Age-Related Patterns of Symptoms and Risk Factors in Acute Coronary Syndrome (ACS): A Study Based on Cardiology Patients' Records at Rehman Medical Institute, Peshawar.

Introduction Acute Coronary Syndrome (ACS) is a critical condition characterized by reduced blood flow to the heart and includes various conditions such as ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. Objectives The aim of this study was to investigate age-related patterns of symptoms and risk factors in ACS patients and to evaluate how diagnostic test results differ among various age groups of ACS patients. Methodology This retrospective study was conducted from May to November of 2023 on patients with acute coronary syndrome admitted to the cardiology ward of Rehman Medical Institute (RMI), Peshawar. The sample size was 137 ACS-diagnosed patients based on the inclusion and exclusion criteria. After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2022 based on proforma with the variables demographic data, troponin I level, presented symptoms, and associated co-morbidities of the patients. The inclusion criteria were patients of all genders, patients diagnosed with Acute Coronary Syndrome (ACS), and patients whose records were available in the cardiology department of Rehman Medical Institute.  Results The results show that ACS is more prevalent in the age group of 50-69 years (p=0.037) and is significantly more common in males (p=0.019). Chest pain emerged as the predominant symptom, with a significant association of p=0.029 between chest pain and patients of ACS in the age group 30-49 years. While raised troponin I levels were prevalent across all age groups. Moreover, specific risk factors such as diabetes mellitus, hypertension, and family history of CAD showed the significance of p= 0.04, p=0.006, and p=0.021, respectively, with the age group 50-69 years old. Conclusion This study highlights the importance of considering age and gender in ACS management and provides insights into age-related patterns of symptoms and risk factors, which can contribute to optimizing preventive strategies and improving patient care. Further research is needed to explore the underlying mechanisms and assess long-term outcomes in different age groups.

Congenital Afibrinogenemia With Facial Haematoma.

Congenital afibrinogenemia is a rare inherited blood disorder characterized by a deficiency of fibrinogen, leading to abnormal blood clotting. It is caused by mutations in fibrinogen genes and results in a propensity for bleeding. We present the case of a one-year-old male child with congenital afibrinogenemia who developed a left-sided facial haematoma following a fall from a walker. The child had a history of active bleeding during cannulation and had not undergone circumcision due to the risk of bleeding. This case highlights the need for timely diagnosis and appropriate management of rare bleeding disorders such as congenital afibrinogenemia. Collaboration between different specialties, including haematology and genetic counseling, is crucial for comprehensive care. The rarity of the condition underscores the importance of raising awareness among healthcare professionals. Genetic counseling and family studies are essential for assessing genetic implications and guiding decision-making. Further advancements in diagnostic tests and replacement therapy are needed to improve the management of patients with afibrinogenemia, particularly in regions with a high prevalence of consanguineous marriages.

Association Between Venous Thromboembolism Prophylaxis and the Incidence of Thromboembolism Following Orthopedic Procedures: A Cross-Sectional Study.

INTRODUCTION: Venous thromboembolism (VTE) is a significant concern following orthopedic procedures, necessitating effective prophylactic measures. The rates of VTE prophylaxis, however, vary widely between institutions and nations, falling between 13% and 70% on average. In the absence of adequate thromboprophylaxis, pulmonary embolism, which accounts for 5% to 10% of mortality in hospitalized patients, is one of the leading causes of death. This study investigates the relationship between VTE prophylaxis and thromboembolism incidence, considering patient characteristics, risk assessment completion, anticoagulant prescription, and weight-bearing status. OBJECTIVES: To evaluate the knowledge gap by examining the relationship between VTE prevention and the prevalence of thromboembolism also to examine the anticoagulant prescription trends for patients being discharged from orthopedic operations and to investigate the connection between post-procedure weight-bearing status and the development of VTE problems. METHODOLOGY: A retrospective, cross-sectional design was employed, analyzing 200 orthopedic procedure patients from January to June of 2023 performed at Rehman Medical Institute. After getting ethical approval from the institutional ethical approval board, data were collected on the basis of variables encompassing patient attributes, surgery details, VTE risk factors, prophylaxis type, and VTE complications. Data was entered and analyzed via IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were then presented in the form of a table. RESULTS: Among 200 individuals 24 individuals experienced VTE, while 176 did not. Significant gender-based VTE differences were observed (p = 0.01). Hypertension (HTN) showed a significant association (p = 0.04) with VTE. Major surgeries were correlated with higher VTE incidence (p = 0.03). Pharmacological prophylaxis reduced the occurrence of VTE (p = 0.01). Early mobilization and Ted stockings were correlated with lower VTE incidence (p = 0.04, p = 0.12). CONCLUSION: This study reveals gender-specific VTE differences, emphasizes the role of HTN, surgical nature, and prophylaxis in VTE incidence, and supports tailored prophylactic strategies. Our findings align with previous research and emphasize the significance of tailored prophylaxis strategies. By examining multiple factors, including gender, co-morbidities, surgical characteristics, and prophylactic methods, our study contributes to the evidence base that supports clinical decision-making and enhances patient safety in orthopedic surgery.

