IntroductionWhile tetanus has largely been eradicated with the advent of the tetanus vaccine, its prevalence in Pakistan remains alarmingly high due to insufficient uptake of the vaccination program. The clinical presentations that the disease elicits range from mere opisthotonos to more sinister complications, including respiratory failure and death, often posing an insurmountable challenge for hospitals. MethodsA retrospective cross-sectional study was conducted and analyzed the medical charts of 43 patients with a confirmed diagnosis of tetanus infection. The charts were perused for the patients' demographics, clinical characteristics, and disease outcomes. The prevalence of various clinical symptoms and complications were reported in terms of frequencies and percentages. ResultsThe mean age of the patients hovered at 29.53 ± 16.53 years, with a range of 12 to 65 years. Of those affected, 83.7% were males while 16.3% were females. Notably, none of the infected patients had a prior history of vaccination against tetanus. Trismus was noted to be the most prevalent clinical manifestation and was found in 90.70% of the patients while paraesthesia at the site of infection, found in 6.98%, was the least prevalent. The overall mortality was noted to hover at 46.5%. ConclusionWhile tetanus has largely been eradicated, its prevalence in Pakistan remains alarmingly high. The complications noted in the study have implications for the country's public health system and aims to better inform the current state of the national vaccination program.

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To evaluate the sociodemographic and clinical characteristics of patients presented with acute selfpoisoning at a tertiary care hospital in Pakistan. Methods and Patients A comparative study was conducted at Lady Reading Hospital MTI between May 2018 to May 2019 for a duration of 12 months. All patients diagnosed with acute self-poisoning were included in the study. Patients with inconclusive diagnosis, who were dead prior to the arrival to the hospital, or had an incomplete history of poison exposure were excluded from the study. At the time of arrival to the emergency department, the patient was first stabilized. Patients were grouped into two according to the type of exposure, i.e., accidental self-poisoning and deliberate self-poisoning (DSP). Sociodemographic and clinical characteristics of patients were recorded in a preformed proforma. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 26 (IBM Corp., Armonk, NY, USA). Results The mortality rate in patients with accidental poisoning was 9.62%, whereas it was 26.28% in DSP patients. Data were stratified according to the mode of poisoning, i.e., accidental vs DSP, and variables were assessed in patients who did not survive. It was found that 60% of patients who died in the accidental group were aged 0-15 years. In contrast, only one patient between aged 0-15 years died in the DSP group and the majority of the deaths occurred in those aged 25.1-35 years (31 [75.6%]). Conclusions In conclusion, women more often attempted suicide, whereas males suffered accidental poisoning more frequently. Firstly, we found a female predominance in the DSP group, whereas males were more prevalent in with young children experiencing accidental poisoning. Longer time from ingestion of poison to the arrival is associated with poor patient prognosis.

Background and Aim: Ischemic mitral regurgitation (IMR) is the most prevalent complication following myocardial infarction (MI) and coronary artery disease. Acute or chronic MI can lead to IMR resulting from an abnormality in regional wall motion or dysfunction of papillary muscles in a territory with structurally normal mitral valve leaflets, coronary artery disease and chordae tendineae. The present study aimed to determine the incidence of ischemic mitral regurgitation in ST elevation myocardial infarction and its impact on hospital course. Material and Methods: This cross-sectional study was conducted on 164 myocardial infarction patients in the Department of Cardiology of Pakistan Institute Medical Sciences Hospital, Islamabad over a time period of 6 months. Institute research and ethical committee approved the study protocol. Patients with prior mitral surgery, heart failure, previous myocardial infarction, and mitral valve disorders were excluded. Demographic detail, echocardiographic parameters, and myocardial complications were recorded. Other parameters such as Killip class, in-hospital mortality, and MI territory with respect to electrocardiographic changes were recorded. Data analysis was carried out in SPSS version 26. Results: Of the total 164 MI patients, there were 114 (69.5%) male and 50 (30.5%) females. The overall mean age was 58.62±8.62 years. The incidence of IMR was 106 (64.6%), out of which the prevalence of mild, moderate, and severe MR were 86 (81.1%), 12 (11.3%), and 8 (7.6%) respectively. No significant association was found between the presence of IMR and other parameters such as diabetes, smoking, hypertension, gender, and BMI. There was a significant association between triglyceride and serum LDL-cholesterol levels with IMR presence. On comparing the IMR and no MR cases, left ventricular ejection fraction reduced but pulmonary arterial pressure increased in IMR groups. Conclusion: The present study found that the prevalence of IMR was 64.6% among MI patients and approximately half of the patients who suffer from IMR after having an AMI experience complications as a result of it. A proper treatment decision depends on assessing the severity of the MR in relation to AMI complications. Keywords: Ischemic mitral regurgitation, Myocardial infarction, ST elevation

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