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Objective: To study the frequency of left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus presenting to a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Medicine Dept, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Fifty-one patients between the ages of 30 to 65 years were enrolled, belonging to either gender, presenting to outdoor department, with diagnosed type 2 diabetes mellitus for at least 1 year, on oral hypoglycemic drugs or insulin, and no underlying hypertensive cardiac pathology or diastolic dysfunction. These patients were further analyzed using statistical software based on their 2D echocardiogram findings. Results: Out of 51 type 2 diabetes mellitus patients, there were more males 32(62.7%) as compared to females 19(37.3%), with mean age of 52.25±8.09 years. We observed that 21(41.2%) patients did not have left ventricular diastolic dysfunction at the time of our study, but among these patients, 13(61.9%) had type 2 diabetes mellitus for 1-3 years while remaining 30(58.8%) patients had both type 2 diabetes mellitus and left ventricular diastolic dysfunction, with 13(25.5%) having grade-I, 10(19.6%) having grade-II and 7(13.7%) having grade-III categorization. Conclusion: There was an increased risk of left ventricular diastolic dysfunction in type 2 diabetes mellitus with longer duration of disease and higher HbA1c. Patients with type 2 diabetes mellitus to be followed up for diabetic control and monitored for the presence of asymptomatic left ventricular diastolic dysfunction with measures to be taken to prevent it. [ABSTRACT FROM AUTHOR]

Objective: To determine the reasons for hesitancy regarding COVID-19 vaccines. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Feb to Jun 2021. Methodology: After Ethical Committee approval, 100 respondents were recruited, regardless of vaccination status, and requested to respond to 27 different myths and queries circulating about COVID-19 vaccines. Results: Mean age of participants was 36.25 ± 5.77 years, ranging from 15-80 years. Fifty-three were males and 47 females. 41% of subjects trusted the Sino-pharm vaccine, and 25% preferred Pfizer Bio N Tech, while 34% could not answer due to the lack of knowledge. 55% subjects showed concern about catching the infection from Vaccination. 54% considered vaccines unsafe for pregnant and breastfeeding women. 29% believed it unsafe for the elderly and those with comorbidities. 14% believed it could cause autism in children and infertility in adults. 62% individuals acknowledged that vaccines have no nano chips to track patients. 46% opined that vaccines were rushed through trials and had doubtful efficacy. 11% individuals thought vaccines could alter DNA, while most were aware of this false concept. 28% considered that vaccines were needless because recovery from COVID-19 was excellent, while 63% emphasised the need for Vaccination. 23% deemed the side effects of vaccines more dangerous than the disease itself. 85% individuals favoured use of mask and social distancing after getting the vaccine. Conclusion: Strong efforts are needed to support the COVID-19 vaccine and to eliminate negative propaganda on media outlets. [ABSTRACT FROM AUTHOR]

