.

Comparison of Effect of Nebivolol and Bisoprolol on Sexual Function of Hypertensive Female Patients.

Introduction Male and female sexual dysfunction is frequently found in patients with hypertension. Many studies indicate that this is found more frequently in patients treated with beta-blockers rather than due to hypertension itself; however, almost all studies have been done on male population. This study aims to study the effect of two commonly used beta-blockers on sexual function of a hypertensive female patient. Methods This two-arm open-label randomized prospective study was conducted from April 1, 2019 to March 30, 2020 in a tertiary care hospital at Pakistan. One hundred and fifty participants randomized to group A were given nebivolol 5 mg once daily in addition to their current hypertensive treatment. Another 150 participants randomized to group B were given bisoprolol 5 mg once daily in addition to their hypertensive therapy. Sexual function was assessed on day 0 and day 90 using female sexual function index (FSFI). Results The mean sexual score in the nebivolol group significantly improved after day 90 in comparison to day 0 (24.16 ± 2.1 vs. 26.91 ± 2.6; p-value < 0.0001), while no difference in sexual score in bisoprolol group after day 90 was observed (24.14 ± 2.1 vs. 24.12 ± 2.0; p-value = 0.91). Conclusion In this study, nebivolol group was associated with a significant improvement in sexual function. This can be due to additional vasodilation properties and a low risk of sexual side effects associated with nebivolol.

Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Incidence of Lung Cancer: A Retrospective Study.

INTRODUCTION: Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blockers (ARBs) are taken as the first treatment option for hypertensive patients. The various global trials have suggested that ACEIs and ARBs may increase risk of lung cancer; however, the results are contradictory and there is no local study available. This study is conducted to compare the incidence of lung cancers in patients on ACEIs and ARBs. METHODS: This retrospective study, conducted in a major cardiology unit of a tertiary care hospital in Pakistan, included patients diagnosed with hypertension, between 2005 and 2010, who were prescribed either ACEIs or ARBs. During the period of 2005 to 2010, 47,823 naïve hypertensive patients were reported in the outpatient department of the cardiology unit. Of which, 22,241 were prescribed ACEI and 25,582 were prescribed ARBs. After sorting patient data based on our inclusion criteria, n = 14,891 participants were included in the ACEI group and n = 19,112 participants were included in the ARB group. RESULTS: The incidence of lung cancer in the ACEI and ARB group was n = 165 and n = 160, respectively. In this study, the overall incidence rates of lung cancer in the ACEI and ARB cohorts were 12.2 and 16.6 per 10,000 person-years, respectively. The hazard ratio was 1.32 (95% confidence interval: 1.06-1.64; p-value: 0.01). CONCLUSION: In this study, the incidence of lung cancer was relatively more among people using ACEIs than ARBs. Hence, patients undergoing long-term treatment with ACEIs need regular follow-up and proper scanning to avoid grave complications.

Association Between Serum Vitamin D Levels and Frequency of Relapses in Patients With Multiple Sclerosis.

Introduction Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system affecting the myelin sheath of neurons with a wide range of symptoms. Among various risk factors studied that can increase the relapse, vitamin D is also a potential risk factor. In this study, we will determine the association between vitamin D status and frequency of relapses in patients with MS. Material and methods Seventy-four (74) patients with a confirmed diagnosis of MS, with more than one (01) relapse per year, for a minimum of two years, were included in the case group. Seventy-four (74) participants with a confirmed diagnosis of MS with one (01) or no relapse per year, for a minimum of two years, were included in the control group. After informed consent, the patient blood was drawn via phlebotomy and was sent to the lab for vitamin D levels. Results The mean serum vitamin D level was significantly lower in case group compared to control group (18.21 ± 4.21 ng/mL vs. 29.21 ± 5.72 ng/mL; p-value: < 0.0001). The number of participants with vitamin D level less than 30 ng/mL were significantly higher in patients with case group compared to control group (78.37% vs. 50.0%; p-value: 0.0003) Conclusion In this study, patients with more relapses per year had low level of serum vitamin D. There is emerging strong evidence that vitamin D plays an important role in the pathogenesis, progression, and disease burden of autoimmune disease, including MS.

Alzheimer's Disease and Its Association With Bone Health: A Case-Control Study.

