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Objective: To determine the frequency of congenital cardiac lesions in pregnant women reporting for fetal echocardiogram and correlate with obstetrical risk factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: To be conducted at pediatric cardiology and obstetrical unit of AFIC/NIHD and CMH Rawalpindi, from Jan 2009 to Jan 2020. Methodology: Pregnant women referred for fetal echocardiogram from 19-49 years of age were enrolled. Echo was done between 20 to 36 weeks gestation. Primary outcome was the nature of cardiac lesion and gestation at diagnosis. Neonatal scan was done at follow up to confirm cardiac diagnosis. Secondary outcome was obstetrical risk factors which were the reason for referral. This included age consanguinity, family history, previous history of intrauterine death or early neonatal death, maternal and paternal diseases. Data was collected and analyzed n frequencies and percentage. Chi-square was applied for association between variable and p-valve 0.05 was considered significant. Results: A total of n=967 pregnant women referred to outpatient department for fetal echocardiogram. Congenital cardiac lesion were detected in n=83 patients. Majority of patients had CAVSD (1.2%) CCAVB (1.2%) followed by ASD (1.1%) VSD (0.9%) Abnormal heart rate (0.8%) Single ventricle (0.3%). Most significant maternal age group was between 21 to 30 and 30-40 years (43.7 and 46.2%). Only 3% below 20 years and 6.7% above40 years of age. Most important maternal risk factor was previous off spring 0.5% past family history 0.3% and abnormal obstetrical ultrasound 0.3% Followed by maternal diabetes 0.1% and maternal hypertension 0.1%. The yield of detection of congenital cardiac lesions was 8.3%. Conclusions: Congenital cardiac diseases are the second most common congenital anomaly and huge burden n pediatric population. Timely diagnosis and referral can be lifesaving.

Double Aortic Arch is a rare congenital cardiovascular anomaly. Its first successful surgery was performed by Robert Gross in 1945 at Children Hospital Boston, USA. It accounts for 0.4 to 1% of all congenital cardiac defects. Patients having a Double Aortic Arch mostly present with symptoms in the 1st week of life but depending upon the severity of symptoms can present at any age in childhood. We present a case report of two month old baby with noisy breathing, intermittent cough, gross jugular notch retraction and sub costal recession. His Cardiac CT was subsequently done which showed a Double Aortic Arch of left dominant variety encircling the trachea. Surgery was done and the encircling artery compressing the trachea was recognized, dissected and interrupted. Marked relief of tracheal and/or esophageal compression was evident from operation day. Post operative recovery was speedy. Patient’s follow up of was done at 1, 4 and 24 weeks. His recovery was unremarkable. Currently he was thriving well.

Objective: To observe the effect of modified ultrafiltration on hemodynamics of pediatric patients. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Pediatric Cardiac Surgery department, AFIC/NIHD Rawalpindi, from Jun 2019 to Dec 2019. Methodology: A total of 60 pediatric patients were included undergoing open-heart surgery with cardiopulmonary bypass, having age ≤6 years and weights ≤15kg. To assess hemodynamics parameters observed were pre modified ultrafiltration and post modified ultrafiltration measurements of haemoglobin level, systolic pressure, diastolic pressure, central venous pressure and the number of transfusions given after off-bypass. The data was entered and analyzed in SPSS-23. Results: The pre-operative mean Hb level of the 60 sampled patients was 12.08 ± 2.89 g/dl. The findings taken pre modified ultrafiltration and post modified ultrafiltration of haemoglobin level was (9.91 ± 0.91 g/dl and 13.09 ± 1.38 g/dl, p0.005) compared pre modified ultrafiltration and post modified ultrafiltration respectively. Conclusion: The study concluded that modified ultrafiltration has a significant impact on haemoglobin levels after bypass, decreases the allogenic transfusions and also improve the hemodynamics of the patient.

Double Aortic Arch is a rare congenital cardiovascular anomaly. Its first successful surgery was performed by Robert Gross in 1945 at Children Hospital Boston, USA. It accounts for 0.4 to 1% of all congenital cardiac defects. Patients having a Double Aortic Arch mostly present with symptoms in the 1st week of life but depending upon the severity of symptoms can present at any age in childhood. We present a case report of two month old baby with noisy breathing, intermittent cough, gross jugular notch retraction and sub costal recession. His Cardiac CT was subsequently done which showed a Double Aortic Arch of left dominant variety encircling the trachea. Surgery was done and the encircling artery compressing the trachea was recognized, dissected and interrupted. Marked relief of tracheal and/or esophageal compression was evident from operation day. Post operative recovery was speedy. Patient’s follow up of was done at 1, 4 and 24 weeks. His recovery was unremarkable. Currently he was thriving well.

