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Objective: To compare the complications between closure device and manual compression in patients after percutaneous coronary intervention through femoral access site. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology, from Mar to Nov 2021. Methodology: Eighty patients who underwent percutaneous coronary intervention through the femoral access site during the study period were recruited in this analysis. Patients were randomly divided into two groups for the procedure adopted for hemostasis after percutaneous coronary intervention. Group-A underwent manual compression of the femoral access site, while hemostasis in Group-B was achieved with the help of a closure device. Hematoma formation, pseudo-aneurysm, AV fistula and bleeding were compared in both groups.Results: Eighty patients participated in this analysis. Of them, 50(62.5%) were male and 30(37.5%) were female. The mean age of patients was 48.85±8.93 years. In 35(43.75%) patients, hemostasis was achieved by manual compression (Group-A), while in 45(56.25%) patients, by vascular compression device (Group-B). Both groups did not differ statistically significantly in Hematoma formation, AV fistula formation, bleeding, and pseudo-aneurysm formation (p-value: 0.05).Conclusion: There was no statistically significant difference in the complications studied among the closure device method and manual compression of hemostasis in PCI through femoral vein access.

Objective: To determine the hospital outcome of acute myocardial infarction patients with COVID-19 and compare it with patients without COVID-19. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, RawalpindiPakistan, from Mar to Oct 2021. Methodology: The study included PCR-positive patients with COVID-19 infection who had acute myocardial infarction diagnosed by a consultant cardiologist. The hospital recorded clinical outcomes within two days of acute myocardial infarction. Data regarding outcome was compared with patients who had acute myocardial infarction but did not have COVID-19. Results: Fifty cases of COVID-19 and myocardial infarction were included in the study. An equal number of patients with no evidence of COVID-19 but having myocardial infarction were also included. The mean age of the study participants was 49.96±897 years. Out of 100 patients, 79(79%) were male, while 21(21%) were female. Statistical analysis showed that all the outcome parameters studied had no significant difference in both the acute myocardial infarction patients with and without COVID-19 (p-value>0.05). Conclusion: Our study results revealed no statistically significant difference in the hospital outcome of patients with acute myocardial infarction who were suffering from COVID-19 and those who were not.

Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in non-cardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuro-radiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of non-cardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population. Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value<0.001) with raised CKMB/Myoglobin levels in the target population. Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers.

Objective: To determine the association of serum Ammonia levels with severity of grades of hepatic encephalopathy in patients presenting to the department. Study Design: Comparative cross-sectional study. Place and Duration of Study: Emergency Department, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 100 patients presenting with hepatic encephalopathy at the emergency department of our hospital. Based on clinical findings and relevant investigations, a consultant gastroenterologist or emergency medicine physician diagnosed hepatic encephalopathy or the underlying cause. In addition, serum Ammonia levels were done on all the patients at the time of presentation and associated with grades of hepatic encephalopathy and other factors. Results: Out of 100 patients included in the final analysis, 67 were males, and 33 were females. Infection (29%) was the commonest aetiology of hepatic encephalopathy, followed by Constipation (23%). In addition, 59% had normal serum ammonia levels, while 41% had raised ammonia levels in their serum. High grade of hepatic encephalopathy and raised Child-Turcotte-Pugh score were statistically significantly associated with raised ammonia levels in our study participants. Conclusion: Raised serum ammonia levels were a common finding among patients with hepatic encephalopathy. Therefore, patients with a high grade of hepatic encephalopathy and a high Child-Turcotte-Pugh score at the time of presentation should be considered at a higher risk of having hyperammonemia.

Objective: To determine the frequency and association of esophageal varices with diameter of portal vein more than 13 mm in patients of chronic liver disease (CLD). Study Design: Cross-sectional study. Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2018. Methodology: The study included one hundred and sixty-one patients of chronic liver disease with portal vein diameter more than 13 mm. Patients with the history of variceal bleeding, prior variceal treatment and liver transplantation were excluded. A consultant radiologist performed the hepatobiliary ultrasound in all the patients to measure the portal vein diameter. The presence of esophageal varices was confirmed on upper GI endoscopy performed by the consultant gastroenterologist. Results: The mean age of the patients was 47.16 ± 9.36 years. Most of the patients included in our study 102 (63.35%) were between 46-65 years of age. Out of the 161 patients, 95 (59.01%) were males and 66 (40.99%) were females. Esophageal varices were found in 128 patients (79.50%) with chronic liver disease with portal vein diameter >13 mm. Age, gender, duration of illness and BMI had no relation with the presence of esophageal varices in our target population. Conclusion: Patients of CLD with portal diameter greater than 13 mm had more chance for the presence of esophageal varices in our study.