Introduction Alzheimer's disease is associated with low bone mineral density. Various studies have linked early-onset Alzheimer's disease with bone health. In this study, we will determine the association between bone health and recently diagnosed Alzheimer's disease in the local population. Methods This case-control study was conducted at the neurology unit from April 2019 to Sept 2019. One hundred and fifty (150) Alzheimer's patients with recently (within the last six months) confirmed diagnoses, based on clinical symptoms, mental status, and computed tomography (CT) scan, were included from the neurology outpatient department. The gender and age-matched 150 healthy participants were included in the study as the reference group. Various parameters of bone health and mental status were measured. Results Participants with Alzheimer's had a significantly lower level of serum vitamin D (15.2 ± 4.2 ng/mL vs. 27.5 ± 8.1 ng/mL, p-value: < 0.0001) and lower level of serum osteocalcin (4.3 ± 1.7 ng/L vs. 5.6 ± 2.0 ng/L, p-value: < 0.0001). Participants with Alzheimer's disease had more people with T-score ≤ -2.5 as compared to the general population (52.0% vs. 16.6%, p-value <0.0001). Conclusion Alzheimer's disease is associated with poor bone health as compared to the general population of the same age. Bone health can be an important parameter to screen patients at risk of Alzheimer's disease. The management of Alzheimer's disease should include a regular assessment of bone health, and the treatment plan should include therapies to improve bone health.

Sensitivity and Specificity of Hepatitis B Virus Screening via Rapid Immunoassay Chromatographic Test.

INTRODUCTION:  In low-income and high hepatitis B and C virus burden countries like Pakistan, it is important to develop cheap yet efficient strategies in diagnosing as well as treating hepatitis. The aim of this study is to assess the sensitivity and specificity of serum hepatitis B surface antigen (HbsAg) via Rapid Immunoassay Chromatographic Test (RICT) for the screening of hepatitis B, compared to the gold standard laboratory-based method. METHODS:  The study was conducted in the Hepatology Clinic of Civil Hospital, Sukkur. All records of the clinic from June 1, 2018, to December 31, 2018, were accessed for identification of the records in which hepatitis B screening via RICT and then confirmatory polymerase chair reaction (PCR) by gene amplification with forward and reverse primers was done. RESULTS:  There were 151 samples in this study. There were 32 (94.1%) true-positive and three (5.8%) false-negative samples. There were two (2.5%) false-positive and 114 (97.4%) true-negative samples. The sensitivity of HbsAg detection via RICT for the screening of 1-1B V was 91.43%, specificity was 98.28% and the accuracy was 96.69%, compared to PCR. CONCLUSION: The RICT method has high sensitivity and specificity. In low-income and high-hepatitis B virus-burden countries like Pakistan, it serves as a very efficient screening tool that is easy to use, cheaper in cost, and gives rapid and accurate results.

Prevalence of Falls and Fractures in Alzheimer's Patients Compared to General Population.

Introduction Alzheimer's disease (AD), found in the aging elderly population, is a progressive neurodegenerative disorder that leads to worsening memory loss and cognitive impairment. Falls and fractures are common in the overall elderly population. Hence, the purpose of this study is to determine the prevalence of falls and fractures in Alzheimer's patients compared to the general population. Methodology This longitudinal study was conducted at the neurology outpatient department (OPD) in a tertiary healthcare setup in Pakistan from November 2019 till April 2020. Previously confirmed diagnosed Alzheimer's patients from neurology OPD were included in one group. Equal number of gender and age-matched healthy participants were included in the reference group. Participants were followed for 12 months to determine the incidence of falls and non-vertebral fractures. Results The incidence of fall was significant in the Alzheimer group compared to the reference group (22.8% vs. 10.9%; relative risk (RR): 2.08; P-value: 0.01). Fractures were also significantly more common in the Alzheimer group compared to the reference group (12.8% vs. 5.1%; RR: 2.51; P-value: 0.03). Conclusion This study demonstrated a higher incidence of falls and fractures in Alzheimer's patients compared to healthy non-Alzheimer individuals. Management of AD should include measures to reduce falls and fractures in addition to standard therapy.

Do COVID-19 Antibodies Provide Long-Term Protection?

