Background and objectivesIn comparison to real-time polymerase chain reaction (RT-PCR) testing, blood-related parameters including absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratio (NLR) carry an indeterminate potential in the assessment of corona virus disease 2019 (COVID-19). Our main objective was to assess their efficacy in timely identification of COVID-19 patients and to determine whether these biomarkers can be employed as an early diagnostic tool in patients presenting with symptoms suggestive of COVID-19. MethodologyThis cross-sectional study was conducted at the Emergency Department of a Tertiary Care Hospital in Rawalpindi, Pakistan from November 2020 to March 2021. Patients suspected to have COVID-19 on a clinical basis (fever, cough or shortness of breath) were selected by using convenience non-probability sampling. RT-PCR was used to diagnose COVID-19 after evaluating NLR and ALC of the sample population.An NLR = 3.5 and ALC < 1 x 10 3 cells/mm 3 was considered as the cut-off value. Statistical analysis was conducted via SPSS 23.0 (IBM Corp., Armonk, NY). Chi-square and independent t-tests were used to correlate various data variables, while p-value <0.05 was considered significant. ResultsOut of the 172 subjects included in the study, the mean age was 40.6 ± 10.0 years, while 51% of individuals were males. Fever was found to be the most prevalent complaint (94%). Double RT-PCR testing showed that 51.2% of the population was RT-PCR positive, having a mean ALC of 1.4 ± 0.9 x 10 3 /mm 3 , significantly lower than RT-PCR negative cases (p < 0.001). In addition, NLR was drastically elevated for RT-PCR-positive individuals (p < 0.001) while it also had a distinctly high specificity of 91.7% among COVID-19 patients. Additionally, NLR did not correlate with any of the baseline patient-related parameters (presenting complaint, age, and gender). ConclusionNLR and ALC are potentially efficacious measures for an early diagnosis of COVID-19, and can be possibly utilized for an early diagnosis of COVID-19 suspects.

IntroductionAcute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. MethodologyThis prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi, Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. ResultsA total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. ConclusionSVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.

Objective: To assess the use of C-reactive protein in patients with STEMI and NSTEMI to differentiate between the type of myocardial infarction at our hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi and Armed Force Institute of Cardiology & National Institute of Heart Disease, from Mar 2020 to Feb 2022. Methodology: Patients diagnosed with MI by a consultant cardiologist were included in the study. They underwent all baseline investigations, including C reactive protein, at the time of presentation to a cardiac emergency. The treating consultant diagnosed MI (ST elevation or non-ST elevation) based on electrocardiogram findings. Values of C reactive protein and other socio-demographic variables were compared in both groups (patients with and without ST elevation MI). Results: A total of 3500 patients with myocardial infarction were included in the final analysis. 2219(63.4%) had NSTEMI,while 1281(36.6%) had STEMI. Statistical analysis showed that C-reactive protein levels were not statistically different in both groups (p-value-0.375), but gender and Creatinine kinase myocardial bound levels were different in patients with non-ST elevation myocardial infarction and ST-elevation myocardial infarction (p-value<0.001). Conclusion: Raised levels of C reactive protein were not statistically significantly different in ST-elevation myocardial infarction and non-ST elevation myocardial infarction patients. CKMB may give a better clue for differentiation between these two types of myocardial infarctions.Keywords: Creactive protein, Non-ST-elevation myocardial infarction, ST-elevation myocardial infarction.

Objective: To study electrocardiographic changes during haemodialysis and determine the relationship between electrolyte alterations and acid-base balance.Study Design: Cross-sectional analytical study. Place and Duration of Study: Haemodialysis Unit, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2022. Methodology: Adult patients with end-stage renal disease on maintenance hemodialysis were selected by convenience sampling. Exclusion criteria included current hospitalization, chest pain during haemodialysis, intra-dialytic hypotension,atrial fibrillation, pericardial effusion, shortening of haemodialysis sessions and unwillingness to participate in the study.Twelve lead electrocardiograms were recorded immediately before the start and end of haemodialysis sessions. At the same time, serum urea, creatinine, potassium, calcium and phosphate were measured. Bicarbonate levels were assessed by venous blood gas analysis. In addition, measurements for heart rate and durations of the PR interval, QRS complex, QT interval andcorrected QT interval reported by ECG machine software were recorded. Results: There were 35 patients with a mean age of 48.69±11.39 years. Duration of QRS complex increased from 92.83±9.98 to 100.00± 17.94 seconds after haemodialysis (p=0.017). Changes in other parameters were insignificant. QT/QRS and QTc/QRS ratios reduced by 0.27±0.62 and 0.31±0.62 after haemodialysis (p=0.014 and 0.005, respectively). Changes in none of the biochemical parameters during haemodialysis could predict the reduction in QT/QRS or QTc/QRS ratios. Conclusion: The reduction in the index of cardiac electrophysiological balance during hemodialysis was not related to intradialytic changes in different electrolytes or base content.