SSR based Characterization of Indigenous Harnai Sheep Breed of Balochistan

This study was on the molecular characterization of Harnai sheep breed in Balochistan. A set of (n=16) ovine specific SSR markers, recommended by FAO, was used on (n=50) blood samples from unrelated animals of Harnai sheep breed from their breeding tract. Various genetic parameters were observed using Pop gene software. A total of 74 alleles were found on 13 loci. The finding values for observed number of alleles (Na), effective number of alleles (Ne) and Shannon’s Information index (I) the average values were found along with standard deviation to be 2.448±0.869, 1.7050.604 and 0.5890.357 respectively, further more, the mean values of observed heterozygosity (Obs_Het) expected homozygosity (Exp._Hom), expected heterozygosity (Exp_Het), effective number of allele (Ne) average Heterozygosity (Ave Het) were found to be 0.598±0.299, 0.366±0.284, 0.602±0.238, 0.363±0.219, 0.347±0.209 and 0.347±0.209, respectively. The value of F-statistic ranged from 0.2851 to 0.9132 for different microsatellite markers with an average of 0.515±0.021. Majority of the markers showed higher than average expected reduction in heterozygosity. The standard errors were generally low, which indicated that homozygosity prevails in the population under study. This might be due to intense inbreeding in this flock of Harnai sheep.

Surgical Site Infection and its Relation with Prophylactic Antibiotics Prescription Pattern in a Tertiary Care Hospital of North India

Background: Contribution of antibiotic prophylaxis in reducing surgical site infection for some procedures is well known. In spite of knowledge about the effectiveness of antibiotic prophylaxis, its administrative regimens are often inappropriate. Objectives: To study the pattern of use of preoperative prophylactic antibiotic and its relationship with surgical site infection (SSI) in a tertiary care teaching Hospital. Methods Hundred case records files of patients admitted in surgical wards of Jawaharlal Nehru Medical College, Aligarh who had undergone open bowel surgery, were randomly selected from the Central Record Section and analyzed for prescription pattern for prophylactic antibiotics according to World Health Organization prescribing indicators for number of antibiotics, antibiotics prescribed by generic name and antibiotics prescribed from ‘Essential Medicines’ List per encounter. Cost of antibiotics, commonly prescribed antibiotics and timing of administration were also studied. Patients who developed surgical site infection and those who did not were compared statistically. Results: Commonly administered antibiotics were Ceftriaxone, Metronidazole and Amikacin given intravenously just before surgery. No relationship was seen between patient’s age, type of surgery or site of disease and choice of antibiotics. No drug was prescribed by generic name. Total cost on antibiotics was Indian Rupees 73.1 to 218.0. Surgical site infection developed in 40 patients. No significant relationship found between administration of any antibiotics or their cost and development of surgical site infection. High degree of resistance to Fluoroquinolones followed by second and third generation Cephalosporins was found in infecting organisms. Conclusions: Prescribing pattern was not based on World Health Organization criteria for rational use of drugs and not evidence based. This study indicates the need for interventions to improve rational use of antibiotic prophylaxis in India.

Antibacterial Activity of Nigella Sativa Linn. Seeds Against Multiple Antibiotics Resistant Clinical Strains of Staphylococcus aureus

Objective: Staphylococcus aureus is one of the major resistant pathogens extremely adaptable to antibiotic pressure. Nigella sativa (black cumin) seed extracts and essential oil have been shown to possess antimicrobial activity against several bacteria but little work has been done on their effect against multidrug resistant S. aureus strains isolated from patients. So, we studied antibacterial activity of Nigella sativa against multidrug resistant clinical strains of Staphylococcus aureus. It was an experimental, in vitro study. Materials and methods: Nigella sativa (black cumin) seed essential oil and extracts were tested in varying dilutions against 40 clinical strains of Staphylococcus aureus which were isolated from patients attending a tertiary care teaching hospital in North India using disc agar diffusion technique on inoculated Muellar Hinton agar plates under standard laboratory conditions. The tested strains were resistant to 4 or more clinically used antibiotics belonging to at least 3 different classes. Results: The Methanolic extract and oil of Nigella sativa were found active against 38 and 35 multi-drug resistant strains respectively. Both the oil and Methanolic extract showed remarkable dose dependant antibacterial activity against the tested strains up to a dilution of 1:50 as evident from the zones of inhibition. Conclusion: Nigella sativa possesses antibacterial activity against multidrug resistant clinical strains of Staphylococcus aureus