INTRODUCTION: Post severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, an immune response is generated among healthy, immunocompetent individuals with immunoglobulins (IgG and IgM) antibodies. IgM rises earlier than IgG, indicating a recent infection. However, a detailed analysis is required to assess long-term immune reactions induced by antibodies. METHOD AND MATERIALS: The study was conducted at a tertiary care hospital in Pakistan from June 2020 to October 2020 where serum samples were collected from patients. The samples were obtained by phlebotomy for antibody testing. All the reactive patients were followed up after 60 days of initial testing. RESULTS: A total of 728 patients participated in the study, of which 79​ (10.8%) were seropositive at baseline. Seventy-two (91.1%) participants came back for follow-up after 60 days (two months) and were included in the final analysis. Among the 72 participants, 35 (48.6%) exhibited symptoms of coronavirus disease 2019 (COVID-19) infection and 37 (51.4%) were asymptomatic. After 60 days, 37 (including 20 symptomatic and 17 asymptomatic) participants were still seropositive for SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) test. Mean change in percentage from seropositive to seronegative was more in asymptomatic compared to symptomatic patients (54.0% vs. 42.8%). CONCLUSION: In this study, humoral immunity against SARS-CoV-2 is not long-lasting among individuals with mild signs and symptoms. Care should be taken while implicating that antibodies can provide long term protection against SARS-CoV-2. Further large-scale studies are needed.

Prevalence of Irritable Bowel Syndrome and Frequency of Symptoms in the General Population of Pakistan.

INTRODUCTION: Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder. Risk factors include infective enteritis, female sex, antibiotic exposure, anxiety, and depression. The aim of this study is to find out the prevalence of IBS in healthy population and determine the characteristics of symptoms. MATERIAL AND METHODS: A cross-section study was conducted in the internal medicine unit of a tertiary care hospital in multiple cities of Pakistan. Eight hundred (800) healthy peoples were selected for study from June 2019 to August 2019. Diagnosis of IBS was made by using Rome III criteria. RESULTS: The prevalence of irritable bowel syndrome (IBS) in general population in our study was 33.2%. IBS was more common in females compared to males (57.7% vs. 42.2%; p value = 0.009). IBS was more common in age group between 20 and 29 years (45.5%). Among patient diagnosed with IBS in this study, the most common was bloating (74.7%) followed by increased stool frequency (54.4%). CONCLUSION: IBS is very prevalent in Pakistan, yet there is very little data and awareness related to it. Any change in stool frequency or consistency in young adults, especially women, shall be evaluated for IBS after ruling out other diseases. Early diagnosis and treatment of IBS will assist in improving the patient's quality of life.

The Effect of Preoperative Hematocrit Levels on Early Outcomes After Coronary Artery Bypass Graft.

Introduction Coronary artery bypass graft (CABG) is the most potent of surgical procedures; in this procedure, the narrowing of the coronary artery due to atherosclerotic plaque is bypassed by forming an alternate route for blood flow to the heart. There are various risk factors associated with the procedure. The aim of this study was to observe if postoperative outcomes are affected by preoperative hematocrit (hct) levels in patients. Methods  This longitudinal study was conducted from April 2019 to December 2019. Eighty-two (82) participants who were to undergo CABG surgery were divided into two groups based on their preoperative hct levels. Group 1 had 42 participants with lower levels of hct (less than 35.5% for women and 38.3% for men), whereas group 2 consisted of 40 participants with normal hct levels (greater than 35.5% for women and 38.3% for men). Results The results showed that participants undergoing CABG with lower than normal hct levels had increased blood loss through drainage as compared to participants who had normal hct levels (680.1 ± 301 mL vs. 500.7 ± 412 mL; p-value: 0.02). Group 1 participants also had an increased need for blood and blood product transfusion as compared to group 2 (3.2 ± 1.8 units vs. 1.8 ± 0.9 units; p-value: <0.0001). Furthermore, the participants in group 1 had longer stays in the ICU relative to the other group (5.2 ± 3.1 days vs. 3.4 ± 2.5 days; p-value: 0.003). Conclusion Based on our findings, patients who undergo CABG surgery with lower than normal hct levels are at increased risk of certain complications, including excessive blood loss, need for transfusion, and increased duration of ICU stay. Therefore, preoperative hct levels should be routinely checked in patients undergoing CABG to prevent these complications.