A Case Report of Chilaiditi's Syndrome With Sigmoid Volvulus.

Chilaiditi's syndrome is the hepatodiaphragmatic interposition of the colon. It can be caused by any pathology of intestinal, hepatic, and diaphragmatic factors. Any anatomic variations or functional abnormalities can increase the development of Chilaiditi's syndrome. It is usually asymptomatic and is found indecently in radiological studies. It is treated conservatively as long as any complications do not arise. This case of Chilaiditi's syndrome was associated with sigmoid volvulus and multiple tubercles on its surface. A 35-year-old male patient presented to the outpatient department (OPD) with complaints of weight loss, bilateral flank pain, abdominal distention, decreased appetite, vomiting, and diarrhea. CT scan showed a grossly distended loop of the colon with sigmoid volvulus and Chilaiditi's sign. A laparotomy was done, sigmoid volvulus was relieved, a biopsy of tubercles was taken for histopathology, and a colostomy was done. The biopsy result showed abdominal tuberculosis. The colostomy was later reversed. Chilaiditi's syndrome is usually treated surgically because it is associated with other complications in the gastrointestinal tract. Previous studies showed the management of cases by colonic resection with primary anastomosis; however, there was one case that reported mortality due to an anastomosis leak. In this article, we present a case of Chilaiditi's syndrome associated with sigmoid volvulus and abdominal tuberculosis as seen on biopsy, which was managed surgically by colostomy followed by colostomy reversal on follow-up.

Incidental Finding of Post-Transplant Erythrocytosis After Renal Transplantation in a Patient With Chronic Kidney Disease: A Case Report.

Renal transplant aims to provide a healthy substitute for the chronically damaged kidney while also correcting the anemia of chronic disease by producing erythropoietin for effective erythropoiesis. However, in a small number of renal transplant patients, the hematocrit continues to rise even after correction of the anemia, ultimately leading to abnormally increased hemoglobin and hematocrit. This condition is termed "post-transplant erythrocytosis" (PTE). We present a case of a 50-year-old male who was diabetic, positive for hepatitis B surface antigen, and negative for polymerase chain reaction. He presented with symptoms of acute hepatitis. During the work-up, PTE was diagnosed. Our case sheds light on a common complication of renal transplant known as PTE, its possible complications in the patient, and the necessary interventions to prevent untoward outcomes. PTE, although a less common complication of renal transplant, can become serious and potentially fatal due to its sequelae of thromboembolism. The complications can range from simple thrombophlebitis and thrombosis of digital and brachial arteries to more severe events such as pulmonary embolism or stroke and cardiovascular events. Regular post-transplant follow-ups with frequent bloodwork will aid in the early diagnosis of PTE, allowing for timely intervention with appropriate treatment options such as venesection or angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme (ACE) inhibitors.

Ciprofloxacin-Induced Acute Delirium in a Young Female.

Ciprofloxacin is a commonly used drug in our setup. Neurological disturbances are rare side effects of its use and are reported in older adults, patients with comorbidities, or patients with a background of psychiatric illness and antipsychotic drug use. We report the case of a 21-year-old female who developed delirium after taking ciprofloxacin for a urinary tract infection. She underwent extensive workup and her final diagnosis was based on the exclusion of other causes. Her symptoms completely settled within three weeks of ciprofloxacin discontinuation.

Feto-Maternal Outcomes and Treatment Compliance in Metformin Versus Insulin-Treated Gestational Diabetic and Non-Diabetic Patients at the Rehman Medical Institute, Peshawar.