Evaluation of albumin, fibrinogen levels with orthopedics traumatic patients' outcome after massive transfusion in tertiary care hospital at Peshawar

Objective: Objective of study was assessment of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion

Study Design: Observational / cross sectional study

Place and Duration of Study: This study was carried out at orthopedic department of a tertiary care Hospital, Peshawar from March 2014 to July 2015

Materials and Methods: In all patients, the initial resuscitation was performed as soon as admitted to the emergency room. Blood samples were obtained at admission and after 24 h. Part of the serum was frozen and stored at -70°C for determination of fibrinogen and albumin by an immunoturbidometric assay. Electrolytes, hemoglobin, and hematocrit levels were measured on admission. For early restoration, normal saline or ringer was used, clinical events were recorded thereafter until death or hospital discharge

Result: We were studied forty six traumatic patients with severe limb injuries and result showed that 20 patient [41.3%] and 27 [58.7%] were alive

There was significant difference outcome observed in fibrinogen level after 24 h and in case of albumin levels, there was no significant difference observed

Conclusions: When orthopedics traumatic patients received massive transfusion, fibrinogen level play significant role in determination of these patients, while serum albumin is not important factor

Phenytoin induced Stevens-Johnson syndrome in a 38 year male patient: A Case Report

Adverse drug reactions (ADRs) are one of the leading causes of death among hospitalized patients and occur in 0.3 to 7 per cent of all hospital admissions. These may vary from mild rashes to severe reactions such as Stevens-Johnson syndrome (SJS). Antiepileptic drugs-induced SJS is a life-threatening severe cutaneous adverse reaction. We report here a case of phenytoin induced SJS in a 38 year old male patient presenting at emergency room. The patient responded to the treatment and was prescribed tab. Levetrecitam and remained symptom free since then.

Outcome of operative and non operative treatment of glenoid fossa fractures in a tertiary care hospital in Peshawar

This study was aimed at reviewing operative and nonoperative treatment of Glenoid fossa fractures in our hospital and view to identifying measures necessary to improve outcome. Retrospective study. This study was conducted at Orthopedic Department of Lady Reading Hospital, Peshawar from March 2012 to July 2014. 21 patients of glenoid fossa fractures were included in this series with 14 males and 7 females. Patients with displacement of >5 mm who were fit to undergo surgery within 3 weeks of injury were operated using a posterior Judet's approach. Overall 8 patients with displaced fractures were operated [Group A] while 9 patients with displaced fractures [Group B] and 4 patients with undisplaced fractures [Group C] were managed nonoperatively. The incidence of associated injuries was 57.14%. The mean length of hospital stay was 15.3, 32.5, and 3.9 days in groups A, B, and C, respectively. In group A, average constant score was 86.98. The least constant score was observed for group B [57.97] while group C had an average constant score of 85.9. Brachial plexus injury and fracture-dislocations had poorer outcome. Operative treatment for displaced glenoid fractures is a viable option at centers equipped to handle critically ill patients and subset of patients with fracture-dislocation as opposed to fracture alone should always be treated operatively due to persistent loss of function

Risk factors for renal dysfunction after total hip joint replacement in one territory care hospital in Peshawar

Objective: The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surgery

Study Design:Observational cohort study

Place and Duration of Study: This study was conducted in Orthopedic Department of Lady Reading Hospital, Peshawar from March 2013 to February 2014

Materials and Methods: A study was conducted among 212 consecutive primary hip joint replacements performed. According to the RIFLE criteria, increased postoperative serum creatinine was considered indicative ofpostoperative renalinjury

Results: Eighty-one patients [14.1 %] had significant moderate or severe postoperative renal dysfunction in which4 patients [1.9 %] acquired severe and permanent renalimpairment

Conclusion: We identified advanced age, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors

Outcome of nonunion femur with Ilizarov technique

Objective: to find the outcome of Ilizarov technique in nounion femur patients

Study design: descriptive case series

Place and Duration of study: department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from 1999 to 2014

Methodology: all patients with nonunion of femur with and without bony defect were included in this study. Bone loss cases because of other reasons like congenital causes and bone tumors, were excluded