The Risk Factors for the Wearing-Off Phenomenon in Parkinson's Disease.

INTRODUCTION: First-line treatment of Parkinson's disease (PD) includes a dopamine analog, levodopa, administered in combination with carbidopa to increase efficacy. Wearing-off (WO) phenomenon is a frequent complication which is defined as a reoccurrence of motor and non-motor symptoms during levodopa free interval, which has a negative impact on the quality of life of patients. Through this study, we aim to determine risk factors that lead to the manifestation of the WO phenomenon among patients presenting in our out-patient department of a tertiary care hospital in Pakistan. METHOD: A observational case-control study was conducted from April 2019 to December 2019 in a tertiary care hospital in Pakistan. A total of 101 patients who had PD were included in the study. They were randomized into two groups i.e. patients who had WO phenomenon (59 participants) and patients who did not experience WO (42 participants) phenomena. Patients were evaluated based on a self-administrated questionnaire. A p-value of less than 0.05 was considered significant. RESULT: WO was significantly higher in those patients who had earlier onset of Parkinson (59 ± 10 vs. 65 ±8; p<0.002) and had the disease for a longer duration (7.9±5.1 vs. 5.6±3.1, p<0.002). Other findings included, there was more risk of WO in patients on anti-parkinsonian treatment for longer duration (7.2±5.1 vs. 3.9±3.5, p<0.010) and on longer duration on levodopa treatment (6.9±4.9 vs. 3.1±2.8, p<0.0001). CONCLUSION: Our study demonstrated several factors which are responsible for the WO phenomenon. This will aid neurologists to consider these risk factors while prescribing different treatment modalities for the disease to improve efficacy and mitigate WO effect among patients, specifically while advising levodopa.

Role of Montelukast as Monotherapy in Improving Quality of Life of an Asthmatic Patient in Pakistan.

INTRODUCTION: Uncontrolled and inadequately managed asthma substantially reduces Quality of Life (QOL) and can lead to premature death. The aim of this study is to understand the role of montelukast in improving quality of life in asthmatic patients by comparing it with placebo. METHODS: This prospective, single-arm, interventional study was conducted from September 2019 to February 2020 in the pulmonology outpatient department of a tertiary care hospital in Pakistan. All patients were prescribed montelukast (10 mg once daily). RESULTS: At day 28, participants had a higher score on the Asthma Quality of Life Questionnaire-Standard (AQLQ-S) overall and in all sub-domains compared to day 0. The improvement was significant overall and for the sub-domains of symptoms, activity limitations, and environmental stimuli. CONCLUSION: Montelukast has an effective role in asthma control as well as in improving the quality of life in the Pakistani population.

Diabetic Ketoacidosis: Clinical Characteristics and Precipitating Factors.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a complication of hyperglycemia. Through this study we plan to study the clinical features of DKA and precipitating factors responsible for DKA in type 1 and type 2 diabetes. METHODS: This cross-sectional observational study was conducted in the emergency department of a tertiary care hospital in Sukkur, Pakistan from August 2019 to February 2020. Symptoms and precipitating factors were noted in a self-structured questionnaire. RESULTS: Out of 71 patients, 19 (26.7%) patients had type 1 diabetes mellitus and 52 (73.3%) patients had type 2 diabetes mellitus. The most common clinical symptom was nausea and vomiting (57.7%), followed by pain in abdomen (42.2%) and dehydration (42.2%). We found that the most common precipitating factors were infections (69.0%) and non-compliance to treatment (53.5%). Among various infections, people commonly presented with pneumonia (38.7%) and urinary tract infection (30.6%). CONCLUSION: Diabetic ketoacidosis presents with vague symptoms such as nausea, vomiting, and pain in abdomen. Characteristic findings of DKA such as Kussmaul breathing was present in limited patients. Infections in diabetic patients should be carefully monitored as they are the most common precipitating factors for DKA.

Prevalence and Symptom Characteristics of Irritable Bowel Syndrome Among Bronchial Asthma Patients in Pakistan.