Introduction Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The diagnosis is made on the basis of the oral glucose tolerance test (OGTT) which according to the guidelines of ACOG regards a blood glucose level higher than 190mg/dL after the one-hour test as the criteria for GDM. The first-line agent for GDM is insulin injections; however, it has high costs and also causes its own feto-maternal complications which can include weight gain and polyhydramnios. On the contrary, metformin has fewer complications, is cheaper, and is emerging as a better alternative for the first-line agent for the treatment of diabetes mellitus type 2. GDM had a prevalence of 11.8% in the year 2018 in all trimesters of pregnancy in Pakistan. This study was thus conducted to determine the feto-maternal outcomes of non-GDM and GDM patients on insulin, metformin, and combined treatment respectively admitted to gynecology ward Rehman Medical Institute (RMI) Khyber Pakhtunkhwa, Pakistan in the year 2019. Objectives To determine the feto-maternal outcomes in patients of GDM on metformin treatment and the feto-maternal outcomes in patients of GDM on insulin treatment and to compare the feto-maternal outcomes of mothers with GDM to those without GDM. Methodology This is a retrospective study conducted from January to April 2020 on patients of gestational diabetes mellitus undergoing either metformin, insulin, or both therapies admitted to the gynecology ward, Rehman Medical Institute (RMI). After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2019 on the basis of proforma with the variables: demographic data, glycemic control (via OGTT), mode of labor, primary open-angle glaucoma (POAG), and feto-maternal outcomes. Data was entered and analyzed via SPSS version 21.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY) and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were formulated on the basis of these reports which were then presented in the form of graphs and tables. Results Out of 150 mothers who were admitted for delivery at the gynecology ward, 123 (82.0%) women were 30-40 years of age. Non-gestational diabetics patients were 78 (52%) whereas gestational diabetic mothers were 72 (48%); within these GDM-positive mothers 44 (61.1%) were on metformin, 21 (29.1%) were on insulin and seven (9.7%) were on combined treatment. Among modes of delivery, C-section was the most common (113 [76%]), mostly in non-GDM mothers (95 [45.1%]) followed by those on metformin treatment (36 [31.8%]). Considering fetal outcomes there was a significant association between NICU admissions, neonatal jaundice, and breech presentation with insulin-treated mothers (p=0.06, p=0.003, p=0.004, respectively CI=95%). Among maternal outcomes, there was a significant association between pregnancy-induced hypertension (PIH) and insulin-treated patients (p=0.02 CI=95%), premature rupture of membranes (PROM), and metformin-treated patients (p=0.01 CI=95%) whereas eclampsia was significantly associated with mothers not having GDM (p=0.001 CI=95%). Conclusion Based on this preliminary data and considering feto-maternal outcomes, metformin appears to be a safer drug as compared to insulin in the treatment of GDM with more compliance.

Case Report on Crossed Fused Renal Ectopia With a Large Calculus and Its Management.

Among congenital renal anomalies, the ectopic kidney is a rare occurrence. Crossed fused renal ectopia (CFRE) - an even rarer subtype of ectopic kidney - is characterized by both kidneys being fused together on one side of the spine. CFRE is usually asymptomatic but can present with vague symptoms if the anomalous kidney becomes infected, is obstructed by calculus, or has a neoplastic change. There is no indication for surgical intervention if the kidney functions normally. This report presents a case of CFRE in a 31-year-old male with recurrent right flank pain resulting from a large calculus in the upper moiety of the fused kidney. The calculus was surgically removed by percutaneous nephrolithotomy (PCNL). The patient was discharged on analgesics, antibiotics, and potassium citrate tablets, with an order to follow up after one month. On follow-up, the patient's double-J (DJ) stent was removed and an X-ray was performed to rule out any complications. No signs of stones, strictures, or other complications were noticed.

An Undiagnosed Case of Chronic Pancreatitis With Multiple Visceral Arteries Pseudoaneurysm.

Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient's fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.

Thrombotic Sequela of Asymptomatic COVID-19 Infection.

Severe coronavirus disease 2019 (COVID-19) is known to be associated with thrombotic events like ischemic stroke. However, in the case of mild or asymptomatic disease, a thrombotic event like ischemic stroke is rare and has never been reported in our country. We present the case of a 28-year-old male patient with no co-morbidities who was diagnosed to have ischemic stroke involving the basilar artery. No risk factors for ischemic stroke could be found except for post-COVID-19 status, evident by the presence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).