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SARS-CoV-2 infection affects and modulates serum as well as hematological parameters. However, whether it modifies these parameters in the existing disease conditions, which help in the erection of specific treatments for the disease, is under investigation. Here, we aimed to determine whether serum and hematological parameters alteration in various diseases, diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD) and myocardial infarction (MI) conditions correlate and signal SARS-CoV-2 infection, which could be used as a rapid diagnosis tool for SARS-CoV-2 infection in disease conditions. To assess the projected goals, we collected blood samples of 1,113 male and female patients with solo and multiple disease conditions of DM/HTN/IHD/MI with severe COVID-19, followed by biochemical analysis, including COVID-19 virus detection by RT-qPCR. Furthermore, blood was collected from age-matched disease and healthy individuals 502 and 660 and considered as negative control. In our results, we examined higher levels of serum parameters, including D-dimer, ferritin, hs-CRP, and LDH, as well as hematological parameters, including TLC in sole and multiple diseases (DM/HTN/IHD/MI) conditions compared to the control subjects. Besides, the hematological parameters, including Hb, RBC, and platelet levels, decreased in the patients. In addition, we found declined levels of leukocyte count (%), lymphocyte (%), monocyte (%), and eosinophil (%), and elevated level of neutrophil levels (%) in all the disease patients infected with SARS-CoV-2. Besides, NLR and NMR ratios were also statistically significantly (p < 0.05) high in the patients with solo and multiple disease conditions of DM/HTN/IHD/MI infected with the SARS-CoV-2 virus. In conclusion, rapid alteration of sera and hematological parameters are associated with SARS-CoV-2 infections, which could help signal COVID-19 in respective disease patients. Moreover, our results may help to improve the clinical management for the rapid diagnosis of COVID-19 concurrent with respective diseases. [ABSTRACT FROM AUTHOR]

Background: Chronic valvular heart disease leads to systolic dysfunction and left atrial enlargement that ultimately results in heart failure.Purpose: To investigate prognostic importance of Echocardiography and plasma natriuretic peptide levels that increase as a compensatory response and can be used as predictive markers for cardiac hypertrophy.Material and Methods: The patients were divided into three groups: 51 with left ventricle hypertrophy due to aortic valve disease; 126 with left atrial enlargement due to mitral valve dysfunction; and 76 with both conditions. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels were measured in all three respective groups showing dilated cardiomyopathy.Results: The mean left ventricular end-diastolic dimension at 64.3 ± 1.6 mm (P < 0.00) and left atrial dimension at 58.3 ± 3.7 mm (P < 0.00) were significantly high. However, patients with both conditions showed significantly high values for left ventricular end-diastolic dimension (63.3 ± 3 mm, P < 0.00) and left atrial dimension (54.9 ± 4 mm, P < 0.00) when compared with controls. A significant positive correlation was found between plasma natriuretic peptides levels and dilated cardiomyopathy. The mean values of ANP were 173 ± 46.6 pg/mL (P < 0.00), 140.4 ± 42.4 pg/mL (P < 0.00), and 295.1 ± 67.5 pg/mL (P < 0.00), significantly high in all three respective disease groups. The levels of BNP were also significantly high at 189 ± 44.5 pg/mL (P < 0.00), 166.6 ± 36.6 pg/mL (P < 0.00), and 323 ± 69.1 pg/mL (P < 0.00) in the disease groups with left ventricular hypertrophy, left atrial enlargement, and the disease group showing both characteristics, respectively.Conclusion: Significant positive associations were found between left ventricle hypertrophy and left atrial enlargement with ANP and BNP. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the concentration of N terminal proBNP (NT-proBNP) and partially the serum uric acid in the severe condition of aortic valve dysfunction for assessment of left ventricle hypertrophy. Methods: The study was conducted in the signal transduction lab department of biochemistry Quaid-IAzam University, Islamabad from September 2013 to February 2017. NT-proBNP and serum uric acid were measured in one hundred patients of aortic valve dysfunction. The patients were divided into three main groups: 1) Aortic stenosis, 2) Aortic regurgitation, and 3) Aortic stenosis with Aortic regurgitation. The results were compared between disease and controls groups. Results: High level of plasma NT-proBNP was detected in all the three disease groups of aortic valve (stenosis, p<0.001), (regurgitation, p<0.001) and (stenosis with regurgitation, p<0.001). In addition, nonsignificantly increased level of serum uric acid was also observed in left ventricle hypertrophy in all the three respective disease groups of aortic valve. Conclusion: Increased secretion of NT-proBNP during cardiac remodeling can be related to the severity of left ventricle hypertrophy due to aortic valve abnormality in all the disease groups of severe stenosis, severe regurgitation, and combine disease condition of severe stenosis and severe regurgitation. However, non-significant increase in uric acid concentration is also identified which may be due to one of the factors involved in left ventricle hypertrophy in all the three disease groups of aortic valve. The interaction of uric acid with NT-proBNP during cardiac remolding due to aortic valve dysfunction is still not clear. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of carotid artery disease in patients with left main stem coronary disease undergoing coronary artery bypass grafting. Methodology: This cross sectional study was conducted in Department of Cardiovascular surgery Lady Reading Hospital Peshawar from July 2014 to June 2016 for a period of two years. All the patients with Left main stem disease referred for coronary artery bypass grafting were scanned for carotid stenosis with duplex scan. Patients with ongoing angina, hemodynamic instability, emergent CABG were excluded. The carotid stenosis≥ 70% was considered severe while 50-69% was considered moderate. Results: A total of 109 patients were included in the study. Of them 87(79.80%) were males. Mean age of the patients was 60.87 ±4.88 years. Out of total 109 patients 69 (63.30%) patients had no carotid artery diseases or non significant disease i.e. less than 50% stenosis, while 30 (27.5%) had moderate disease (50-69%stenosis). While 10 (9.20%) had severe carotid artery stenosis (≥70%). Conclusion: There is high frequency of significant carotid artery stenosis in patients with left main stem coronary disease. It is recommended that all the patients with left main stem disease should be screened with carotid duplex scan to decrease neurological complications during CABG. [ABSTRACT FROM AUTHOR]

