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Background: Coronary artery disease (CAD) is a leading cause of mortality worldwide. Treatments such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are crucial for managing CAD. While CABG is often preferred for complex cases, many patients require PCI due to graft failure or new blockages post-CABG. This study evaluates PCI outcomes in Pakistani and Saudi patients with prior CABG, addressing the scarcity of regional data., Objective: The primary objective was to measure the success rate of PCI in post-CABG patients, defined as achieving less than 30% residual stenosis without major complications. Secondary objectives included assessing the incidence of restenosis, repeat revascularization, and major adverse cardiac events (MACEs) over one year., Methods: This one-year prospective cohort study was conducted at multiple tertiary care hospitals in Pakistan and Saudi Arabia, involving 246 participants aged 18 years and older who had previously undergone CABG. Participants underwent PCI using standard procedures. Data were collected on demographic information, clinical characteristics, procedural details, and follow-up outcomes. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with descriptive statistics summarizing the baseline characteristics. The chi-square test or Fisher's exact test compared categorical variables, and the t-test or Mann-Whitney U test was used for continuous variables. A p-value of less than 0.05 was considered statistically significant., Results:  The mean age of the participants was 63.5 ± 10.2 years, with 73.2% being male. The PCI success rate was 91.5% (95% CI: 88.2-94.8%), with most patients achieving less than 30% residual stenosis. There were 15 cases (6.1%) of MACEs, including five myocardial infarctions (2.0%) and 10 urgent revascularizations (4.1%). Restenosis occurred in 20 patients (8.1%; 95% CI: 4.7-11.5%), and repeat revascularization was required in 18 patients (7.3%; 95% CI: 4.0-10.6%). Kaplan-Meier survival analysis indicated no significant difference in MACE-free survival between patients with and without restenosis (log-rank test, p=0.423)., Conclusion: The high success rate of PCI in post-CABG patients across both Pakistan and Saudi Arabia suggests that it is a viable option even in complex cases. These findings can inform clinical practice, emphasizing the importance of consistent follow-up and tailored interventions to enhance patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Sulaiman Alrajhi University, Riphah International University, Khyber Medical University, Lady Reading Hospital, Altamash General Hospital issued approval IRB/RIU/2023/78432, IRB/SAU/2023/10456, IRB/KMU/2023/19234, IRB/AGH/2023/23498, IRB/LRH/2023/56123. The study adheres to ethical recommendations, including obtaining informed consent, ensuring participant confidentiality, minimizing risks, and upholding the right to withdraw from the study at any time. Participants were selected fairly, and any adverse events were promptly reported and addressed. The integrity of the data was preserved, and the potential benefits of the research were carefully weighed against any associated risks. Participants were also provided with access to study results and offered any beneficial treatments following the conclusion of the study. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohammad et al.)

Background: Acute ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular condition requiring timely intervention to restore coronary blood flow and minimize myocardial damage. While percutaneous coronary intervention (PCI) remains the gold standard, it is often insufficient for patients with complex coronary anatomy, such as multivessel disease or left main coronary artery involvement. Hybrid coronary revascularization (HCR), which combines PCI and coronary artery bypass grafting (CABG), offers a novel approach to managing these complex cases., Objective: The primary objective of this study was to evaluate the outcomes of HCR in patients presenting with acute STEMI, particularly those with high-risk features such as multivessel disease or left main coronary artery involvement., Methods: This prospective cohort study was conducted at Shalamar Hospital, a tertiary care center in Lahore, Pakistan. The study enrolled 342 patients diagnosed with acute STEMI between January 1, 2023, and December 31, 2023. Participants underwent HCR, consisting of PCI with drug-eluting stents and minimally invasive CABG. Key outcomes included the incidence of major adverse cardiovascular events (MACE) within one year, graft patency at six months, and overall procedural success. Data were collected through patient records and follow-up assessments, and statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.)., Results: The one-year MACE rate was 14.6%, with 6.1% of patients experiencing myocardial infarction, 4.4% requiring repeat revascularization, and 4.1% experiencing cardiac death. Graft patency at six months was 94.7%, and the overall procedural success rate was 98.2%. One-year survival was observed in 95.3% of the patients., Conclusion: HCR is a safe and effective strategy for managing acute STEMI, particularly in patients with complex coronary anatomy. It offers a balanced approach by reducing the need for invasive procedures and improving patient outcomes. Further multicenter studies are necessary to confirm these findings and establish standardized guidelines for HCR., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Shalamar Hospital issued approval 384/IRB/2023/SHL. Consent was obtained or waived by all participants involved in the study. The Institutional Review Board of Shalamar Hospital granted approval for the study titled "Examining the Outcomes of Hybrid Coronary Revascularization in Acute STEMI Patients," authored by Dr. Ameer Aslam, Dr. Fraz Ahmad, and others. The ethical approval number for this study is 384/IRB/2023/SHL. The study adheres to ethical recommendations, including obtaining informed consent, ensuring participant confidentiality, minimizing risks, and upholding the right to withdraw from the study at any time. Participants were selected fairly, and any adverse events were promptly reported and addressed. The integrity of the data was preserved, and the potential benefits of the research were carefully weighed against any associated risks. Participants were also provided with access to study results and offered any beneficial treatments following the conclusion of the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmad et al.)