Results: forty-eight patients with nonunion femur were included in this study. The number of males was 44 and females 4. The mean age of patients was 27 year [range: 07 year to 59 year]. The mode of injury was road traffic accident in fifteen patients, firearm injury in five, crush injury in earthquake in one, postsurgical implant infection in nineteen and chronic osteomyelitis in seven. Nonunion was in proximal femoral segment in three patients, midshaft in sixteen and distal femur in twenty-nine cases. Segmental bone loss was present in thirty-one patients. Preoperative shortening was in noted in thirty-four patients. Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in few cases

Conclusions: Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in 10 cases

Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh, Saudi Arabia

To assess the prevalence of pseudoexfoliation syndrome [PEX], and associated ophthalmic complications among Saudi patients. The prevalence of PEX and associated ocular co-morbidities were determined among the Saudi patients visiting the Primary Care Clinic of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2009 and January 2010. A total of 1967 patients were examined biomicoscopically by ophthalmologists to determine the presence of PEX and associated ocular complications. Sixty-nine of the 1967 examined patients [3.5%] showed the presence of PEX with no significant gender difference. There was an age dependent increase in the prevalence of PEX after the age of 50 years. Pseudoexfoliation syndrome was associated with higher intraocular pressure, cataract, and poor vision. There was no significant difference in the prevalence of PEX in male and female Saudi patients. Pseudoexfoliation syndrome is an age-related disorder, and its prevalence increases with age. Further larger population based studies are warranted to assess the prevalence of PEX and associated risk factors

Outcome of Internal Fixation of Fractures in a Tertiary Care Hospital in Peshawar

Objective: This study was aimed at reviewing internal fixation in our hospital and attendant complications with a view to identifying measures necessary to improve outcome. Study Design: Retrospective study Place and Duration of Study: This study was conducted at orthopedic department of Lady Reading Hospital, Peshawar from March 20 12to February 20 14. Materials and Methods: The operation register was used to identify patients who had undergone internal fixation in the main theatre of the hospital over a Three-year period were collected and their case notes were subsequently retrieved from the medical records unit of the hospital. Data pertinent to study interests were extracted using a questionnaire Results: One hundred and fifteen patients had intemal fixation during the study period but case notes of only 100 patients could be retrieved. Most patients were males with male to female ratio of 2.3:l. The mean age of patients was 32.87 and 15.2 years and the mean duration of surgery was 20.56 hours. Plate and screws constituted the most commonly used implants. Interval between surgery and fracture union was increased by long operation time [> 2. lhrs] and occurrence of post operative complications. Conclusion: Improvement in operating facilities and choice of implants would reduce operation time and post operative complications thereby impacting positively on fracture union time

Comparison of pore size analysis of existing and experimental surgical gowns

Majority of the public and private sector hospitals are using reusable gowns and scrubs whereas only a few hospitals are using disposable ones. Protection during surgery is very important both for the patient as well as for the surgeon. The reasons are not only hygienic but also creating a barrier so that the bacteria and the viruses do not transfer from patient to doctor and vice versa. The surgical gowns have been in use for many decades. With the advancements in the field of manufacturing [weaving and finishing], the quality of gowns has been improving over the period of time. In Pakistan, there is no awareness yet regarding the construction of surgical apparels viz. surgical gowns and scrubs so no standards are being followed as such during the manufacturing [weaving and finishing] of surgical apparels. For effective barrier function of surgical gowns and scrubs, it is necessary for them to comply with certain standards in terms of physical characteristics viz. mass per unit area, number of threads per unit length, tensile strength etc. The idea behind this study was to evaluate the physical characteristics of surgical gowns and scrubs currently being used in different public sector hospitals of Lahore. [1] To evaluate the pore size of existing and experimental surgical gowns being used in different hospitals of Lahore. [2] To compare the pore size analysis of existing surgical gowns with experimental surgical gowns. Experimental study design was used. January 2014- April 2014. Samples of fabric used for making surgical gowns and scrubs were collected from different hospitals of Lahore and evaluated for pore size with the help of optic microscope. For experimental gowns the fabric was developed according to the international standards. Pore size of surgical gowns was measured with the help of scanning electron microscope. The results showed large pores in existing surgical gown. No length or width wise pores in the experimental surgical gowns fabric except there are tiny holes of 0.5 after 20 launderings. The existing reusable surgical gowns did not offer any resistance against bacterial penetration because of large pores. The fabric used for the existing surgical gowns was not up to the mark and did show large pores under microscope. The experimental surgical gown showed no pores in the fabric structure when subjected to scanning electron microscope. The functional ability of resistance against bacterial penetration of the surgical gowns is important because the risk of SSI. If the patient develops SSI weather it is grades 1, 2 or 3, the cost is significant. The cost effectiveness of the existing reusable surgical gowns becomes insignificant as none of the existing surgical gowns offer any resistance against bacterial penetration and the risk of SSI with subsequent treatment cost. Necessary guidelines can be formulated and proposed to the concerned departments of various hospitals, in the light of which they can design some specifications and select appropriate materials for surgical apparels in future