Valvular heart disease (VHD) is an active process involving a wide range of pathological changes. The major complications of VHD are stenosis and regurgitation, which are macroscopic phenomena, induced in part through cellular changes. Altered expression of mitochondria associated genes causes membrane potential depolarization, leading to the increased levels of apoptosis observed in cardiac dysfunction. Objective of this study is to find molecular medicine candidates that can control expression of the key mitochondria apoptosis regulatory genes. Present study aims to assess the way microRNA are involved in regulating mitochondrial apoptosis regulatory genes and observation of their expression in the heart valve dysfunction. Apoptotic genes PUMA and DRP1 were found to be highly expressed, whereas anti-apoptotic gene ARC was down regulated. The expression level of GATA-4 transcription factor was also reduced in cardiac valve tissues. MicroRNAs miR-15a and miR-29a were repressed, while miR-214 was up regulated. Furthermore, study showed that PUMA, DRP1 and ARC expression might be attenuated by their respective miRNAs. Our results indicate that mitochondria regulatory genes might be controlled by miR-15a, miR-29a and miR-214, in VHD patients. Present study may provide platform for future research regarding potential therapeutic role of miRNAs in CVDs. [ABSTRACT FROM AUTHOR]

Objectives: To assess the use of NIPPV (non-invasive positive pressure ventilation) during weaning from mechanical ventilation in post-op patients in an ICU and compared this procedure with intermittent mandatory ventilation (IMV) by analyzing cardiac and respiratory parameters and complications. Methodology: A randomized clinical trial was conducted from June 2009 to July 2010 on Post-operative surgical patients that were on IMV for more than 48 hours, who failed at 30 minutes of spontaneous breathing T-piece trial (SBT). If failure occurred before the 30th minute, he/she was included in the group previously defined by random assignment. Patients in the experimental group were extubated and placed on NIPPV, whereas other patients (the control group) returned to IMV. Daily SBT was carried out thereafter in order to evaluate the possibility of extubation in control group. Results: Of 60 patients who failed T-piece trials, 30 patients were placed on NIPPV & 30 on (IMV). The ages of patients in the NIPPV and IMV groups were 45.7± 18.11 and 47.10 ± 18.45 years respectively. In both groups, ventilation time before T-piece trial was 2-3 days. Patients of the NIPPV group had a shorter stay in the ICU and in the hospital i.e., 2.93 ±0.785 days versus 7.4+1.11 days for IMV group. No serious complications were observed in both groups. Conclusion: The results of this study suggest that the combination of early extubation and NIPPV is a good alternative. [ABSTRACT FROM AUTHOR]