Background Laparoscopic sleeve gastrectomy (LSG) has become a widely accepted bariatric procedure for treating morbid obesity and associated comorbidities due to its relatively straightforward technique and positive outcomes in terms of weight loss and metabolic improvement. Objective To investigate the frequency and types of early complications following LSG using four ports. Methods This prospective observational study was conducted at Al Hadi International Hospital, Swabi, Pakistan, from January 2022 to December 2022. A total of 369 patients aged 25-65 years with a BMI of 35-55 kg/m 2 were included. Data on demographic characteristics, surgery duration, intraoperative blood loss, and hospital stay were collected. Early complications within 30 days post-surgery, including bleeding, infection, and leakage, were documented. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results The mean age of patients was 43.6 years (SD = 11.8) and the mean BMI was 42.3 kg/m 2 (SD = 6.5). The average surgery duration was 92 minutes (SD = 22) and the mean intraoperative blood loss was 100 mL (SD = 50). Early complications occurred in 18% of patients with bleeding, infection, and leakage each accounting for 5%, 4%, and 3%, respectively. Reoperation was required in 5% of patients due to these complications. Higher BMI (45.2 vs. 41.8 kg/m 2 , p = 0.04) and longer surgery duration (105 vs. 88 minutes, p = 0.03) were significantly associated with increased complication rates. Comorbidities were present in 60% of patients with complications compared to 34% without complications (p = 0.03). Conclusion The four-port technique in LSG is associated with an 18% early complication rate with significant risk factors being higher BMI and longer surgery duration. Careful patient selection, standardized surgical techniques, and robust postoperative care are essential to minimize complications and improve outcomes in LSG., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Review Board of Bacha Khan Medical Complex issued approval BKMC/ERB/2021/124. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ullah et al.)

Leptospirosis, a zoonotic infection prevalent in Pakistan, presents diverse clinical manifestations ranging from mild flu-like symptoms to severe multiorgan failure known as Weil's disease. This case study reports on a 24-year-old woman with leptospirosis complicated by acute kidney injury and hyperbilirubinemia, unresponsive to standard therapies. Despite initial treatment with antibiotics and hemodialysis, her condition deteriorated. Following a single session of plasmapheresis, marked clinical and laboratory improvements were observed. Notably, plasma exchange effectively reduced bilirubin levels, underscoring its potential benefit in severe leptospirosis. This case highlights the role of plasmapheresis as rescue therapy in critically ill patients, demonstrating significant outcomes in cases resistant to conventional management. Further research is warranted to refine guidelines on the optimal timing and frequency of plasma exchange in such settings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ullah et al.)