Objective: To compare trans-atrial/Trans-pulmonary and trans-annular/trans-ventricular techniques of surgical correction of tetralogy of fallot. Study Design: Descriptive cross sectional study. Place and Duration of Study: AFIC-NIHD Rawalpindi, from Jan 2005 to Jan 2020. Methodology: Pre-op variables included age, gender, weight, SaO2 and any previous operation (like Modified Blalock Taussig Shunt.) Operative variables were any previous Blalock Taussig Shunts and if present, then their takedown, Cardiopulmonary Bypass Time, Aortic Clamp Time, any Right Ventricle - Pulmonary Artery conduit, Main Pulmonary Artery patch-plasty, Left Pulmonary Artery/ Right Pulmonary Artery patch-plasty, dosage of inotropes and pacing started during weaning off CPB. Post-op variables were mechanical ventilation time (hrs), ventilation time >72 hrs, dosage and duration of inotropes, pacing >24 hrs, renal complications, neurological complications, sepsis, low cardiac output, re-ventilation, tachyarrythmias, any re-opening surgery, mean intensive care unit stay (hrs), overall hospital stay (days) and overall all-cause mortality. Results: A total of 1271 TOF patients were operated. In (38.6%) cases Trans-atrial / Trans-pulmonary approach was used while in 780 (61.3%) correction was done by TAP/TV technique. In both techniques, male patients were 365 (66.4%) vs. 73 (64.1%) females. Mean age was 5 ± 2.3 vs. 4 ± 2.5 years, MPA patch-plasty was 190 ± 5 (38.6%) vs. 780 ± 8 (100%) (p-0.058), RPA/LPA Patch Plasty was 25 ± 6 (5%) vs. 180 ± 10 (23%) (p- 0.025), In ICU, Ventilation hours was 25 ± 8 and 30 ± 12, Ventilation >72 Hrs was 15 (3%) vs. 65 (8.3%) (p-0.015), Inotrope duration >72 Hours was 90 (18.3%) vs. 400 (51.2%) (p-0.338), pacing >24 hours was 30 (6.1%) vs. 150 (19.2%) (p-0.0001), renal complications were 10 (2.3%) vs. 35 (4.4%) (p- 0.285), Neurological complications were 7 (1.4%) vs. 15 (1.9%) (p0.553), Sepsis was 11 (2.2%) vs. 47 (6%) (p-0.33), Low cardiac output was 15 (3%) vs. 66 (8.4%) (p- 1.000), re-ventilation was 10 (2%) vs. 110 (14%) (p- 0.41), Tachy-arrhythmia was 25 (5%) vs. 150 (19.2%) (p- 0.11), re-openings were 19 (3.8%) vs. 65 (8.3%) (p- 0.0003), ICU stay (Hours) was 87 ± 8 vs. 108 ± 10, Mortality was 35 (7.1%) vs. 75 (9.6%) (p-0.094), Mean hospital stay (Days) was 12.2 ± 2.5 vs. 15.8 ± 4.9. Conclusion: Fifteen years’ experience of Tetralogy of fallot corrections at AFIC-NIHD indicates that Trans-atrial / Trans-pulmonary approach is more beneficial to patients due to high survival rate, less morbidity, less hospital stay and an early discharge. This ultimately translates into less financial burden on the patients, hospital, society and the country at large.

Reporting and monitoring systems cannot be hurriedly cobbled at the first sign of an impending emergency‟. Crisis Management Cell was established on 29 January 2020 as part of the Medical Directorate COVID-19 response strategy with a mandate to act as a data collection point & repository for relevant decision making andpolicy formulation. Since its inception, it has proved its mettleby enabling a paradigm shift from an existing traditional passive surveillance system to an active, near-real-time data collection and disseminationarrangement. This transition involved a whole-hearted commitment of top brass and a herculean effort on part of Crisis Management Cell. Its functioning non-stop,24/7 on war-like footings for attaining assigned objectives has beenhighly appreciated by all rank and file. By writing this case study, authorsintend to share theworkdone by Crisis Management Cell for nearly seven months. By narrating a tale of blood, sweat and tears thepurpose is to critically review the Crisis Management Cell structures, processes and outcomes. We provide insightful lessons and discerning tips based on our first-hand experience of what went well, what did not, and what could. The purpose is not only to highlightits distinctive work but also to highlight that the tasks were performed at break-neck pace. We conclude by commenting on theutility and effectiveness Crisis Management Cell in achieving the desired output which is also evident from the fact that itsinitial mandate pertaining to COVID-19 wasexpandedto include Dengue Surveillance and Disease Early Warning System.