Objective: To determine clinical presentations and source among severe acute respiratory syndrome corona virus 2 positive health care workers of tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Mar to Jun 2020. Methodology: A cross sectional study was conducted by using a questionnaire for risk assessment regarding exposure to Corona Virus Disease 2019 (COVID-19) virus and practices of participants. Health care workers who were exposed or had fever, cough, shortness of breath, were asked to undergo semi-quantitative real-time reverse transcriptase–polymerase chain reaction test for Severe Acute Respiratory Syndrome Corona Virus 2 on nasopharyngeal and oropharyngeal swabs. Results: Out of the 92 health care workers who tested positive, 80/92 (86.95%) were males, 12/92 (13.04%) females. Asymptomatic cases were 53/92 (57.60%) and 39/92 (42.40%) were symptomatic, 10/92 (10.8%) of the participants were doctors, 06/92 (6.52%) nurses, 36/92 (39.14%) paramedics and 40/92 (43.47%) were hospital auxiliary staff. Among symptomatic cases, 28/39 (71.79%) developed fever with myalgia, 22/39 fever alone, 23/39 (58.97%) headache, 13/39 (33%) sore throat, 15/39 (38%) runny nose, 11/39 (28.20%) mild shortness of breath on exertion, 7/39 (17.94%) diarrhea and 5/39 (12.82%) experienced loss of taste. Conclusion: As the Corona Virus Disease 2019 pandemic continues, chances of health care workers getting infected are high so it is critical to improve the knowledge of Health care workers. Educational interventions and further studies are warranted in this regard. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of comorbid illnesses in fatal cases of COVID-19 in various hospitals of Rawalpindi/Islamabad during the first three months of pandemic in Pakistan. Study Design: Case series study. Place and Duration of Study: Combined Military Hospital Rawalpindi (CMH), Pak Emirates Military Hospital Rawalpindi (PEMH), Benazir Bhutto Hospital (BBH), Rawalpindi Institute of Urology (RIU) and Pakistan Institute of Medical Sciences Islamabad (PIMS), from 20th Feb 2020 to 19th May 2020. Methodology: A total of 51 adult fatal cases were studied retrospectively during the subject period. The patients were admitted in any of above mentioned hospitals for variable time during the study period. There were 35 males and 16 females. Patients' ages ranged from 24 to 90 years. The cases were studied for presence of various comorbid illnesses that could have aggravated the complications of COVID-19 and contributed towards mortality. Results: Out of 51 fatal cases 23/51 (45%) had Diabetes mellitus (DM), 18/51 (35%) had Hypertension, 12/51 (23%) Ischemic Heart Disease, 03/51 (06%) had Chronic Renal Failure and Cancer, 02/51 (4%) had Chronic Obstructive Pulmonary Diseases (COPD) and Tuberculosis (TB). Conclusion: Diabetes mellitus and cardiovascular illnesses were the commonest comorbid in patients who died of COVID-19 followed by Chronic Renal Diseases, Malignancy, Tuberculosis (TB) and Chronic Obstructive Pulmonary Diseases (COPD). [ABSTRACT FROM AUTHOR]

Crimean Congo Hemorrhagic Fever (CCHF) one of the fatal viral infections has been described in around 30 countries around the world and is endemic in some parts of Pakistan. The fever is transmitted to humans by the bite of an infected tick either by direct contact with the blood or tissue via infected humans and livestock. We present here case of a 34-year-old Pak defense services officer who reported with nonspecific symptoms of high grade fever, myalgias and vomiting but rapidly deteriorated and developed bleeding diathesis. He was diagnosed to have CCHF and managed with Ribavirin, repeated transfusions and IV fluids with strict nursing barrier and use of Personal Protective Equipment (PPE). The patient recovered well. [ABSTRACT FROM AUTHOR]

Thyroid storm is caused by the excess of thyroid hormone; it is a rare as well as fatal condition. The most effective way to decrease the mortality and morbidity caused by this disease is to diagnose it as soon as possible. The presenting features comprise a multitude of non-specific symptoms such as high fever, tachycardia, heart failure, gastrointestinal upsets, delirium, and coma. We presented a unique incident of thyroid storm in a middle aged woman who was admitted for high fever, confusion and atrial fibrillation. Clinical diagnosis of thyroid storm was augmented by laboratory findings of hyperthyroidism. The patient was managed accordingly and she eventually recovered. [ABSTRACT FROM AUTHOR]

Introduction: Disorders of sexual differentiation (DSD) is the term used for neonates without a definite male or female phenotype. Previously, terms like "intersex" and "pseudohermaphroditism" were used for such individuals. However, DSD is the recommended terminology since 2006. According to a study, about 1 in 3000 children is born with ambiguous genitalia. True hermaphrodite or ovo-testicular disorder of sexual differentiation (OVO-DSD) is the rarest variety. The gonads in these individuals are asymmetric with bilateral ovarian and testicular tissue (in varying ratios), which may be separate or combined as ovo-testes. Karyotype varies from 46XX to 46XY to 46 XY/46 XX mosaicism. [ABSTRACT FROM AUTHOR]