Introduction: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden and is a leading cause of morbidity and mortality. Acute exacerbations of COPD often lead to respiratory failure, necessitating a thorough understanding of its prevalence. This study aimed to investigate the prevalence of respiratory failure among adult patients experiencing acute exacerbations of COPD., Materials and Methods: A descriptive, cross-sectional study was conducted over a span of seven months at the internal medicine department of Hayatabad Medical Complex, Peshawar. A total of 255 adult patients with acute exacerbations of COPD were included, and their demographic data, as well as arterial blood gas (ABG) analysis results, were collected. The prevalence of respiratory failure was defined by specific arterial blood gas criteria., Results: The study revealed a notable prevalence of respiratory failure (41.18%) among COPD patients presenting with acute exacerbations. Factors such as older age and male gender were identified as being associated with a heightened risk of respiratory failure., Conclusion: In conclusion, acute exacerbations of COPD predominantly affect middle-aged males (65.5%), with the 51-60 age group being the most impacted. Respiratory failure was present in over 41% of cases. ABG analysis indicated significant acid-base imbalances, hypoxemia, and hypercapnia, with compensatory chronic respiratory acidosis. These findings highlight the need for targeted interventions to manage and prevent COPD exacerbations, especially in middle-aged men., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Review Board (ERB) of Hayatabad Medical Complex, Peshawar issued approval ERB/HMC 1849. It is stated that Principle Investigator Rizwanullah, a resident physician at HMC, is allowed to conduct a study on "Exploring the Prevalence of Respiratory Failure in Adults Presenting with Acute Exacerbation of Chronic Obstructive Pulmonary Disease." Make sure to keep patient confidentiality and avoid any harm during this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ullah et al.)

Background Renal calculi therapy has advanced significantly in recent years, with mini-percutaneous nephrolithotomy (PCNL) emerging as a minimally invasive treatment modality. Mini-PCNL has been subjected to several modifications to achieve the best possible outcomes and reduce morbidity. This study aimed to compare the efficacy and safety of Swiss LithoClast Trilogy™ and pneumatic Swiss LithoClast™ in managing renal stones with mini-PCNL. Methodology This descriptive retrospective study was conducted at the Department of Urology, Lady Reading Hospital, from January 1, 2023, to December 31, 2023. A record of male and female patients aged more than 18 years who underwent mini-PCNL for renal stones was retrieved. The following two groups of patients were created: group A (n = 25) mini-PCNL with Swiss LithoClast Trilogy™ and group B (n = 26) mini-PCNL with pneumatic Swiss LithoClast™. The efficacy and safety profile of both groups was compared. Results A total of 51 patients were enrolled, with 25 in group A and 26 in group B. Groups A and B had mean ages of 45.2 and 47.5 years, respectively. Male participants outnumbered females in both groups, 72% (n = 18) in group A and 77% (n = 20) in group B. Group A had a mean stone size of 15.8 mm, and group B had a mean stone size of 16.5 mm. Stone-free rate on postoperative day one was 88% (n = 22) in group A and 84.6% (n = 22) in group B, with no statistically significant difference (p > 0.05). At the end of three months, 96% of participants in group A and 84.6% of patients in group B were found to be free of stones, and the difference between the two groups was not statistically significant (p > 0.05). Intraoperative hemorrhage occurred in 12% (n = 3) of group A and 15.4% (n = 4) of group B patients, with no significant difference (p > 0.05). Conclusions There were no significant differences in stone-free rates, complication rates, or intraoperative/postoperative complications between mini-PCNL with Swiss LithoClast Trilogy™ or Pneumatic Swiss LithoClast™., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Farooq et al.)

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93±5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Anjum et al.)

Background Typhoid fever presents a significant challenge in developing nations, exacerbated by the emergence of antibiotic-resistant strains due to widespread prevalence and overuse of antibiotics. This study seeks to assess the antibiogram profiles of Salmonella species isolated from blood cultures of patients hospitalized at two prominent tertiary care hospitals in Peshawar, Pakistan: Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC). By examining these profiles, the research aims to provide valuable insights into the evolving landscape of antibiotic resistance in the context of typhoid fever management. Materials and Methods This retrospective cross-sectional study utilized data gathered from two hospitals in Peshawar, KTH and HMC. Cases of enteric fever were identified based on positive blood cultures for Salmonella species. The study encompasses demographic information, seasonal prevalence, and antibiogram profiles of 3,137 cases that were presented between 2017 and 2023. Results Among the total 3,137 cases, males accounted for the majority, comprising 63% (2,044 cases). Particularly notable was the clustering of cases among children and adolescents aged one to 24 years. The incidence peaked during the months of summer and spring, from April to September. In terms of Salmonella Typhi isolates, considerable resistance was noted against first-line antibiotics such as amoxicillin/clavulanate (80.1%), co-trimoxazole/trimethoprim-sulfamethoxazole (66.6%), and chloramphenicol (86.9%), as well as against ceftriaxone (79.7%) and ciprofloxacin (51.6%). Conversely, certain antibiotics displayed higher sensitivity patterns, including meropenem (97.8%), doripenem (99.5%), imipenem (97.7%), ertapenem (96.5%), polymyxin B (99.4%), colistin (98.1%), and tigecycline (97.3%). Despite a limited sample size of 214 specimens, fosfomycin demonstrated a remarkable sensitivity of 93.4%. Sensitivities of amikacin and gentamicin were 90.7% and 81.5%, respectively. However, the sensitivity of azithromycin was concerning, standing at 66.5%. The antibiogram pattern for Salmonella exhibited significant and drastic changes. Conclusion In conclusion, this study sheds light on a higher prevalence of typhoid fever among males, with a notable seasonal peak observed during the summer and spring months. The age group most affected spans from one to 24 years. Salmonella isolates displayed significant resistance to conventional first-line antibiotics, alongside ciprofloxacin and third-generation cephalosporins. Azithromycin exhibited lower sensitivity compared to amikacin, gentamicin, and fosfomycin. The research advocates for the empirical use of amikacin, gentamicin, fosfomycin, and meropenem in the treatment of typhoid fever in Pakistan. Urgent measures, including regular Salmonella antibiogram surveillance, antibiotic stewardship, public health education, and Salmonella vaccination programs, are deemed crucial for primary disease prevention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ullah et al.)

