Predictors of Prolonged Hospital Stay in Patients with Acute Pulmonary Thromboembolism- A Hospital Based Cohort Study

Aims and Objectives: Patients with pulmonary thromboembolism (PTE) are commonly admitted to hospital and generally have a prolonged hospital stay in this part of the world. We aimed to determine different clinical and laboratory parameters that are associated with prolonged hospital stay in our set-up and to analyse effectiveness of Pulmonary Embolism Severity Index (PESI) score as a predictor of prolonged hospital stay in patients with PTE. Materials and Methods: It was a hospital based observational prospective study. Confirmed cases of PTE defined as patients with evidence of thrombus on CT pulmonary angiogram (CTPA) were included in this study. Depending on the length of hospital stay, patients were divided into two cohorts: Shorter Hospital stay (less than mean i.e., < 10 Days) and Prolonged Hospital stay (longer than mean i.e., ? 10 Days). Logistic regression analysis was done to identify predictors of prolonged hospital stay. Results: 150 patients were included in the study with 67 patients (44.67%) having shorter hospital stay (<10 days) and 83 patients (55.33%) having prolonged hospital stay (?10 days). On multivariate regression analysis, parameters that were found to be statistically significant were hypotension at presentation, decreased level of consciousness, pco2 < 30 mmHg, presence of S1Q3T3 pattern on electrocardiogram (ECG) and high risk PESI (class III-V). Conclusion: PESI class can be effectively used to predict prolonged hospital stay in patients with pulmonary embolism. Patients with hypotension at presentation, decreased level of consciousness, pco2 less than 30 mmHg, and S1Q3T3 on ECG are more likely to have prolonged hospital stay in our healthcare setup.

Design and evaluation of dental pastes Containing anti-inflammatory drugs

Abstract Periodontitis is an oral disease associated with inflammation and pain with swollen and bleeding gums. In the present study, dental pastes containing NSAIDs, namely, diclofenac sodium and nimesulide (1 % w/w) were prepared to treat periodontitis. Dental pastes of diclofenac sodium and nimesulide (1 % w/w) were prepared with/without mucoadhesive hydrocolloid polymers such as sodium carboxy methyl cellulose (NaCMC), hydroxyl ethyl cellulose (HEC) and methyl cellulose (MC) by conventional trituration method. The pH, drug content, viscosity, tube spreadability and tube extrudability of these prepared dental pastes were measured. These dental pastes of diclofenac sodium and nimesulide (1 % w/w) were characterized by FTIR analyses for drug-excipient compatibility. The in vitro drug releases from these dental pastes in 6.4 pH phosphate buffer solution displayed sustained release over longer period and the drug release rate was found to be decreased when the concentration of mucoadhesive polymer was increased. These dental pastes displayed good adhesion to the oral mucosa revealing more retention time in mouth when tested for ex vivo mucoadhesion using bovine cheek pouch. The stability study results reveal that the DC3 and NC3 dental paste formulations were found stable enough over a longer period in different storage conditions. The present study revealed that the prepared mucoadhesive dental pastes of diclofenac sodium and nimesulide (1 % w/w) had good adhesion with the oral mucosa to maintain consistent release of drugs over prolonged time.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan / Análise sistemática do morcego de leisler Nyctalus leisleri (Kuhl, 1817) capturado na região das FATA, Paquistão

Extensive field surveys were carried out to explore the distribution of Leisler’s Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Extensas pesquisas de campo foram realizadas para explorar a distribuição do morcego de Leisler Nyctalus leisleri (Kuhl, 1819), em uma área selecionada das regiões das FATA, Paquistão. Espécimes do morcego de Leisler Nyctalus leisleri (Kuhl, 1819) (n = 5) foram coletados na Agência Kurram (Shublan) (N33.8229788 E70.1634414), na elevação 1.427 m, e na Agência Khyber (Landi Kotel) (N34.0909899 E71.1457517), na elevação 1.091 m, por dois anos de pesquisa, estendendo-se de maio de 2013 a agosto de 2015. Os comprimentos médios da cabeça, do corpo, do pé traseiro, da orelha e da cauda dos espécimes de Nyctalus leisleri capturados na área de estudo foram de 65,08 ± 1,58 mm, 44,06 ± 0,52 mm, 8,38 ± 0,60 mm, 13,20 ± 0,99 mm e 39,46 ± 1,46 mm, respectivamente. Para análise molecular, foram obtidas e analisadas as sequências do gene COI. A média das divergências intraespecíficas de Nyctalus leisleri foi de 0,04%. As divergências interespecíficas médias de Nyctalus noctula e Nyctalus leisleri foram de 0,2%. A concentração média de cada nucleotídeos foi A = 26,3%, T = 32,8%, G = 15,9% e C = 25%. Os conteúdos médios de A + T foram de 59,2% e de C + G foram de 40,9%. Na árvore filogenética, Nyctalus leisleri e Nyctalus noctula agruparam-se com um valor significativo de suporte de bootstrap.