Objective: To analyze the frequency and sites of bone erosion on computerized tomograghy scan in Allergic Fungal Rhinosinustis in Pakistan. Study Design: Retrospective observational study. Place and Duration of Study: Department of ENT, Combined Military Hospital Lahore, Malir Karachi and Rawalpindi, from Jan 2010 to Dec 2019. Methodology: Total 230 cases of Allergic Fungal Rhinosinusitis were screened, out of which 85 patients having bone erosions on computerized tomograpghy scan were included in the study. Bone erosion in different paranasal sinuses and their sub sites were evaluated. Depending upon the number of bone erosion, patients were divided into three categories as mild, moderate and severe. Those having erosion at a single site were labelled as mild, those with two sub sites of erosion as moderate and those with more than two subsites of erosion were labelled as severe cases. Results: Detailed evaluation of computerized tomography scan of paranasal sinuses revealed bone erosion in 85/230 (36.9%) cases. Mean affected age was 23.96 ± 12.71 years. There were 52 (61.1%) males and 33 (38.9%) females. Ethmoid sinus was the most commonly involved sinus to have bone erosions 55 (38.19%) followed by maxillary sinus 38 (26.38%) then sphenoid sinus 27 (18.75%) and lastly frontal sinus 24 (16.6%). Out of 85 patients 48 (56.1%) were having mild, 22 (25.8%) moderate and 15 (17.6%) had severe disease. Conclusion: Allergic Fungal Rhinosinusitis has high frequency of bone erosion. Computerized tomography scan is an important and effective investigation in finding these bony erosions and ethmoid sinus is the commonest site of bone erosion among paranasal sinuses. [ABSTRACT FROM AUTHOR]

Objective: To explore the knowledge, attitude and sexual practices among pregnant women reporting to a tertiary care hospital Study Design: Cross-sectional analytical study. Place and Duration of Study: Antenatal clinic of Obstetrics & Gynaecology Department, Combined Military Hospital Rawalpindi Pakistan, from Jan to Jun 2020. Methodology: Three hundred and seventy women who attended the antenatal clinic during the study period were interviewed. The responses to chosen preferences were recorded on a structured questionnaire. Results: The majority of participants believed that intercourse could be done throughout pregnancy, it does not result in complications, and improves marital relationships. However, it was difficult due to the changed physical appearance, but it was not unpleasant for the husband. Only 51.1% of participants agreed to decreased libido. 77.6%, 71.6% and 75.4% were of the opinion that it was not prohibited in religion, neither influence baby nor labour respectively. Conclusion: Most pregnant women maintain sexual activity during pregnancy. The majority had adequate knowledge and a positive attitude. [ABSTRACT FROM AUTHOR]

Objective: To look for the factors associated with outcomes in patients managed for invasive fungal infections at the Infectious Diseases Department of a Tertiary Care Hospital Study Design: Comparative cross-sectional study Place and Duration of Study: Department of Infectious Diseases, Pak Emirates Military Hospital, Rawalpindi Pakistan,from Apr 2021 to Sep 2022. Methodology: A total of 90 patients with a different types of invasive fungal infections diagnosed by consultant infectious diseases were recruited. First, they were given standard treatment for fungal infection; they were diagnosed as per guidelines. Then, they were followed up for one month to look for an outcome. Results: Out of 90 patients with invasive fungal infections included in the study, 62(68.8%) had a good outcome, while 28(31.2%) had a poor outcome. The mean age of the patients recruited in our study was 39.54±6.27 years. Of all the participants, 65(72.2%) patients were male, while 25(27.8%) were female. Statistical analysis revealed that poorly controlled diabetes, COVID-19 infection and HIV positive were statistically significantly associated with poor outcomes in our study participants (p-value<0.05). Conclusion: The Considerable number of patients with invasive fungal infections had a poor outcome in our study. The presence of poorly controlled diabetes, COVID-19 infection and being HIV positive were the factors associated with poor outcomes in our study participants. [ABSTRACT FROM AUTHOR]