Objective The objective of this study is to measure renal function improvement after endopyelotomy for secondary pelvi-ureteric junction (PUJ) obstruction using technetium-99m diethylene-triamine-pentaacetate (DTPA) renal scintigraphy. Material and methods This descriptive study was carried out at the Department of Urology, Institute of Kidney Diseases, Peshawar, Pakistan from June 1, 2021, to May 31, 2023. The study included 118 secondary PUJ blockage patients who underwent endopyelotomy. Patient demographics, clinical history, and preoperative imaging findings were obtained. DTPA renal scintigraphy assessed renal function improvement postoperatively at intervals to determine the efficacy of endopyelotomy. Results The majority of the patients included in the study were male (n=65, 55.1%). The average age of the patients was 45.2 years, with the majority falling within the age range of 46-60 years (n=42, 35.6%). All patients had ultrasonography and computed tomography imaging done, and preoperative renal functions were obtained. Comorbidities included hypertension in 32 (27.12%) and diabetes in 18 (15.25%). DTPA renal scintigraphy showed improved renal function in 81.35% of patients at three months, 88.13% at six months, and 83.05% at 12 months; 15.3% of patients needed further treatments, and 5.1% had PUJ blockage recurrence. Conclusion This study offers significant insights into the results and complexities of endopyelotomy in patients suffering from PUJ blockage. The findings indicate that the technique efficiently enhances kidney function and alleviates symptoms in most patients. However, the study also emphasizes the need to monitor patients undergoing this procedure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ullah et al.)

Objective To determine the frequency of hepatitis A, B, C, and E viruses (HAV, HBV, HCV, HEV) in pregnant women with acute hepatitis presenting to the medical units of HMC, Peshawar. Methods This is a descriptive cross-sectional study in which 442 pregnant women, either multi or primigravida, with yellow discolouration of the sclerae of the eyes and elevated alanine aminotransferase (ALT) > 100 U/L on laboratory tests were chosen by convenience (non-probability) sampling to assess the frequency of HAV, HBV, HCV, HEV. Results The majority, i.e., 58.8%, were in the age range of >30 years and presented in the third trimester. Of the subjects, 81.90% had parity in the range of 1-5, 89.4% were multigravida, 71.3% were illiterate, and 73.1% were in the low-income category. Anti-HEV was detected in 47.3% of pregnant women, Anti-HCV in 30.3%, Hepatitis B surface antigen (HBsAg) in 11.5%, Hepatitis A-IgM in 5%, and 5.90% of the cases were virus-free. Conclusions HBV, HCV, and HEV exposure, in particular, may have a substantially larger impact on pregnancy and neonatal outcomes than HAV. As a result, at the first prenatal appointment, standard viral hepatitis screening in pregnant women may need to be reviewed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Khan et al.)