Effect of increasing dialysate flow rate on achieved kt/v in patients on maintenance hemodialysis

Background: In patients suffering from End Stage Renal Disease [ESRD] life can only be sustained by renal replacement therapy, including renal transplant or dialysis, which can be peritoneal dialysis or hemodialysis. Adequate dose of hemodialysis must be offered to patients for better quality of life. Hemodialysis adequacy, Kt/V, is one of the most important issues influencing the survival of patients on maintenance hemodialysis. Some patients do not achieve target Kt/V even with extended treatment time or by increasing blood flow rates. These patients have poor quality of life because of toxic effects of uremia, decreased appetite, metabolic complications of renal failure. These selected patients can be offered adequate dialysis by increasing dialysate flow rate, hence achieving adequate Kt/V, so quality of life can be improved

Objective: This study was conducted to determine the effect of increasing dialysate flow rate from 500 ml/min to 800 ml/min on achieved Kt/V, in under dialyzed patients who were on thrice weekly regular hemodialysis and were not achieving required Kt/V

Patients and Methods: This cross sectional study was conducted in hemodialysis unit, Sheikh Zayed Hospital, Rahim Yar Khan from 1 st November 2011 to 3 Oth April 2012. We included 100 regular under dialyzed patients using Fresenius 4008S dialysis machines, equipped with online clearance modules [OCM] to measure Kt/V. The patients were dialyzed for 4 hours, at dialysate flow rates 500ml/min and then 800ml/min each session. OCM-based single pool Kt/V was noted at the end of each dialysis session. The difference between two Kt/V was noted

Results: When 100 underdialyzed patients who were previously dialyzed at Qd 500ml/min, were offered 4 hour dialysis with Qd of 800ml/min, 87% patients achieved target Kt/V of > 1.2. While 13% still did not achieved target Kt/V. So a significant number of patients were able to have adequate dialysis

Conclusion: Some patients did not achieved required target Kt/V>1.2 on conventional dialysate flow rate of 500ml/min despite of extended treatment time and optimized blood flow rates and hence were underdialyzed. But they achieved Kt/V > 1.2 when dialyzed for 4 hours at Qd 800ml/min. So it is concluded that better dialysis can be offered to these selected patients by increasing dialysate flow rate from 500ml/min to 800ml/mm, achieving better Kt/V and thus quality of life can be improved

Comparision of efficacy of levocetirizine with montelukast and levocetirizine alone in persistent allergic rhinitis

To compare the efficacy of levocetirizine with montelukast and levocetirizine alone in patients with persistent allergic rhinitis in our setup. Patients with symptoms of AR attending ENT clinic were registered and divided into two groups based on drug given. Patients with odd numbers were included in group A receiving levocetirizine 5mg with montelukast 10mg once daily while patients with even numbers were included in group B receiving only levocetirizine 5mg once daily. Data was collected at visit 1 prior to medication, visit 2 one week after medication and visit 3 two weeks after medication. Medication history review, nasal symptom assessment and anterior rhinoscopy were done at each visit. Patients were evaluated for rhinorrhea, sneezing, nasal itching and nasal obstruction on a scale. Total symptom complex score [TSCS] was calculated by adding scores of all four variables under study using proforma. Lower the score more effective will be the drug. One hundred twenty four patients were included in study; 63 were male and 61 were female. TSCS was 9 -10 in 73.3% patients at visit 1 in levocetirizine + montelukast group that improved to 4-5 in 28.3% and 3- 4 in 65% patients at visit 2 and 3 respectively. Patients receiving levocetirizine alone had TSCS of 9 to 10 in 52.9% at visit 1 with an improvement to 3-4 in 9.4% and 49.1% at visit 2 and visit 3 respectively. Levocetirizine with montelukast is superior to levocetirizine alone in controlling overall symptoms of AR.

