Background: It is always been never ending process to search for the ideal method for cardiovascular autonomic function tests. However, some considerations of the feasible application of the squatting tests seem justified. Squatting is an active posture test that can be used to assess baroreflex sensitivity. Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and large changes in arterial blood pressure (BP) and heart rate allowing precise baroreflex assessment.[1] Aims and Objectives: The aim of this study is to assess: (1) The frequency of an abnormally large fall in BP on standing from supine and (2) the underlying hemodynamic mechanisms of this fall in BP on standing from supine and from squatting. Materials and Methods: Sample size selected was 100 from first year medical students. Basal hemodynamic parameters were recorded in sitting and squatting position, then alteration in these hemodynamic parameters after standing was noted. The mean of three readings of BP obtained, respectively, in each position was considered representative for that position. Statistical analysis is done. Result: The change in the position from supine to standing causes a fall in the systolic as well as diastolic BP which was not statistically significant, whereas change in position from squatting to standing, the fall in the systolic and diastolic BP were statistically significant. Conclusion: The squatting test is an active posture maneuvers that impose one of the most potent orthostatic stresses. This careful analysis in healthy individuals should help in the understanding of disturbances that may be observed in patients with autonomic dysfunction.

Pulmonary embolism is a substantial disease with high rate of both morbidity and mortality, which becomes more prevalent in documented diabetic patients.The aim of the present study was to evaluate the contribution of glycemic gap as a biomarker towards defining the intensity and consequence of pulmonary embolism in diabetic patients.Diabetic patients who were admitted to Khaja Banda Nawaz Institute of Medical Sciences with a confirmed diagnosis of pulmonary embolism, during the period between January 2019 and September 2020 were enlisted for the present study. Patients selected for the study were in the age group of ≥18 years and they were from either gender.The present study selected 162 diabetic patients (among them 80 were females and 82 were males), with mean age of 48.6±6.6years. Out of 162 patients, 136 (84%) were survivors and26 (16.0%) were non-survivors. Among survivors, 13 (8%) patients showed clinical deterioration with time and 21 (12.8%) patients needed ICU admission. Non- survivors had advanced age group (53.3±3.4 vs. 49.2±3.2, p=0.002), higher PESI (102±21.7 vs. 74.6±14.3, p<0.001) and prolonged hospital stay (4.9±0.29 days vs. 4.1±0.23 days, p<0.001). There was a highly significant difference regarding the glycemic gap between non- survivors and survivors (37.3±9.3 vs. 83.1±11.6, p<0.001), patients with and without clinical deterioration (104.02±12.3 vs. 47.2±12.3, p<0.001), and patients who were and were not in-need of ICU admission (43.1±14.8 vs. 106.2±23.7, p<0.001). Resultsof the present study proves that uplifted level of glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was showing strong correlation to the increase in rigourness of disease along with rate of mortality in diabetic patients with pulmonary embolism. Therefore, we proposed to use glycemic gap as a biomarker in predicting the severity and prognosis of pulmonary embolism.

In this present time, it is a necessity to re-evaluate the basic concept of asthma as well as COPD, that these two are separate conditions, or when out of these two conditions one evolves from the other, or whether they both exists together. Total 60 numbers of patients were included in our prospective study, those all have chronic disease of airways and were classified into three respective groups namely, i) chronic obstructive pulmonary disease, asthma–COPD overlap (ACO) [WU1] [k2] and the last one is asthma. The patients were selected from outdoor patient department of Khaja Nawaz Institute of Medical Sciences from the month of January 2020 to the month of September 2020, where the patients that suffers from chronic obstructive pulmonary disease and ACO were diagnosed carefully according to “GOLD” guidelines 2020 and the patients that suffers from asthma were carefully diagnosed according to the GINA guidelines 2020. All the patients that were selected in the study only after careful and thorough history taking, clinical examination of the patient, all the laboratory finding was done carefully, chest X-ray was done, spirometry was done before administration of bronchodilator and again spirometry was done after the administration of bronchodilator i.e. reversibility test was done, and last but not the least, examination of sputum was done that too carefully for careful eosinophil count. Total number of patients included in the study was 60 that suffers from COPD, Asthma, Asthma [WU3] COPD overlap. It included 41 (68.3%) males and 19(31.6%) females. In our prospective study out of 60 19 patients i.e. 31.9% out of total were diagnosed of having COPD, out of 60, 18 i.e. 30% have problem of asthma, and 18 patients i.e. 30% out of total were having ACO. We in our study found that all the three experimental groups show history of atopy, with 61.9% patients belong to ACO group, 17.3% belongs to COPD and 84.2% belongs to Asthma [WU4] group. When comparison between all the experimental groups were made regarding sputum eosinophil count, revealed that all the three experimental groups show positive eosinophil count with respect to 22.2% in case of ACO, 84.2% in case of asthma group and 13% in case of COPD. Out of three experimental groups, only ACO group represents the highest percentage among different patients that have disease of obstructive airways. It also reveals some of the features of disease asthma like atopy and positive sputum eosinophil count along with some features of chronic obstructive pulmonary disease with respect to old age and those people has a positive history of smoking.

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