INTRODUCTION: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that leads to a variety of symptoms including abdominal discomfort and change in stool frequency and consistency. Asthma is a common disease of the airway. Some studies have suggested that a relationship between IBS and asthma exist, while others have contradicted the claim. This study aims to determine the prevalence of IBS in asthmatic patients and compare their symptoms with symptoms of IBS patients in non-asthmatic patients. METHODOLOGY: In this case-control study, 100 known and documented asthmatic patients were included as cases, and 100 non-asthmatic healthy patients were included as controls from July to August 2019. These patients were given a questionnaire based on ROME II criteria for the diagnosis of IBS. Prevalence and symptoms of IBS were compared between cases and controls. A probability level, P < 0.05 was considered significant.  Result: IBS was found in 41 out of 100 asthma patients (41%) and 18 out of 100 controls (18%) with a P-value of 0.0005 and was more common in females in both asthmatic (63.41%) and non-asthmatic patients (66.66%). Symptoms such as abdominal pain/distress (63.41% vs. 11.11%, P-value: 0.0013) and bloating (82.92% vs. 33.33%, P-value: 0.0005) were significantly higher in asthmatic patient with IBS compared to non-asthmatic patient with IBS. CONCLUSION: Prevalence of IBS among asthma patients was significantly higher as compared to non-asthmatics. Routine screening of asthma patients and further studies to understand the pathogenesis underlying association between IBS and asthma should be conducted to detect and manage such patients effectively.

Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis.

Introduction Rheumatoid arthritis is a chronic, inflammatory, and multisystem disease, which, along with the joints, can involve the cardiovascular system. The treatment of rheumatoid arthritis or rheumatoid arthritis itself can lead to atherosclerosis, which is considered one of the major causes by which it can affect the cardiovascular system. In this study, we will assess the risk of cardiovascular events in patients with rheumatoid arthritis as compared to the general population. Method This case-control study was conducted from January 2018 to November 2018. Two-hundred twenty-two (222) patients with diagnosed rheumatoid arthritis were included as cases in the study. Two-hundred eleven (211) patients were included in the study as the control group (patients without rheumatoid arthritis). All the data were recorded in a self-structured questionnaire. Result Participants with rheumatoid arthritis also showed an increased risk of myocardial infarction (MI) by an odds ratio of 2.50 (95% CI; 0.77-8.14). There was also an increased risk of cardiovascular death in participants with rheumatoid arthritis by an odds ratio of 1.99 (0.58-6.71). Conclusion The study suggests that rheumatoid arthritis along with joint inflammation can also affect the cardiovascular system. Hence, a multidisciplinary team of rheumatologists and cardiologists should manage patients suffering from rheumatoid arthritis, which will improve morbidity and mortality in such patients.

Comparison of the Prevalence of Erectile Dysfunction Between Hypertensive and Normotensive Participants: A Case-Control Study.

Introduction Hypertension is a very common risk factor for erectile dysfunction (ED). In recent time, changes in lifestyle has led to an increase in the prevalence of hypertension, which has increased the risk of ED. The purpose of this study is to assess the prevalence of ED in hypertensive patients and compare various domains of sexual activity between hypertensive and normotensive participants. Methods This case-control study was conducted in an outpatient department of a tertiary health care hospital in Pakistan from March 2019 to September 2019. Two hundred and twelve clinically diagnosed hypertensive patients were enrolled and were identified as case group. Control group consisted of 212 people, without any history of hypertension. Sexual function was assessed with the International Index of Erectile Function (IIEF). Results The prevalence of erectile dysfunction in hypertensive group was 61.79%, compared to 20.28% in normotensive group. Erectile weakness (OR = 4.32, CI 2.64-7.05), impaired morning erection (OR = 5.02, CI 2.98-8.47), complete erectile failure (OR = 2.32, CI 1.14-4.75), impaired spontaneous erection (OR = 5.45, CI 3.28-9.03), ejaculatory disturbances (OR = 5.20, CI 2.96-9.12) and reduced sexual interest (OR = 5.12, CI 3.04-8.64) were found to be significantly higher in patients with hypertension compared to normotensive participants. Conclusion This study has found ED to be prevalent in hypertensive patients. Identifying and acknowledging hypertension as a risk factor may help identify patients with ED and reinforce the clinician's importance of asking sexual history of hypertensive patients.