Systematic analysis of leislers bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan

Abstract Extensive field surveys were carried out to explore the distribution of Leislers Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leislers Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Resumo Extensas pesquisas de campo foram realizadas para explorar a distribuição do morcego de Leisler Nyctalus leisleri (Kuhl, 1819), em uma área selecionada das regiões das FATA, Paquistão. Espécimes do morcego de Leisler Nyctalus leisleri (Kuhl, 1819) (n = 5) foram coletados na Agência Kurram (Shublan) (N33.8229788 E70.1634414), na elevação 1.427 m, e na Agência Khyber (Landi Kotel) (N34.0909899 E71.1457517), na elevação 1.091 m, por dois anos de pesquisa, estendendo-se de maio de 2013 a agosto de 2015. Os comprimentos médios da cabeça, do corpo, do pé traseiro, da orelha e da cauda dos espécimes de Nyctalus leisleri capturados na área de estudo foram de 65,08 ± 1,58 mm, 44,06 ± 0,52 mm, 8,38 ± 0,60 mm, 13,20 ± 0,99 mm e 39,46 ± 1,46 mm, respectivamente. Para análise molecular, foram obtidas e analisadas as sequências do gene COI. A média das divergências intraespecíficas de Nyctalus leisleri foi de 0,04%. As divergências interespecíficas médias de Nyctalus noctula e Nyctalus leisleri foram de 0,2%. A concentração média de cada nucleotídeos foi A = 26,3%, T = 32,8%, G = 15,9% e C = 25%. Os conteúdos médios de A + T foram de 59,2% e de C + G foram de 40,9%. Na árvore filogenética, Nyctalus leisleri e Nyctalus noctula agruparam-se com um valor significativo de suporte de bootstrap.

Characterization of biofilm formation by Escherichia coli: An in vitro study

Objective: The purpose of the present study was to characterize the effects of medium, optical density (OD), andincubation time on biofilm formation by Escherichia coli in brain heart infusion (BHI) and Luria-Bertani broth(LB). Methods: The main procedure involved fixing the bacterial film with 95% ethanol, staining with 0.1% crystalviolet, releasing the bound dye with 33% glacial acetic acid, and measuring the OD of the solution at 570 nm using amicroplate reader. Results: It was found that 3 and 5 days of incubation are critical for biofilm formation as indicatedby the OD values of 0.55–0.35 and 0.70–0.39 in BHI and LB, respectively, at OD 0.05. Similarly, pattern in resultswas noted for OD 0.1 in both media BHI and LB. Conclusion: It is confirmed that 3 days (72 h) are required forobtaining effective biofilm formation in both BHI and LB at 37°C at OD 0.05 and 0.1.

​Concurrent Hyperfractionated Chemoradiation Versus Conventional Fractionated Chemoradiation With Low-Dose Weekly Paclitaxel In Locally Advanced Non–Small-Cell Lung Cancer In A Tertiary Cancer Center In Kashmir: A Prospective Study

Introduction: Lung cancer is the most common cancer worldwide and has a poor prognosis but integration of chemoradiationhas led to an increase in overall survival time and percentage of cured patients with acceptable toxicity.Purpose: The purpose of this study was to compare the efficacy of hyperfractionated (HFX) radiotherapy with conventionalradiotherapy and weekly concurrent paclitaxel in stage IIB/III non-small-cell lung cancer (NSCLC).Materials and Methods: A total of 60 patients were enrolled, of which 30 patients were given twice daily radiotherapy(1.2 Gy each) to a total of 72 Gy over 5–6 weeks and 30 patients were given single daily fraction (2 Gy) to a total of 66 Gy forthe same duration to achieve a comparable biological effective dose. Both groups received weekly 50 mg/m2 paclitaxel.Results: An overall response of 83.3% versus 56.6% with a partial response of 70% versus 53.3% and complete response(CR) of 13.3% versus 3% was seen in HFX radiotherapy versus conventional radiotherapy which was statistically significant(P = 0.04). 10 of 25 patients and 11 of 17 patients who achieved response in study and control groups, respectively, progressed.The median survival of patients in HFX radiotherapy arm was 18 months, compared to 9 months in conventional radiotherapyarm. The median time to local recurrence was 19 versus 11 months with local recurrence-free survival of 72% versus 66% at1 year follow-up. The 1 and 2 year survival rates were 76% and 40% in study arm and 50% and 26% in control arm (P - 0.005).Esophagitis (70% vs. 63.3%), skin reaction (70% vs. 63.3%), and radiation-induced pneumonitis (50% vs. 43.3%) were thecommon toxicities with no statistical significance between the two groups. Overall, there was mild chemotherapy-related toxicity.Conclusions: The combination of HFX radiation with weekly paclitaxel is effective treatment with a moderate degree of toxicityin stage IIB/III NSCLC. An average response to treatment and the use of lesser drugs have made us to consider this therapyin locally advanced NSCLC.