Objective: To find the frequency of acute kidney injury in patients undergoing coronary artery bypass grafting. Methodology: The study was conducted in cardiovascular unit Lady Reading Hospital Peshawar. It was cross sectional study. Sampling technique was non probability convenient sampling. Data was collected from 20.2.2013 to 20.8.2013. Total 179 patients included in the study. All patients with known coronary artery disease were included in the study whom were planned for revascularization in the form of coronary artery bypass grafting (CABG). Post-operatively all patients' serum creatinine till 48th post op hour was observed to detect acute kidney injury. Acute Kidney Injury (AKI) was defined as more than 50 % or elevation of 0.3 mg/dl of creatinine level from base line. Results: A total of 179 patients undergoing coronary artery bypass grafting were included in the study. Average age of the patients was 46.88 years ±9.91 with range 20-60 years. Patients were divided into four groups according to age. The acute kidney injury after coronary artery bypass grafting was ob- served in 14 (7.82%) patients. Acute kidney injury was more common in old age and it was non significantly more common in male gender. Conclusion: In spite of current highly advance cardiac surgery techniques and post operative care still there is high incidence of acute kidney injury following revascularization and subsequent worst outcomes. [ABSTRACT FROM AUTHOR]

Objective: To find the frequency of complete heart block (CHB) in patients undergoing surgical perimembranous Ventricular septal defect (VSD) closure. Methodology: This was a Descriptive cross sectional study performed in Cardiovascular Department Lady Reading Hospital Peshawar. Data was collected from 28 January 2013 to 28 July 2013 with sample size of 103.Sampling technique was non probability consecutive. All patients with perimembranous ventricular septal defect, aged 5 years to 25 years with any gender were included in the study. Results:-Mean age was 12.63 years ± 6.63. Patients were divided in four categories according to their age. Over all complete heart block in the perimembranous ventricular septal defect after surgical closure was 10(9.71%). Age wise distribution of complete heart block shows that majority of the complete heart block 6(12.8%) were found in age less than or equal to 10 years. Conclusion:-VSD closure is less often associated with CHB but there should be arrangements for pace maker to timely pace the patient in case of any emergency. [ABSTRACT FROM AUTHOR]

Objective: To assess the success rate of surgical excision, complications and midterm follow up of patients with atrial myxoma in our center. Methodology: In this retrospective case record study, all patients of atrial myxoma since January 1993 till December 2009 admitted in the department of Cardiovascular Surgery, Lady Reading Hospital Peshawar for surgical excision were assessed for operative success rate, peri-operative complications and midterm follow up for 6 months. Results: A total of 57 patients underwent surgical excision for atrial myxoma. Mean age of the sample was 35.2±16.7 Years. There were 37(64.91%) female patients. Forty five (78.94%) patients had palpitations while 38(66.66%) patients reported shortness of breath and 5 (8.77%) patients had atrial fibrillation preoperatively. Diagnosis of atrial myxoma was made with transthoracic echocardiography in 50 (87.71%) patients. Fifty (87.71%) patients had myxoma located in the left atrium while five (8.77%) patients had myxoma in the right atrium and two (3.5%) patients had the myxoma attached to the mitral valve leaflets. Only 2 patients had embolic phenomenon; one recovered completely in two weeks time while the other undergone successful embolectomy. There was no intraoperative mortality and only one patient died post operatively due to multi organ failure. On six month follow up, there was no local recurrence while 8 (14.03%) patients had atrial fibrillation. Only two patients (3.5%) were lost to follow up. Conclusion: Our experience with surgical excision of atrial myxoma suggests that it is curative with minimum complications and recurrence rate. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of atrial fibrillation after mitral valve replacement surgery. Methodology: This study was performed in cardiac surgery ward of Lady reading Hospital (LRH) Peshawar. It was a descriptive cross sectional study. Data was collected from 1.3.2014 to 28.02.2015. Statistical analyses were performed using SPPS version 14. Mean ± SD were used for quantitative and Frequencies and percentages were used for categorical variables. Results: Total 120 patients undergone through mitral valve replacement. Male patients were 48 (40%), Mean age of the study population was 46.20 years ± 9.14SD. Atrial fibrillation (AF) was observed in 45 (37.5%) patients. Post operative AF was similar between both gender and all ages. Conclusion: Atrial fibrillation is common finding in patients undergoing Mitral valve replacement surgery and is not affected by age and sex [ABSTRACT FROM AUTHOR]

Both the fetus and mother are under tremendous life threatening stress in case of an aortic dissection during pregnancy. We present case of a 25 years old diagnosed case of Marfan Syndrome primigravida at 29 weeks of gestation. The patient wa6s referred from a clinic due to nausea, vomiting and dyspnea. Aortic dissection ( AD) was evident upon Echocardiography. The patient was under observation when she suddenly developed jaw, chest and back pain. Her first degree relative (father) had died due to an AD at the age of 25. The patient was resuscitated and all possible medical efforts were taken along side an emergency cesarean section but the patient died soon after the delivery. Awareness needs to be raised in such medical cases and a clinical approach needs to be developed for critical care of pregnant patients. Proper surgical techniques and use of better medical technology are required to make and early diagnosis. Further studies/ case reports around the world would assert our findings and lead to better treatment options. [ABSTRACT FROM AUTHOR]