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Objective:  To document association of hyper-glycemia with mortality in septicemic patients.Methods:  After approval from departmental review committee, this retrospective comparative study was conducted from the chart review of 197 medical files of patients with primary diagnosis of bacterial sepsis admitted in a medical unit of department of Internal Medicine, King Edward Medical University Lahore from October 2012 to Septfember 2013. Sepsis was defined as by international sepsis definitions conference criteria 2001. “Diabetics” were evident from history; the term nondiabetic was used for the rest. Highest blood sugar value recorded during admission with Optium Xceed glucometer was used for analysis. Mean blood sugar of discharged and deceased patienswere compared (t-test), mortality of diabetic and non-diabetic patients was compared by frequency of hyper-glycemia (≥ 200 mg/dl) by chi-square test. SSPS vers-ion 20 was used. A p-value Results:  Mean age of patients was 59.8 years, 92 (46.7%) males, and 105 (53.3%) were females. Mean blood sugar was high in known diabetics (314 ± 129 mg/dl), and non-diabetics (210 ± 109 mg/dl). Higher mean blood sugar was significantly associated with mortality in females (p = 0.032); trend towardssignificance was found in non-diabetic females (p = 0.065). Association of mortality in relation to hyperglycemia (Blood sugar ≥ 200 mg/dl), was found significant in whole study group (p = 0.038); sub-analysis revealed prominent association in non-diabetics (p = 0.027), and females (p = 0.04).Conclusion:  Despite certain limitations of this study, hyperglycemia (blood sugar >200 mg/dl) may be a bad prognostic marker in septicemicnondiabetic female population; they need special attention for earlier and aggressive treatment.

Objective: To compare lipid profile in thrombotic and haemorrhagic stroke patients. Place of Study: All general medical and neurology wards of Mayo Hospital Lahore. Patients and Methods: Study was conducted in 40 consecutive patients of stroke admitted in hospital. Serum lipid (total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio) were estimated in all selected patients within 7 days of onset of stroke and findings were entered on study proforma specifically designed for this purpose and analyzed statistically by student`s "t" test. Results: Out of 40 patients included in the study, 22(55%) were suffering from thrombotic stroke while 18(45%) suffered from haemorragic stroke. The difference in the values of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio was not statistically significant between the two groups of patients. Conclusion: It is concluded that serum lipids i.e., total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio does not have any differential effect in the causation of thrombotic or haemorrhagic strokes.

Objective: Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. Place of Study: East Medical and Cardiology wards of Mayo Hospital Lahore. Study Design: A descriptive cross-sectional study. Patients and Methods: 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students `t` tests. Results: The percentage of left ventricular hypertrophy (LVH) was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. Conclusion: 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age.

Cardiac failure occurring in last trimester of pregnancy or within one to six months after delivery in a woman without a history of heart disease and with no cause for heart failure other than pregnancy is termed as peripartum cardiomyopathy. To determine fetomaternal morbidity and mortality in women presenting with peripartum cardiomyopathy, we did an open non-randomized observational descriptive study at Department of Cardiology Mayo Hospital, Lahore from January 2004 to Oct 2005. The women referred from Lady Willingdon and Lady Aitchison Hospitals to Cardiology Department of Mayo Hospital during last trimester and after delivery for work up of heart failure were included. Twenty five women presented with heart failure due to peripartum cardiomyopathy were included in this study, 40% in last trimester, 40% within one month and 20% within 4 month after delivery. The mean age was 35 + 5 years. Out of these 2 (8%) were primiparous, 13 (52%) were multiparous and 10 (40%) were grandmultipara. Ten (40%) were booked and 15 (60%) were nonbooked for antenatal care. Twenty (40%) patients were diagnosed for the first time and 5 (20%) had recurrence. Based on NYHA classification 20% were in class I, 40% class II, 20% class III and 20% in class IV. The patients were on standard medical treatment. All patients reviewed at follow up after 1, 6, and 12 months. No maternal mortality occurred. Antenatal ward admission was required for 32% women due to obstetric reasons and 8% due to cardiac cause. Five had spontaneous labor and 5 inductions were done for obstetric reasons: poor biophysical profile, previous caesarean section, uncontrolled diabetes, breech presentation and fetal distress. Three babies have intrauterine growth retardation. On echocardiography mean ejection fraction was 20-25% with global hypokinesia, 5 patients had clot in LV apex, 10 had whiff of mitral regurgitation and tricuspid regurgitation. We conclude that peripartum cardiomyopathy has high morbidity and mortality. Women are very much receptive about c ontraception in the immediate post partum period, therefore counseling of the patient and their family should be done to reduce maternal mortality.