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Aim: To determine the association between TIMI risk score and in-hospital mortality and adverse events in acute STEMI patients undergoing primary PCI at a tertiary cardiac care facility. Study design: Retrospective study. Place and duration of study: Catheterization Laboratory of Cardiology Unit, Dr. Ruth KM Pfau, Civil Hospital Karachi from 1st October 2017 to 31st March 2019. Methods: Three hundred and sixty six acute STEMI patients who admitted through emergency and underwent primary angioplasty were enrolled. A proforma was filled out for the said subjects that encompasses continuous and categorical variables including age, gender, family history of coronary artery disease, smoking history, diabetes, hypertension, dyslipidemia, systolic and diastolic blood pressure, heart rate, onset symptoms to emergency room (whether >4 hours or ≤4 h), location of myocardial infarction [anterior, inferior, lateral or posterior, and right ventricular infarction], drugs given prior to angioplasty[aspirin, clopidogrel, prasugrel, heparin, Glycoprotein IIb/IIIa receptor antagonists], success of angiography, culprit vessel, number of diseased vessels, and in-hospital outcomes.. Results: 270 (73.8%) were males and 96 (26.2%) were females with male to female ratio 2.8:1. Mean age was 56.25±11.45 years. Main risk factors were hypertension 230 (62.8%) cases, diabetes 198(54.1%) cases and smoking 167 (45.6%) cases. Onset of symptoms to the arrival to emergency room for treatment was ≤4 hours 201 (54.9%) cases and >4 hours in 165(45.1%) cases. In hospital mortality rate was 3.82%. Hospital in mortality 11(3%) cases was associated with hypertension and diabetes. Conclusion: This study show that a significant number of patients were observed adverse outcomes associated with higher TIMI risk score for in hospital. Therefore, the prognostic TIMI risk score is a powerful tool for predicting hospitalized patients. Key words: Acute myocardial infarction, Coronary artery disease, TIMI Risk Score, In-Hospital Mortality.

Aim: The correlation of cardiopulmonary bypasses (CPB) and cardiac troponin I (cTnI) in predicting arrhythmia remain unclear. Aim of this study to investigate the correlation of cardiopulmonary bypasses duration and cardiac troponin I with the type of arrhythmias. Methods: This is a retrospective observational study took place in our hospital between May 2020-December 2021.The study included a total of thirty-three patients who underwent open-heart surgery. Patients between the age of 2 months and 14 years of both genders with the diagnosis of ventricular septal defect (VSD), atrioventricular defect (AVSD) and tetralogy of Fallot (TOF) were included in this study. Patients with preoperative a history of major intraoperative events and high-level of cardiac troponin I were excluded from the study. The accuracy was calculated using sensitivity and specificity. The area under the ROC curve (95% CI) and p-value were also calculated. Results: Out of thirty-three patients undergoing open-heart surgery, 58.1% were male and were one year of age or more (71%). A statistically significant correlation among arrhythmia, cardiac troponin I and cardiopulmonary bypasses was observed (p < 0.05). Cardiac troponin I predicted high-level sensitivity for arrhythmias, hospital stay, and intensive care unit stay, while low specificity was reported for cardiac troponin I compared to cardiopulmonary bypasses. Conclusion: The higher level of cardiac troponin I was correlated with the underlying burden of arrhythmias. A novel high- sensitivity cardiac troponin I assay can protectively recognize patients at low risk of arrhythmias. Keywords: Arrhythmia, Cardiac troponin I, Cardiopulmonary bypass, Sensitivity, Specificity

Introduction: Organophosphate poisoning (OP) is a serious public healthproblem. Cardiac manifestations are seen in majority of patients with OP and may range fromsinus tachycardia to more serious ventricular tachyarrhythmias. Objectives: To determinethe electrocardiographical manifestations of acute organophosphate poisoning at a tertiarycare hospital. Study Design: Observational study. Setting: Department of Medicine, AbbasiShaheed Hospital, Karachi. Period: February 2011 to August 2011 over a period of six months.Patients and methods: All patients of either sex presenting with the history or evidence ofexposure to organophosphorus compounds within 24 hours with characteristics manifestationsof organophosphate poisoning were included in the study. Electrocardiographic manifestationswere observed before the institution of medical therapy. Results: A total of 123 patients, 81(65.9%) male and 42 (34.1%) female were included in the study. The Mean (+SD) age ofthe study participants was 29.07 (+ 9.61) years. Majority (74%) patients had age <35 yearsand 78 (63.4%) patients in this study had time duration of <6 hours between ingestion oforganophosphorus and institution of therapy. The overall electrocardiographic changes wereobserved in 86.2% of patients. Out of these, ST elevation was seen in 19.8%, T-wave inversion in17.9%, prolonged PR interval in 9.4%, atrial fibrillation in 6.6% and prolonged QTc interval seenin 46.2%. Conclusion: Electrocardiographical changes are common manifestation of acuteorganophosphate poisoning. Prolonged QTc interval and ST segment elevation are the mostcommon finding in our patients. As these changes in ECG can lead to serious consequences,therefore it should be carefully evaluated in every patient with OP so that early intervention canbe done.

Subjects and Methods: This is a comparative study of analgesic efficacy between aspirin, diclofenac and ketorolac. 40 albino rats were taken and divided into 4 equal groups. Group A, B, C and D treated with normal saline, Aspirin, diclofenac and ketorolac respectively. Results: Significant increase in reaction time was observed with aspirin, diclofenac and ketorolac (p<0.001) using hotplate analgesia meter. Increase in tail flick latency was also found with all three drugs. Ketorolac produces 6.7 second increase in tail flick latency. Conclusion: NSAIDs are the first line of management in acute and chronic pain. Ketorolac is more effective than other nonsteroidal anti-inflammatory drugs. Key words:NSAIDs, Aspirin, Diclofenac, Ketorolac