In the unprecedented COVID-19 situation, Medical Directorate needed to get near-real-time data for decision making and policy formulation. Crisis Management Cell was hence established with a vision to act as a data collection point and repository for Armed Forces COVID-19 PCR positive cases. Its foremost task was transforming a traditionally passive system for disease surveillance to a near-real-time semi-automated one. This coupled with the ensuing workload in the coming days especially during surge, constituted a formidable challenge. Through this work we want to share our hands-on experience of data collection & dissemination at Crisis Management Cell. We aim to inform our readers about the important points that need to be taken into account when establishing disease surveillance centers. As per our experience, these include an assessment of demand for near-real-time data, data handlers, data architecture, data security, data quality, data record, data velocity, data variety, data variability, data documentation, data reconciliation and reflection.

Objective: To gather the opinion of attendants accompanying admitted patients in CMH Lahore about their satisfaction with existing eating and sleeping arrangements. Study Design: Cross sectional survey. Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jul to Aug 2016. Material and Methods: For this descriptive observational study attendants of patients admitted in the hospital for more than 24 hours were administered a questionnaire. Only one family member per patient was surveyed. Results: Three hundred attendants were interviewed for the study of which 162 were males. One hundred and twenty eight 128 (42.7%) came from within the city. One hundred and eighty seven (62.3%) intended to stay with the patients till the time they were discharged. A total of 185 (61.7%) patients had only one attendant whereas 59 (19%) of patients had no attendants available. Two hundred and thirty one (77%) attendants were blood relatives. The hospital canteen served food to 140 (46.7%) attendants. Only 25 (4.3%) attendants were satisfied with their existing eating arrangements. One hundred and seventy eight (59.3%) of attendants slept inside the hospital wards whereas 54 (18%) slept within hospital premises. One third of them were satisfied with their sleeping arrangements whereas the remaining desired more comfortable residential facilities or „Sarais‟ which were affiliated with the hospital. Sixty four (52%) attendants experienced difficulties in affording their boarding and lodging expenses. Conclusion: Patients and families bear the emotional and financial cost of illness. Findings suggest that attendants are not satisfied with their existing sleeping.

To explore the representation of females in the field of medical journal editing in Pakistan.This cross-sectional study was conducted from July 3 to 15, 2015 at Combined Military Hospital, Lahore. After exploring the website of Pakistan Medical and Dental Council, we surveyed the website of each journal and from their latest available edition discerned the editorial board's gender composition. Designations of female members were noted. Data was analysed using SPSS 20.A total of 2342 members served on the editorial boards of 79 journals of which 410(17.51%) were females. The maximum strength of women in a single journal was 23/30(76.6%). There were no women in the editorial boards of 11 (13.92%) journals. Among others, there were 188 (45.9%) Members of Editorial Board, 39 (9.5%) Editors, 39 (9.5%) Associate Editors, 34 (8.3 %) Members Advisory Board, 22 (5.4%) Subject Editors, 10 (2.4%) Editors-in-chief, 8 (2.0%) Student Editors, 7 (1.7%) Statisticians, 3 (0.7%) Bibliographers, 2 (0.5%) Deputy Editors-in-chief, 1 (0.2%) Trainee Editor and 1(0.2%) epidemiologist.There was a low representation of women in the field of journal editing. A number of factors may be incriminated for this poor visibility.

Tropical pyomyositis is a bacterial infection of the skeletal muscles leading to abscess formation, occurring in the tropical areas, often following minor trauma. We report a case of pancarditis as the direct complication of pyomyositis in a 10-year-old girl who presented with painful swelling of her right thigh, high grade fever and impaired consciousness. Echocardiography showed pericardial effusion with strands and a large vegetation in the left ventricle cavity. She was treated successfully with open heart surgical drainage and intravenous antibiotics. We emphasize early diagnosis and prompt treatment of pyomyositis to reduce its associated mortality and morbidities.