Background Mitral regurgitation (MR) is a common complication in hospitalized cardiac patients with ST-segment elevation myocardial infarction (STEMI); however, the patient outcomes depend on various factors that vary across facilities and regions. There is an acute need to stratify STEMI patients by risk of in-hospital mortality. We conducted this study to compare the mortality of patients with acute STEMI with or without MR admitted to different units of the Cardiology Department at Lady Reading Hospital (LRH) in Peshawar. Methods In this prospective study, we compared the mortality rates of STEMI patients with and without MR from June 5 to October 30, 2021. All patients with different types of STEMI treated at LRH were enrolled in the study regardless of age and gender. ST-elevation was confirmed via electrocardiogram, and MR was confirmed via echocardiography. We excluded any patients with primary organic valve disease or congenital heart disease. We also collected patient demographic and clinical characteristics. We used IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY) for statistical analyses. Results Our study population included 228 patients with a mean age of 62.4 ± 12.3 years. Most of the patients were men (n=140; 61.4%), and only 78 (38.6%) were women. The prevalence of MR was 29.4%. Hypertension was the most common comorbidity (63.6%), and inferior wall myocardial infarction (MI) was the most common type of MI (49.1%). Hypertension, prehospital cardiopulmonary resuscitation (CPR), and Killip class ≥ 2 were significantly associated with MR (p<.001). In-hospital mortality was 29.8%, significantly associated with MR (p=.0001). Patients who needed CPR prior to hospitalization and those with Killip class ≥ 2 were less likely to survive (p=.0001). Conclusions MR is common following MI, especially in cases of inferior wall MI. Patients with MR have a poorer prognosis than those without MR following MI, more so when combined with other comorbidities. Regarding its relation to MI complications, an assessment of the MR is necessary to make an appropriate decision for treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ullah et al.)

Objective To assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital. Materials & Methods This cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data. Results The total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most common procedure throughout the study duration (56.8%) and during the COVID-19 pandemic (29 procedures/month). Congenital Heart Surgeries (16.6%) and Valvular surgeries (11.5%) were next on the list. However, congenital heart surgeries were most affected during the pandemic (16 to 5 procedures/month). The average number of surgeries per month peaked at 2017 (135 procedures/month) and after that declined to its low of 46/month during the COVID-19 pandemic (The year 2020). Conclusion Cardiothoracic and Vascular Surgeries have significantly decreased during the COVID-19 pandemic, especially the Coronary Artery Bypass (CABG) and Congenital Heart Surgeries. CABG procedures, however, remained the highest performed surgery even during the pandemic due to their emergent nature. Thoracic, vascular, and combined surgeries have stayed almost constant. The year 2020 (COVID-19 year) saw the lowest number of surgeries performed per month. An uprising trend in the number of surgical procedures is seen in the post-pandemic time (2021)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ullah et al.)

Background Atrial fibrillation (AF) is a common concern in patients with heart disease, especially those with acute decompensated heart failure (ADHF). We conducted a cross-sectional study to determine the frequency of AF and associated risk factors among patients with ADHF at a tertiary care hospital in Peshawar, Pakistan. Methods We conducted a cross-sectional analytical study of hospitalized patients with ADHF treated in a tertiary care hospital in Peshawar, Pakistan, from June 5 to October 30, 2021. The study's primary outcome was the proportion of patients with ADHF who had AF, and our secondary outcome was examining the risk factors for AF. The College of Physicians and Surgeons Pakistan provided ethical approval of the study design. Data were analyzed using IBM SPSS Statistics for Windows version 24.0 (IBM Corp., Armonk, NY, USA). We applied the chi-square test to compare the proportion of AF concerning risk factors (i.e., comorbidities). Results One hundred ninety-four patients with ADHF were included in the study; 54.6% were male and 45.4% female. Most (56.7%) were older than 60, and 38.1% were aged 40-60. The prevalence of AF was 38.1%. Diabetes, hypertension, previous stroke, myocardial infarction (MI), and chronic obstructive pulmonary disease (COPD) were the most common comorbidities. All patients with ADHF with AF also had MI and hypertension. Patients of known coronary artery disease (CAD) but without MI, previous percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery were less associated with AF than other comorbidities. Conclusions We conducted this study to determine the incidence of AF among patients with ADHF. AF occurs in a significant amount of patients with ADHF, and the risk factors associated with AF in these patients include hypertension, history of MI, diabetes, and COPD. Healthcare professionals should screen patients with ADHF for AF, especially those with common risk factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ullah et al.)

