Severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) led to global coronavirus disease 2019 (COVID-19) pandemic. The virus affects the respiratory system predominantly and has resulted in multiorgan complications. Myocarditis, acute coronary syndrome (ACS), cardiogenic shock, and sudden cardiac death were common cardiac manifestations of COVID-19. Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease that is previously reported in patients with COVID-19. SCAD usually occurs in a middle-aged woman with few or without any cardiovascular risk factors. The gold standard for its diagnosis is coronary angiography. The SCAD treatment recommendations depend on the hemodynamic status: conservative therapy in hemodynamically stable SCAD patients and urgent revascularization in hemodynamically unstable SCAD patients. The exact pathophysiology of COVID-19 associated with SCAD is unknown. It is considered a combination of systemic inflammatory response and localized vascular inflammation. The case reported is of COVID-19-associated SCAD in a patient with no history of cardiovascular disease later complicated by the transient ischemic attack (TIA) and left ventricular (LV) thrombus.

Introduction: Rheumatoid arthritis (RA) is associated with various autoimmune disorders, including thyroid dysfunction. However, local data studying the prevalence of thyroid dysfunction in newly diagnosed RA patients are limited.

Introduction: Plasma omentin-1 is a relatively new biomarker that has anti-diabetogenic and its level is inversely related with insulin resistance and diabetes mellitus, thus, increasing the risk of diabetic complications. In this study, we will determine the association between serum plasma omentin-1 levels and diabetes and its complications.Methods: This case control study was conducted from July 2020 to August 2021 in the internal medicine unit of a tertiary care hospital in Pakistan. There was a total of three groups, each comprising 250 patients. One group was type 2 diabetic patients with complications, the second group was type 2 diabetic patients without complications, and the third group was the control group, i.e. participants without type 2 diabetes. Their plasma omentin-1 levels were compared.Results: Patients with diabetic complications had significantly lower serum omentin levels than patients without complications (59.01 ± 9.21 ug/dL vs. 75.72 ± 14.11 ug/L; p-value: <0.0001). Patients with diabetes had significantly lower serum omentin levels in comparison to patients without diabetes (75.72 ± 14.11 ug/dL vs. 90.12 ± 17.89 ug/L; p-value: <0.0001). Conclusion:Based on our study, plasma omentin-1 is negatively associated with diabetes and its complications. Therefore, adequate levels of omentin-1 are needed in order to prevent diabetic complications.

Introduction: Oral methotrexate (MTX) is the first-line therapy for patients with rheumatoid arthritis (RA). However, not all RA patients respond to MTX. In this study, we will determine the risk factors associated with MTX failure.Methods: This retrospective study was conducted in tertiary care hospital in Pakistan. Data of 612 patients who were diagnosed with RA from June 2019 to January 2021 were retrieved from the medical record room. After inclusion, patients were divided into two groups; respondent and non-respondent. Their characteristics and demographics were compared.Results: Out of the total 612 patients, 112 (18.3%) were labelled as non-respondent to MTX. Nonrespondents had a higher predominance of females (86.6% vs. 60.2%; p-value: 0.001), participants with body mass index (BMI) >25 kg/m 2 (54.4% vs. 22.4%; p-value: <0.00001), smokers (34.8% vs. 18.2%; p-value: 0.0001), participants with diabetes (47.3% vs. 23.4%; p-value: <0.0001) and rheumatoid factor positivity (91.0% vs. 64.8%; p-value: <0.0001). Conclusion:Female gender, higher BMI, smoking, higher disease activity, and diabetes were associated with MTX failure. These easily available parameters can help predict the disease process and outcome of treatment. It is important to screen patients who are at risk of MTX failure, so a contingent treatment plan can be devised, in case patients do not respond to MTX.

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