Optical coherence tomography macular findings after successful scleral buckling in eyes with compromised visual status

Objective: To determine the optical coherence tomography [OCT] macular findings after successful scleral buckling in eyes with compromised visual status. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan, from February 2015 to November 2016

Methodology: Patients with postoperative best corrected visual acuity [BCVA] less than 6/6, successful scleral buckling, and flat macula clinically, aged 18-70 years, were included. OCT scan [OCT-Spectralis, Heidelberg Engineering, GmbH 69121] of central 30 degrees around fovea was performed three months postoperatively. Foveal detachment, epimacular membrane [EMM] and cystoid macular edema [CME], were studied on OCT after successful buckling surgery in eyes with compromised visual status

Results: A total of 164 eyes of 164 patients [92 males 72 females] were assessed with OCT. Foveal detachment [FD] was present in 54 cases [32.9%], cystoid macular edema [CME] in 30 [18.3%], and epimacular membrane [EMM] in 11 cases [6.7%]; while no abnormality was detected in 69 [42.1%] cases on OCT

Conclusion: OCT is very helpful in identifying the cause of limited visual recovery after successful retinal detachment [RD] surgery

Surgical evacuation extradural hematoma under local anesthesia

Extradural hematoma as a result of traumatic injury is a serious neurological emergency that required immediate intervention. The standard protocol is to identify the condition at earliest and provide quick surgical evacuation of the hematoma. The situation tends to be fatally deteriorating and marks a high mortality rate and worse health outcomes. We have presented a case of extradural hematoma in this study where the surgery had a delay due to the unavailability of general anesthesia. However, the falling Glasgow Coma Scale scores encouraged the surgeons to induce the surgical procedure with the employment of local anesthesia. The intervention turned out to be successful and produced the possibility of using local anesthesia as an alternative in case of critical emergency situations in order to save a life

Acute sub dural hematoma with extra dural hematoma evacuation in ventricular septal defect patient using conventional craniotomy under local anesthesia following peer regimen

Background: extradural hematoma [EDH], and acute subdural hematoma [ASDH] are common pathologies encountered in neurosurgical emergencies following traumatic injuries usually secondary to road traffic accident, assault and fall. Both extradural hematoma and acute subdural hematoma have dreadful effects on patient's health if not managed properly and timely and even lead to death. The standard treatment for such problems is conventional large craniotomy under general anesthesia to prevent fatal outcomes

Method: we have presented a case of ASDH with EDH in a patient having history of large ventricular septal defect and due to large ventricular septal defect patient had delay in getting fitness and alongside patient had fallen Glasgow Coma Scale [GCS] which encouraged surgeon to perform the surgery under local anesthesia by following Peer Regimen

Results: the outcome of case turned fruitful and providing possibility of Local anesthesia [Peer Regimen] as an alternate in case of critical emergency to save life of patient

Conclusion: acute Subdural hematoma with either concomitant ventricular septal defect or alone can evacuated safely under local anesthesia using Peer regimen. Further studies should be carried to know the more benefits of procedure and potential hazards of procedure and to improve outcome from this lethal type of brain injury

Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules

Objective: To determine diagnostic accuracy of sonographic criteria in differentiating benign from malignant solid thyroid nodule by using new sonographic classification system

Study Design: Cross sectional validation study

Place and Duration of Study: Department of Radiology, Combined Military Hospital Multan from Oct 2014 to Mar 2015

Material and Methods: A total of 150 consecutive cases of either sex ranging in age from 19-60 years with palpable thyroid nodules referred for diagnostic workup were subjected to ultrasound [US] examination for assessment of solid thyroid nodules and it was followed by US-guided fine-needle aspiration [FNA] of all solid thyroid nodules. Each of the biopsied nodule was subsequently placed into one of five categories on the basis of sonographic features i.e. [malignant] [suspicious for malignancy] [borderline] probably benign] and [benign]. Evaluation of accuracy of sonographic diagnosis for solid thyroid nodule was done by comparing results of fine needle aspiration biopsy [FNAB]