Introduction Coronary artery bypass graft (CABG) is the most effective coronary revascularization procedure, and it has been endorsed by many trials and studies over the years. However, due to CABG's immediate adverse effects, patients tend to prefer percutaneous coronary intervention (PCI) for coronary revascularization over it. This article focuses on the recent downtrend in CABG procedures for revascularization among patients for whom it is indicated. This study's main objective was to identify the factors responsible for the downtrend in patients undergoing CABG despite a clear indication for it in those with multivessel diseases. Methods This study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from August 1, 2020, to January 1, 2021. A total of 340 patients with a class-I indication (presence of conditions regarding which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective) for CABG were enrolled in the study. Data related to all the variables were collected from patients and hospital records through an adequately designed proforma. For analysis, we applied the chi-square test to elaborate on the data for information and point biserial correlation to rule out the effect of age and weight on CABG's downward trend. Results The mean age of the patients was 58.77 ±   9.54 years; 65.88% were male, and 34.12% were female. Only 17.65% of the patients underwent CABG; 71.47% opted for medical treatment, and 9.41% underwent PCI. Out of the 280 patients who did not undergo CABG, 26.76% had financial issues; 23.82% were high-risk patients and hence refused surgeries by the surgeons; 20.59% of patients were not willing to undergo surgery; 7.94% were on the waiting list, and 3.24% had deranged renal function tests (RFTs). Conclusions A limited number of patients underwent revascularization therapy even though they had clear indications for CABG. The high-risk status of patients, patients' unwillingness, and the cost of the procedure were the primary reasons behind the downtrend in CABG procedures among patients with a clear indication for the same., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ali et al.)

Introduction The COVID-19 (coronavirus disease) has affected millions of people, wreaking havoc worldwide. World Health Organization (WHO) labelled this disease as a serious threat to public health since its rapid spread from Wuhan, China. The respiratory manifestations of COVID-19 are common, but myocardium involvement causing myocardial injury and rise in cardiac markers is much less discussed. Materials and methods We conducted this retrospective cohort study from 1st April 2020 to 1st October 2020. Data was collected from the Hospital Management and Information System (HMIS) based on inclusion criteria. We used the Cox proportional hazard regression model for survival analysis, estimated the probability curves of survival using the Kaplan-Meier method, and contrasted it with the log-rank test. Results Among the 466 patients, 280 (69%) were male; the rest were female. The majority were both hypertensive and diabetic, and one-third had a myocardial injury on arrival. The most frequent symptoms in more than half of the patients (51.90%) included a combination of fever, dry cough, and shortness of breath. Out of 466 patients, 266 patients were discharged, and 200 did not survive. In our study, 168 (36.05%) patients had a cardiac injury; among them, 38 (22.61%) were in the discharge group, and the remaining 130 (77.39%) patients were in the nonsurvivor group. Our study results showed that the mortality rate was higher in patients with high cardiac troponin I (cTnI) levels (hazard ratio [HR] 3.61) on admission. Conclusion Our result concluded that measuring cTnI levels on presentation could help predict the severity and outcome in COVID-19 patients. It will allow physicians to triage patients and decrease mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ali et al.)

Introduction Diabetes mellitus (DM) is a chronic metabolic disease. It is the principal cause behind the high morbidity and mortality attributed to cardiovascular disease. This article's objective was to determine a connection between high glycated haemoglobin levels (HbA1c) and coronary artery disease (CAD). Materials and Methods Cross-sectional research took place at the lady reading hospital, Peshawar, Pakistan, from 1st July 2020 to 31st December 2020. In this study, one hundred fifty-one type II diabetic patients took part. We labelled all of them as acute coronary syndrome (ACS) on arrival. Non-probability consecutive random sampling technique was used for sampling. We categorized patients based on their HbA1c levels into two groups. These groups included good glycemic control (HBA1c ≤ 7. 5%) and patients with poor glycemic control (HBA1c  ≥ 7.5%). We classified the angiographic results of these patients as normal coronary arteries (NCAs), single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Continuous variables such as age, weight, height, and body mass index (BMI) between HBA1c levels were analyzed using the Mann-Whitney U test. The fisher's exact test was performed to compare the categorical variables between the two classes. Results Of the total 151 patients, 89 (58.9%) were males, and the rest were female. The mean age was 55.4 ± 11.2 years. The most common risk factors were diabetes and hypertension, whereas ST-segment elevation myocardial infarction (STEMI) was the most common presentation. 107 (70.86%) patients had poor glycemic control (HbA1c>7.5%). Coronary angiographies showed TVD in 77 (50.99%) patients. Among these patients with TVD, 6 (14%) patients had good glycemic control, while 71 (66%) patients had poor glycemic control, which is significant (P ≤ 0. 001). None of the patients with poor glycemic control had NCAs. Conclusion This article found a link between high levels of HbA1c and the degree of coronary artery disease (CAD) among diabetic patients. Our study's results demonstrated that high HbA1c was related to severe CAD. It would need additional studies with a large sample size to evaluate the more profound impact of HBA1c on coronary arteries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Khan et al.)