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 determine the myopathy in patients with diabetes taking atorvastatin and look for the factors correlated with the presence of myopathy among these patients. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from, Jul to Dec 2018. Methodology: A total of 166 patients of both genders with type 2 diabetes mellitus taking atorvastatin for at least three to twelve months were included. Blood samples were drawn and Creatinine kinase (CK) levels were determined by automated analysis by colorimetry. Myopathy was taken as muscle symptoms associated with elevations in Creatinine Kinase at least 10 times the upper limit of normal. Results: Mean age of patients was 51.530 ± 5.70 years with age range from 40-70 years with. Mean duration of diabetes was 6.174 ± 2.27 years, mean duration of taking atorvastatin 7.186 ± 2.17 months and mean creatinine kinase levels were 1760.325 ± 5111.71 IU/L. Males were 68.7% as compare to females 31.3%. Myopathy was seen in 8.4% patients. Long duration of Diabetes Mellitus and atorvastatin use was statistically significantly related with the presence of myopathy. Conclusion: Myopathy was found in a significant number of patients taking atorvastatin. High risk population in our study emerged out to be patients with long duration of Diabetes Mellitus and long use of atorvastatin.

ABSTRACT Objective: To determine the frequency and causes related to the precipitation of breakthrough seizures among adult patients with epilepsy despite antiepileptic treatment. Study Design: Cross sectional analytical study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from May 2018 to Oct 2018. Methodology: The sample population comprised of 161 adult patients of epilepsy reporting to Military Hospital Rawalpindi with the epilepsy using the antiepileptic drugs (AEDs) at least for the past six months. Detailed history and physical examination was carried out for all the patients. Frequency of breakthrough seizures among this population was calculated and relationship were assessed with the precipitation of the breakthrough seizure. Results: Out of 161 patients of epileptic included in the study, 78 were male and 83 were female. Out of these 80.1% patients had breakthrough seizures. After applying the logistic regression we found that increasing age, marital status, sleep deprivation, total duration of treatment, missing one or two doses of antiepileptic drugs and watching television for long hours were strongly related to the precipitation of breakthrough seizures in our study patients. Conclusion: There was showed high frequency of breakthrough seizures in our population despite the use of AEDs. Special attention should be paid to the patients with increasing age and living alone. Education of patients regarding proper sleep, stress management, restricting TV hours and strict compliance should be done in order to prevent the phenomenon of breakthrough seizures and achieve a good control over this potentially life threatening condition.

ABSTRACT Objective: To determine the frequency of cerebral venous sinus thrombosis (CVST) among the patient with headache presenting from high altitude (HA). Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from 24th Apr 2018 to 24th Jan 2019. Methodology: The sample population comprised of patients presenting with the headache, living at a height of 3000-8200 meter above sea level. CT-scan brain, MRI brain and MRV brain was performed on all the cases. Carotid Doppler, d-dimers, thrombophillic screen, autoimmune profile, EEG and other relevant investigations were performed of all the cases diagnosed with CVST. Age, altitude, total time spent at HA and acclimatization were correlated with the presence of CVST among the patients of headache at HA. Results: Out of 60 patients reporting with headache from HA, 9 had presence of CVST on the relevant neuroimaging. Among these cases of CVST 2 had secondary polycythemia, 1 had protein C deficiency and 1 had protein S deficiency. Poor acclimatization had a significant relationship with the presence of CVST when logistic regression was applied. Conclusion: Cerebral venous sinus thrombosis should be considered a possibility while evaluating the causes of headache among the patients reporting from high altitude. Special attention should be given on acclimatization process for the people who are ascending to high altitude.

Objective: To look for the frequency of thyroid dysfunction in heart failure patients with reduced ejection fraction at Medicine/Cardiology Department. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Sialkot, from Nov 2019 to Apr 2020. Methodology: The sample population comprised of patients diagnosed with the heart failure and ejection fraction of 40% at Medicine/Cardiology unit. Patients underwent thyroid functions test from the laboratory of our hospital and were diagnosed as hypothyroid, hyperthyroid or euthyroid by consultant cardiologist and medical specialist. Age, gender, body mass index and New York heart association (NYHA) class were associated with thyroid dysfunction among the study participants. Results: Out of 110 patients with heart failure and low ejection fraction who underwent thyroid function testing during the study period, 92 (83.6%) patients were euthyroid, 14 (12.7%) had thyroid profile parameters showing hypothyroidism, while 04 (3.6%) had laboratory findings of hyperthyroidism. After chi-square, we found that patients with New York heart association class III and IV and high body mass index had a statistically significant relationship with thyroid dysfunction (pvalue 0.017 and <0.001 respectively) among the patients of heart failure with low ejection fraction. Conclusion: Thyroid dysfunction, especially hypothyroidism, emerged as a common finding among heart failure patients with low ejection fraction. Patients with New York heart association class III and IV and high body mass index should be considered high-risk and may be screened for thyroid problems if present with heart failure