Results: The mean age of the patients [n=150] was 42.34 +/- 4.78 years; seventy three percent [n=109] were females and twenty seven percent [n=41] were males. Frequency of thyroid nodules [on FNAB as gold standard] was revealed as 20.7% [n=31] malignant and 79.3% [n=119] benign, accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, keeping FNAB as gold standard showed 18.7% [n=28] true positive, 4.7% [n=7] false positive, 2% [n=3] false negative and 74.6% [n=112] true negative

Ultrasound finding has sensitivity of 90.3%, specificity of 94.12% and diagnostic accuracy of 93.3%

Conclusion: Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, while keeping FNAB as gold standard was high and is recommended for diagnosis of malignant solid thyroid nodules

Bilateral renal lymphangiectasia with ascites and pleural effusion

A 42 year male patient with complaints of dull abdominal pain and hematuria for 01 year was referred by Nephrologist for abdominal ultrasound [USG]

USG demonstrated echogenic kidneys, perinephric and renal sinus cystic fluid collections bilaterally with minimal ascites and mild right sided pleural effusion. The USG findings were confirmed by computed tomography [CT] and magnetic resonance imaging [MRI] scan and were characteristic of renal lymphangiectasia. Awareness regarding renal lymphangiectasia will result in early diagnosis and management and decreased morbidity

Visual outcome after pars plana vitrectomy in diabetic vitreous hemorrhage

Objectives: To determine visual outcome and frequency of complications after pars plana vitrectomy in diabetic vitreous hemorrhage

Methodology: This was interventional case series conducted at department of ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 2013 to June 2014. Known diabetic patients above 16 years of age, having vitreous hemorrhage were included. Standard three ports pars plana vitrectomy [PPV] with membrane peeling, endolaser and without endotamponade by single study surgeon was done in all patients. Best corrected visual acuity was noted pre operatively and on 1st day, 2nd week and 8th week post operatively. P- value <0.05 was considered statistically significant. Post-operative complications and visual improvement were noted at final visit

Results: Total of 50 patients having diabetic vitreous hemorrhage were included in the study. Mean age was 41.4 years. Male patients were 66%. Clear lens was present in 46% patients and cortical lens vacuoles in 36% patients. Fresh vitreous hemorrhage was present in 80%. Baseline and final post-operative best corrected visual acuity logarithm minimal angle of resolution was 1.01 +/- 0.17 and 0.74+/- 0.25 respectively. The difference in pre and post-operative best corrected visual acuity logarithm minimal angle of resolution was 0.045 which was statistically significant. There were no post-operative complications in 82% patients. Visual improvement was observed in 82%

Conclusion: Most patients with diabetic vitreous hemorrhage regain or retain useful vision after PPV. Many patients may suffer late complications like recurrent vitreous hemorrhage and retinal detachment after successful initial surgery requiring secondary intervention

Open globe injuries with intraocular foreign body: surgical outcome

Objective: To determine surgical outcome and residual co-morbidities after surgical intervention in eyes having Open Globe Injury [OGI] with retained Intra Ocular Foreign Body [IOFB]

Methodology: A prospective interventional case series was carried out at the department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex [HMC], Peshawar from 1st September 2012 to 30th November 2013. Patients who were followed post-op-eratively for at least 90 days were included. Eyes having open globe injury [OGI] and intraocular foreign body [IOFB] who had surgical intervention were included in our study. Visual outcome was determined comparing final best corrected visual acuity [BCVA] with initial BCVA. Co-morbidities were noted at final follow up. For data analysis, Snellen's VA was converted to log MAR VA. Data was analyzed by SPSS version 16

Results: Total of 35 patients were included in our study. Male were 94.3% compared to 5.3% females. Mean age was 32.42 years. Bomb blast injury was cause of eye trauma in 60% cases while 40% were doing hammer and chisel work at the time of trauma. IOFB was impacted in anterior segment in 20% cases while it was impacted in posterior segment in 80% cases. IOFB removal was achieved in 33[94.28%] cases; silicone oil was used as temponade in 48.57% cases. Primary repair was required in 40% cases while rest 21[60%] eyes had self sealed wound. Primary surgical intervention in the form of Pars Plana Vitrectomy, IOFB removal with the use of intraocular magnet or forceps was carried out in 71% cases. Mean BCVA log MAR improved from initial BCVA of 2.20 to 1.20. Common comorbidities at final visit were corneal scars, macular scars and cataract