Background Inappropriate medication dosing can cause adverse drug reactions or ineffective therapy due to declined renal function in patients with renal insufficiency. This necessitates proper renal dose adjustment. This study was proposed to evaluate medication dosage adjustment in hospitalized chronic kidney disease (CKD) patients. Methods This study included all CKD patients hospitalized between May 1, 2019, and April 25, 2020, at the Institute of Kidney Disease, Peshawar, Pakistan. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula, and dose appropriateness was established by evaluating practice with relevant reference books. Results Of the total 1,537 CKD patients, 231 (15.03%) had evidence of dosing error, which was considered for final analysis. Overall, 1,549 drugs were prescribed; 480 (30.99%) drugs required dose adjustment, of which 196 (40.42%) were adjusted properly and the remaining 286 (59.58%) were unadjusted. The most common unadjusted drugs were meropenem, cefepime, ciprofloxacin, and rosuvastatin, whereas captopril, aspirin, bisoprolol, pregabalin, and levofloxacin had the highest percentage of adjusted drugs. On multivariate logistic regression, the number of drugs requiring dosing adjustments and obstructive nephropathy were found to be statistically significant factors that increased the likelihood of the medication dosing errors: a unit increase in the number of drugs requiring dose adjustment increases 5.241 times the likelihood of dosing error. Similarly, the presence of obstructive nephropathy (OR: 0.383; 95% Cl: 0.153-0.960; p = 0.041) was found to be significantly associated with dosing error after adjustment for potential confounding factors. Conclusion The dosing of more than half of the prescribed drugs that required adjustment in CKD patients was not adjusted, which showed that medication dosing errors were high. This highlights the importance of medication prescription according to guidelines in these patients to improve the outcomes of pharmacotherapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Hassan et al.)

Objective In this study, we aimed at comparing the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in healthcare workers (HCWs) in coronavirus disease 2019 (COVID-19) receiving and non-COVID-19 receiving hospitals in Peshawar, Pakistan. Methods This cross-sectional analytical study was conducted in a COVID-19 receiving hospital (hospital 'A') and a non-COVID-19 receiving hospital (hospital 'B'). Using stratified random sampling, 1,011 HCWs (439 from hospital 'A' and 572 from hospital 'B') were recruited to participate in the study. Immunoglobulin G/immunoglobulin M (IgG/IgM) antibodies were checked using Elecsys® (Roche, Basel, Switzerland) Anti-SARS-CoV-2 immunoassay. The chi-squared test was used to compare frequencies, and the binary logistic regression model was used to predict the association between study variables' seropositivity to SARS-CoV-2. A p-value of <0.05 was considered statistically significant. Results The overall seroprevalence to SARS-CoV-2 antibodies in the two hospitals was 30.76%. It was 28.2% in hospital 'A' and 32.7% in hospital 'B' (p=0.129). The seroprevalence in HCWs having direct contact with COVID-19 patients was higher (33.1%) in non-COVID-19 receiving hospital versus 23.8% in COVID-19 receiving hospital (p=0.034). Seroprevalence was highest among administrative staff (44.0%), followed by nurses (30.8%), residents (19.8%), and consultants (17.8%) (p=0.001). As compared to consultants, the administrative and nursing staff were 3.398 and 3.116 times more likely to have positive antibodies, respectively. There were no significant differences in the seroprevalence between the respective categories of staff of the two hospitals. Conclusions The non-COVID-19 receiving hospital had a higher proportion of seropositive HCWs than the COVID-19 receiving hospital. The HCWs in the non-COVID-19 receiving hospital who had direct contact with patients had significantly higher seroprevalence. Seroprevalence was highest for administrative staff followed by nursing staff, residents, and consultants. Regardless of the COVID-19 status of the healthcare facility, all HCWs shall be trained on, and consistently follow, the proper protocols for donning and doffing of personal protective equipment (PPE)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Noor et al.)