Growth hormone therapy; classic short stature children

To detect growth hormone deficiency in short stature children and to observe the response of growth hormone replacement therapy in isolated GH deficient. An interventional descriptive study. The study was carried out in the Department of Pediatrics at Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Pathology Rawalpindi over a period of two years from Jan 2007 to Dec 2008. Thirty short children between three to fourteen years of age having isolated growth hormone deficiency confirmed by laboratory investigation were included in the study prospectively and retrospectively. Growth hormone replacement therapy with recombinant GH was given to all children at the dose of 0.14iu/kg, six days a week subcutaneously. Each patient was assessed and evaluated after every three months. The mean chronologic age was 8.05 +/- 2.74 years with a height age of 4.02 years. The male to female ratio was 1.72:1. They were treated with recombinant GH in a dose of 0.14iu/kg, six days a week, subcutaneously at evening. Response to GH was excellent and the mean growth speed had gone up from 2.53 +/- 0.87 cm per year before the treatment to 8.94 +/- 3.18 cm / year in the first twelve months of treatment and 6.8 +/- 1.6 cm / year during the second year of treatment. During the first twenty four months of treatment, height standard deviation score increased by 1.0 +/- 0.4 SD [p < 0.0001] The height velocity increased, the bone age / chronological age ratio and height SDS for chronological age decreased, while height SDS for bone age increased. There were no adverse reactions. Short stature with classic growth hormone deficiency is not uncommon. Early diagnosis and prompt treatment with growth hormone replacement has a very good outcome and the child attains a reasonable height

Carpal tunnel syndrome

Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. The symptoms of CTS include pain, paraesthesia and hypoesthesia in the hand, in the area innervated by the median nerve, and often occurs or worsens during the night or early morning, waking the patient up. Physical examination and nerve conduction studies are used to diagnose this condition. Early diagnosis and treatment of CTS are important because any delay can cause irreversible median nerve damage. To highlight the role of physical examination and nerve conduction study in the diagnosis of CTS. Setting: Kuwait teaching Hospital Peshawar. June 2008 to June 2010. Methods: Fifty patients of carpal tunnel syndrome were studied. All patients who reported numbness and/or tingling in the median nerve distribution in the hands at least twice weekly during the preceding four weeks were enrolled to undergo clinical examination and nerve conduction tests. Following the clinical examination the symptomatic persons underwent bilateral nerve conduction tests. Out of these twelve patients were males and thirty eight were females with a ratio of 1:3.1. The age range was between 20 to 60 years. CTS was bilateral in 22 patients [44%], right-sided in 23[46%] patients and left-sided in 5[10%] patients. In addition to the clinical presentation, electrophysiology has been proposed as the standard of care for diagnosing CTS with a recommendation that it should be performed in all cases

Prevalence of diarrhoea and use of oral rehydration salt in children of rural and urban areas of Peshawar

To find out the prevalence of diarrhoea and use of oral rehydration salt [ORS] for the management of diarrhoea in rural and urban areas of Peshawar. Two areas from Peshawar districts, one rural [Palosi] and one urban [academy-town] were selected. Hundred parents from each area were interviewed based on a specially designed questionnaire. The data regarding prevalence of diarrhoea and type and mode of delivery of ORS was collected in addition to educational and socioeconomic background. Prevalence of diarrhoea was found to be more in rural area [27%] as compared to urban area [16%]. Use of ORS was more in urban area [99%] as compared to rural area [40%]. Similarly awareness regarding use of ORS was found to be more in urban area [93%] than rural are [32%]. Diarrhoea was more common in the rural area while the use of ORS and the awareness regarding use of ORS was more in the urban area