Conclusion: Bomb blast injuries are most common cause of OGI with IOFB in our region. Significant visual improvement occurs in most of the cases after skilled vitreo-retinal surgical interventions. Common ocular co-morbidities are corneal scar, macular scar and cataract

Attenuation of palmitate induced insulin resistance in muscle cells by harmala, clove and river red gum

The present study aimed to decipher the mechanism of action of selected anti-diabetic plants extracts on palmitic acid mediated insulin resistance in muscle cells. Our results showed that extract from Peganum harmala seeds, Eucalyptus camaldulensis and Syzygium aromaticum leaves, showed significant antioxidant activity. We found that these extracts were able to affect stress signalling by reducing p-38 MAP kinase phosphorylation. They also reduced phosphorylation of substrate for insulin receptor [IRS] at serine residues and increased its phosphorylation at tyrosine residues and also enhanced PKB phosphorylation. Glucose uptake was also enhanced in muscle cells after treatment with these extracts. Extracts from Lantana camara, Psidium gujava fruit and different parts of Cassia alata did not affect FFA mediated down-regulation of insulin signalling. The study conclude that seeds of Peganum harmala and leaves of Eucalyptus camaldulensis and Syzygium aromaticum enhanced insulin signal transduction and glucose uptake in muscle cells via reducing oxidative stress. As a result, these herbal extracts may be considered useful to protect from insulin resistance

Comparative analysis of blood grouping in healthy blood donor using gel card technique and tube method

Blood grouping is a vital test in pre-transfusion testing. Both tube and gel agglutination assays are used for ABO grouping. The main object of this study was to compare ABO grouping and D typing on tube and gel agglutination assay in order to assess the efficacy of each technique. A total of 100 healthy blood donors irrespective of age and sex were included in this study. Results showed that there is no significant difference between these two techniques. However, in 10 samples it was detected that the reaction strength in serum ABO grouping by gel agglutination assay is varied by only one grade when compared to tube agglutination assay. Due to numerous positive effects of gel assay it is more beneficial to implement this technique in the setups where blood banks bear heavy routine work load

Phytochemical and Antidepressant Activities of Selaginella Bryopteris (L.) Baker on Albino Mice.

Selaginella bryopteris is a pteridophytic plant belongs to the family selaginellaceae. Its familiar name is sanjeevani booti. The present study emphasized on phytochemical screening and antidepressant activity of Selaginella bryopteris on Albino mice. Phytochemical analysis was carried with a view to asses the therapeutic values and safty of plant in ethnomedicine. The results of the phytochemical screening shows the presence of alkaloids, flavonoids, phenols, tannins and results of the quantitative estimations revealed that maximum amount of alkaloids are present in methanolic extract when compared to flavonoids, phenols and tannins. From the results of the phytochemical estimations methanolic extract is found to be efficient. The antidepressant activity of Selaginella bryopteris was tested on mice by Hole board test and Rotarod test. In both the tests Diazepam (depressant/ for inducing depressant) is used as standard. The results of the Hole board test showed significant motar performance (head dipping behavior) with the dose of 250mg/kg (48.66±4.05 at 120min) and 500mg/kg ( 69.33±6.36 at 120min) compared to standard of 10mg/kg (1.66±1.20 at 120min) and it was very interesting to note that retention time of mice has been significantly improved in Rotarod test with the dose of 250mg/kg (3.96±0.35) and 500mg/kg (7.23±0.46) of the methanolic extract of Selaginella bryopteris.

When drotaverine [No-Spa] injected in to the perivascular tissues of internal mammary artery [IMA] relives the peri-operative vascular spasm and increases the blood flow in IMA when used as a pedicle graft in CABG

To compare two groups of patients submitted to different modes of delivery of Drotaverine and its effect on internal mammary artery spasm during Coronary artery by pass grafting at The National Institute of Cardiovascular Diseases, Karachi. Experimental study. This study was carried out at the National Institute of Cardiovascular Diseases Karachi from 1[st] Jan 2013 to 31[st] December 2013. Data was analyzed from one hundred patients who underwent CABG at our institute. They were divided into two groups: Group 1 consisted of 50 patients in which Drotaverine [No-Spa] was sprayed topically over the IMA: Group 2 also consisted of 50 patients in which Drotaverine [No-Spa] was injected with blunt needle in the peri vascular tissue of IMA. After Drotaverine application, the mean blood flow were significantly low in Group I was 117.2 +/- 4.87ml/min as compared to Group II which was 136.2 +/- 7.11 ml/min [p<0.01]. Result of our study suggests; Drotaverine injected perivascularly better relieves spasm of internal mammary artery and increases the blood flow