Introduction Universally, blood stream infections are linked with increasing morbidity and mortality. Timely diagnosis for identification of bacterial etiology, their susceptibility pattern and choice of empiric treatment plays a vital role in management. Objective To reveal the etiological profile and antibiotic sensitivity in blood culture specimens in a tertiary care setting. Methods This descriptive study was carried out in pathology laboratory of a tertiary care hospital from August 2016 to July 2019. All the 750 blood culture bottles were processed and isolates were recognized by morphological appearance on recommended media, gram stain, and different biochemical tests using Analytic Profile Index. Antibiotic sensitivity was implemented by modified disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) principles (2019). Results Out of 750 blood samples, 212 (28.26%) were culture positive. The percentage of gram-negative bacilli (n = 105) and gram-positive cocci (n = 104) was almost same (49.52%), while candida spp. was recovered from three (1.41%) isolates. The identified gram-negative bacteria were E. coli and Acinetobacter baumannii each (19.04%), Klebsiella pneumoniae and Pseudomonas aeruginosa each (16.19%), Enterobacter cloaca (11.42%), Salmonella typhi (8.57%), Burkholderia cepacia (1.90%), and Raoultella terrigena (7.61%). Among gram-positive isolates, coagulase-negative staphylococci (79.80%), Staphylococcus aureus (6.73%), Enterococcus spp. (11.53%) and Streptococcus spp. (1.92%) were recovered. Colistin, imipenem, meropenem, and amikacin were most successful against gram-negative rods. The sensitivity to vancomycin, teicoplanin and linezolid was 100%, for gram positive organisms. Methicillin resistance was present in 84.4% Staphylococcal isolates. Conclusion Local data showing changing etiological pattern and antibiogram of isolated pathogens, along with adequate infection prevention and control measures can be useful to improve patient care, in terms of hospital stay, duration of medication and treatment cost., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ejaz et al.)

Objective To determine the mortality of patients with severe COVID-19 in the intensive care unit (ICU) in relation to age, gender, co-morbidities, ventilatory status, and length of stay (LOS). Methods This was a cross-sectional study based on data retrieved for 204 patients admitted to the ICU of Hayatabad Medical Complex, Peshawar, Pakistan, from April to August 2020. Study variables were age, gender, co-morbid conditions, ventilatory status, and length of stay (LOS). The data were analyzed using SPSS version 21 (IBM Corp., Armonk, NY). The independent t-test and the chi-square test were used to compare the means and frequencies of variables. Multivariate regression analysis was used to predict the likelihood of mortality. Results The overall mortality was 77%. Non-invasive ventilation (NIV) was administered to 61.8% of patients. Mortality was higher for invasive mechanical ventilation (IMV) (93.6% vs 66.7%, p<0.001) and for over 60 years (87.3% vs 72.3%, p=0.019). Mortality without co-morbidities was 75.2%. Comparative mortality rates for at least one co-morbidity (79.7%), diabetes mellitus (80.0%), hypertension (100%), diabetes mellitus and hypertension both (87.1%), and chronic obstructive pulmonary disease (75%) were insignificant. The LOS for survivors was longer (8.9±8.9 versus 5.4±5.2 days, p=0.017). The LOS < 24h was associated with higher mortality (85.9% vs 72.9%, p=0.040). On multivariable regression, the likelihood of mortality was high for IMV (7.330, 95% CI 2.667 - 20.143, p<0.001) and elderly (>60 years) patients (2.607, 95%CI 1.063 - 6.394, p=0.036). Mortality decreased with LOS longer than 24h (0.412, 95%CI 0.173 - 0.982, p=0.045). Co-morbidities did not have any effect on mortality. Conclusions Age more than 60 years and IMV were independent risk factors for higher mortality. Longer ICU stay, specifically more than 24 hours, was associated with lower mortality but LOS less than 24 hours might not have a causal relationship with mortality. The odds of survival were not affected by co-morbidities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Rahim et al.)