Treatment of oroantral fistula - a study

The aim of this study was to evaluate and analyze the occurrence, characteristics and treatment outcome of oroantral fistula in 29 patients from Sept 2004 to Nov 2009. These patients were examined both clinically and radio-logically for oroantral fistula. Data regarding the age, gender, cause and site of fistula and treatment outcome was evaluated and reviewed. The age range was 18-60 years with high frequency occurring in 31-40 years. Male outnumbered female. The common cause of OAF was extraction of teeth [n=25, 86.5%] followed by cysts [n=2, 6.7%]. The most common involved tooth in the causation of OAF was upper first molar [n=13, 52%]. Surgical technique used to close the fistula was buccal advancement flap. Recurrence of fistula occurred in 2 patients [6.7%] and were re-operated using the palatal flap. The merits and demerits of the procedure are discussed

Impacted mandibular third molars: pattern of presentation and postoperative complications

The purpose of this prospective study was to evaluate the occurrence, characteristics and postoperative complications of impacted mandibular third molars in 260 patients from Oct 2008 to July 2010. Clinical and radiographic examinations were carried out. Data regarding the age, gender, angulations type, depth and width of impactions and postoperative complications were evaluated and analyzed. The age ranged from 17 to 59 years with high frequency occurring in 3rd decade. The common cause for extraction was pericoronitis. Mesioangular impaction was most common [n=124, 48%] followed by vertical [n=90, 34%]. Majority of the patients presented with Class IIA [n=84, 32.3%] followed by IA [n=61, 23.5%]. Postoperative complications included persistent pain and swelling [16.5%] followed by dry socket [4.2%] and trismus [4.2%]. There was a greater risk of developing complications in horizontal and distoangular types, and in Class IIIC and IIIA impactions

In vitro antimicrobial activity of Nigella sativa seeds extracts against multiple antibiotics resistant bacteria isolated from clinical specimens

To study the effect of Nigella sativa seeds against standard and multiple antibiotics resistant bacteria. Different extracts of N. sativa L. [N.O. Family Ranunculaceae] seeds were tested in varying dilutions for antimicrobial activity against standard strains and clinical isolates of various bacteria by Agar disc diffusion technique using impregnated filter paper discs on inoculated Muellar Hinton agar plates. Commercial antibiotic sensitivity testing discs were used for sensitivity testing and comparison. Methanolic extract showed highest antibacterial activity and zone of inhibition was seen even up to 1:100 dilution. Among the tested clinical strains, resistant to a number of antibiotics, antibacterial activity was more against gram +ve than gram -ve bacteria. Among gram +ve bacteria tested, Staphylococcus aureus, Staphylococcus epidermidis other coagulase -ve Staphylococci and Streptococcus pyogenes were found sensitive to methanolic extract. Among gram -ve bacteria tested, Escherichia coli and Pseudomonas aeruginosa were found sensitive. Out of 155 strains tested, most of them were resistant to a number of antibiotics and 102 were inhibited by the methanolic extract. Methanolic extract of Nigella sativa is found active against many sensitive as well as multiple antibiotics resistant bacteria isolated from clinical specimens, even up to the dilution of 1:100 and 1:50 respectively

Comparison of enoxaparin and dalteparin with unfractionated heparin in the treatment of non-st elevated acute coronary syndrome

Background: The term non-ST elevated Acute Coronary Syndrome [ACS] encompasses unstable Angina [USA] and non-ST segment elevated Myocardial Infarction [NSTEMI], both of which may end up in death or a fatal/non-fatal Myocardial Infarction [MI]. Unfractionated heparin [UFH] has been shown to reduce death and MI in patients with USA and NSTEMI. Of late, there has been a great interest in the role of low molecular weight heparins [LMWHs] in the two conditions and they have been found to be at least as effective as or even more effective than UFH. Methods: A total of 90 patients who presented to CCU of Khyber Teaching Hospital, Peshawar with USA or NSTEMI, from June 2008 to June 2009, were enrolled into the study. An equal number of patients were randomly assigned to one of the three arms for 5 days each: Group A received enoxaparin, group B received dalteparin and group C received UFH. The primary end points of the study were all cause mortality, STEMI, refractory USA, recurrent USA or a major bleed. The secondary end point was minor bleeding. Results: At the end of the study, there were 2 deaths each in the dalteparin and UFH group, whereas no such event was recorded in the enoxaparin group. Two patients had STEMI in the UFH group but none in the other two groups. Conclusion: LMWHs are far more superior to unfractionated heparin. Keywords: Acute Coronary Syndrome, Coronary Artery Disease, Atherosclerosis, Unstable Angina, Myocardial Infarction, Unfractionated Heparin, low-molecular weight heparin