Aim: To assess the progression of bronchial reactivity (BR) and incidence of bronchial hyperreactivity (BH), exercise-induced bronchoconstriction (EIB) and asthma in triathletes over 2 years. Methods: Subjects were seven athletes from the Swiss national triathlon team (mean (SD) age 24.3 (4.8) years), who initially were not asthmatic, not treated with antiasthmatic medication, and who had performed at international level for more than 3 consecutive years (2001)(2002)(2003). To assess BR, BH and EIB, subjects ran on a 400 m track for 8 min at intensities equal to the anaerobic threshold. Tests were conducted in ambient temperatures of 4.4 (2.8)˚C, -8.8 (2.4)˚C and 3.6 (1.5)˚C, and humidity of 52 (16)%, 83 (13)% and 93 (2)%. Forced expiratory volume in 1 s (FEV 1 ) was measured before and at 2, 5, 10 and 15 min after EIB, and 5 min after inhalation of a b2 agonist. Two methods were used to calculate the incidence: (1) the standard assessment; (2) extrapolation of the decrease in FEV 1 to the BH limit. Results: BR increased significantly in the seven athletes (FEV 1 : year, p = 0.04; year 6 EIB, p = 0.002; EIB p,0.001). Within 2 years, BR had increased significantly and even reached BH in some athletes. Three athletes exhibited BH. After extrapolation of the decrease in FEV 1 in all seven athletes, the limit of 10% by definition for BH was determined to occur within 1.77-4.81 years, resulting in 21-57% of athletes with newly developed BH per year. Conclusion: Athletes develop EIB quickly, a rate of increase 195-286 times that of the normal rate for development of asthma.

Objectives: The aim of this study was to assess the efficacy of intravenous vitamin C, hydrocortisone, and thiamine in early weaning (within 48 hours) from vasopressor support in patients with septic shock. We also aimed to assess mortality and intensive care unit (ICU) stay. Study Design: We conducted a descriptive case series study of 50 patients with septic shock who were admitted in the ICU of the Combined Military Hospital Rawalpindi in Pakistan from August 2017 until April 2018. Materials and Methods: The study included men and women (16 to 80 years of age) who were admitted to the ICU with septic shock. Data were analysed using the IBM Statistical Package for Social Sciences (SPSS), version 18.0 (IBM Corp., Armonk, NY, USA). Inferential analysis was done with the help of simple and multivariate binary logistic regression that generated unadjusted and adjusted odds ratios (OR), respectively. Results: Of the 50 patients, 56% (N = 28) were male with a mean age of the respondents being 46.7 ± 18.4. Eighty-four percent were successfully weaned off vasopressors within 48 hours. Median days in the ICU were reported as 8.3 (interquartile range (IQR) = 5). Primary bacteremia (34%) was the most reported cause of ICU admission. The most common vasopressor was norepinephrine and its mean dose was 21.6 ± 10.7 microgram/min. The ICU mortality was observed at 52% (N = 26). Unadjusted OR showed a dose of norepinephrine, Sequential Organ Failure Assessment (SOFA) score, plasma procalcitonin, and plasma lactate to be significant predictors (p-value < 0.05), while the adjusted odds ratio (AOR) showed only a dose of norepinephrine to be a statistically significant predictor (AOR = 0.804, 95% CI = 0.674-0.960; p-value = 0.016). Conclusion: The administration of intravenous vitamin C, hydrocortisone, and thiamine to patients with septic shock was successful in early weaning from vasopressors. There was also a reduction in procalcitonin and lactate levels, as well as the SOFA score. Further trials are needed to determine whether the metabolic resuscitation protocol can become part of the treatment for septic shock.

Objective: To assess the frequency of intra-abdominal hypertension and its relationship with outcomes among patients of laparotomy admitted to the intensive care unit. Study Design: Comparative cross-sectional study Place and Duration of Study: Combined Military Hospital ,Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: Two-hundred patients who underwent laparotomy admitted to the intensive care unit of Combined Military Hospital were recruited in our study. Intra-abdominal pressure was measured after every 8 hours for 72 hours after admission to the intensive care unit. In addition, patients were followed up for two weeks from admission in the intensive care unit to assess the outcome. Results: Out of two hundred patients, 150(75%) had good outcomes, while 50(25%) had poor outcomes. The mean age of patients who underwent the surgery was 40.63±9.448 years. 171(85.5%) patients did not have raised intra-abdominal pressure, while 29(14.5%) had intra-abdominal hypertension. High Body mass index and poor outcome had a significant association with the presence and severity of intra-abdominal hypertension among study participants (p-value<0.05). Conclusion: Considerable number of patients had intra-abdominal hypertension during their stay in the critical care unit after laparotomy. A high grade of intra-abdominal hypertension was associated with poor outcomes in our study participants.

Objective: To explore the clinical presentation of mild to moderate COVID-19 disease. Study Design: Cross-sectional analytical study Place and Duration of Study: Tertiary Care Hospital, Rawalpindi from Mar 2020 to Aug 2020. Methodology: Three hundred and ninety-two patients with mild to moderate illness, PCR positive for COVID 19 were included. Frequency of typical symptoms of COVID-19 disease cough, fever, sore throat and shortness of breath and trends in laboratory assays were recorded. Discharge Criteria was two consecutive negative PCR performed upon 7th and 8th day of admission, subsequently on the 11th and 12th day if found positive previously. Results: A total of 392 patients were enrolled in the study with age range of 9-45 years. Out of 96 (24.5%) patients presented with cough and fever. Out of 112 (28.6%) patients complained of fatigue and myalgias. Chest x-ray had a bilateral patch in 96 (24.5%) patients and serum ferritin was raised in 96 (24.5%) patients. The coagulation profile was deranged in 64 (16.3%) patients. PCR results remained positive till 12th day in 80 (20.4%) patients. Conclusion: Fever, Cough and sore throat and deranged biochemical, radiological and haematological markers prove multisystem implications of mild to moderate COVID-19 disease. PCR can remain positive till the 12th day and beyond in modest disease.