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Objective: To look for the frequency of thyroid dysfunction in heart failure patients with reduced ejection fraction at Medicine/Cardiology Department. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Sialkot, from Nov 2019 to Apr 2020. Methodology: The sample population comprised of patients diagnosed with the heart failure and ejection fraction of 40% at Medicine/Cardiology unit. Patients underwent thyroid functions test from the laboratory of our hospital and were diagnosed as hypothyroid, hyperthyroid or euthyroid by consultant cardiologist and medical specialist. Age, gender, body mass index and New York heart association (NYHA) class were associated with thyroid dysfunction among the study participants. Results: Out of 110 patients with heart failure and low ejection fraction who underwent thyroid function testing during the study period, 92 (83.6%) patients were euthyroid, 14 (12.7%) had thyroid profile parameters showing hypothyroidism, while 04 (3.6%) had laboratory findings of hyperthyroidism. After chi-square, we found that patients with New York heart association class III and IV and high body mass index had a statistically significant relationship with thyroid dysfunction (pvalue 0.017 and <0.001 respectively) among the patients of heart failure with low ejection fraction. Conclusion: Thyroid dysfunction, especially hypothyroidism, emerged as a common finding among heart failure patients with low ejection fraction. Patients with New York heart association class III and IV and high body mass index should be considered high-risk and may be screened for thyroid problems if present with heart failure. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of SGLT-2 inhibitors with DPP-4 inhibitors as the add on therapy to Metformin on HBA1c level in type 2 diabetes patients in Pakistani population. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Sialkot, Pakistan from Nov to Apr 2020. Methodology: The study population comprised of 300 type-II diabetes patients with poorly controlled diabetes on Metformin managed at Combined Military Hospital Sialkot, Pakistan. Patients were divided into two groups via lottery method. Group-A received the SGLT-2 inhibitors at standard dose while group-B received the DPP-4 inhibitors at the usual standard does as recommended by the consultant medical specialist. Values of glycosylated hemoglobin were compared three months after the start of study. Results: Mean age of the patients was 44.31 ± 5.841 years. Mean duration of type 2 diabetes mellitus in the study participants was 4.18 ± 6.369 years. HBA1c after three months of treatment in the SGLT-2 inhibitors-group was 7.01 ± 0.14 mmol/L while in the DPP-4 inhibitors-group was 7.89 ± 0.99 mmol/L. Difference between the two groups was statistically significant (pvalue <0.01). The result showed SGLT-2 inhibitors as the better option for add on therapy to Metformin as compared to DPP-4 inhibitors. Conclusion: SGLT-2 inhibitors emerged as better option to lower the HBA1c level as compared to DPP-4 inhibitors as the add on therapy to Metformin as there was statistically significant difference in HBA1c levels after three months of therapy in both the groups. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and causes related to the precipitation of breakthrough seizures among adult patients with epilepsy despite antiepileptic treatment. Study Design: Cross sectional analytical study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from May 2018 to Oct 2018. Methodology: The sample population comprised of 161 adult patients of epilepsy reporting to Military Hospital Rawalpindi with the epilepsy using the antiepileptic drugs (AEDs) at least for the past six months. Detailed history and physical examination was carried out for all the patients. Frequency of breakthrough seizures among this population was calculated and relationship were assessed with the precipitation of the breakthrough seizure. Results: Out of 161 patients of epileptic included in the study, 78 were male and 83 were female. Out of these 80.1% patients had breakthrough seizures. After applying the logistic regression we found that increasing age, marital status, sleep deprivation, total duration of treatment, missing one or two doses of antiepileptic drugs and watching television for long hours were strongly related to the precipitation of breakthrough seizures in our study patients. Conclusion: There was showed high frequency of breakthrough seizures in our population despite the use of AEDs. Special attention should be paid to the patients with increasing age and living alone. Education of patients regarding proper sleep, stress management, restricting TV hours and strict compliance should be done in order to prevent the phenomenon of breakthrough seizures and achieve a good control over this potentially life threatening condition. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of cerebral venous sinus thrombosis (CVST) among the patient with headache presenting from high altitude (HA). Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from 24th Apr 2018 to 24th Jan 2019. Methodology: The sample population comprised of patients presenting with the headache, living at a height of 3000-8200 meter above sea level. CT-scan brain, MRI brain and MRV brain was performed on all the cases. Carotid Doppler, d-dimers, thrombophillic screen, autoimmune profile, EEG and other relevant investigations were performed of all the cases diagnosed with CVST. Age, altitude, total time spent at HA and acclimatization were correlated with the presence of CVST among the patients of headache at HA. Results: Out of 60 patients reporting with headache from HA, 9 had presence of CVST on the relevant neuroimaging. Among these cases of CVST 2 had secondary polycythemia, 1 had protein C deficiency and 1 had protein S deficiency. Poor acclimatization had a significant relationship with the presence of CVST when logistic regression was applied. Conclusion: Cerebral venous sinus thrombosis should be considered a possibility while evaluating the causes of headache among the patients reporting from high altitude. Special attention should be given on acclimatization process for the people who are ascending to high altitude. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in noncardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuroradiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of noncardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population. Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value<0.001) with raised CKMB/Myoglobin levels in the target population. Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers. [ABSTRACT FROM AUTHOR]