Background: Spinal anaesthesia is a less expensive option to general anaesthesia for surgical procedures below the umbilicus in resource-constrained settings with a shortage of medical gases and specialized an anesthetists. The patient’s airway is not harmed by spinal anaesthesia, and both the patient and the doctor benefits from a host of additional benefits. Following the discontinuation of hyperbaric lidocaine for intrathecal injection because it can results in radiculopathy, bupivacaine is frequently used for spinal anaesthesia. For spinal, doctors employ pethidine, a lipophilic opioid with local aesthetic properties. In this study, pethidine bupivacaine were used as the only anaesthetic a gents to perform spinal anaesthesia, and the immediate postoperative problems and recovery profile were compared. Methodology: For quick surgical procedures on the lower body, 52 American Society of Anesthesiologists physical status I and II patients between the ages of 18 and 60 were randomly assigned to receive spinalanaesthesia. The patients' recovery times for pinprick sensation at S2, plantar flexion, big toe proprioception, and full motor recovery (Bromage score 0) were compared after receiving either 2.5mL of isobaric 0.5 percent bupivacaine or 1mg/Kg of preservative-free pethidine. The immediate postoperative period complications of pain, drowsiness, nausea and vomiting, pruritus, and urine retention were compared. Results: The time to return of pinkprick sensation at S2 was 94.6220.25 minutes and 205.9631.05 minutes, respectively, when pethidine and bupivacaine were compared. Pethidine and bupivacaine had a time to return of plantar flexion of 92.8812.01 minutes and viii 1 93.8539.56 minutes, respectively. Between pedthidine and bupivacaine, the mean recovery times f or the big toe’s proprioception were 31.159.41 and 172.5042.70 minutes, respectively, for full motor recovery (Bromage score 0). All recovery time variation were significant (p 0.0001) across the broad. There was no discernible change in the incidence of pain or sedation in the immediate postoperative period. In the Bupivacaine group, four patients (15. 38%) reported having hardly bearable discomfort. Both groups did not experience any instances of nausea or vomiting. Pruritus was experience by five patients (19.22%) in the pethidine group, but none in the bupivacaine group (0.00 %). Urinary retention incidence varied, and this difference was significant (p = 0.048) Conclusion: Compared to bupivacaine, pethidine had a quicker recovery profile and didn't lead to any major complications right after surgery.

Background and Aim: Diabetes mellitus is an increase in blood glucose levels results in altered fat, protein metabolism, and carbohydrate which leads to cardiac, eye, nervous system dysfunction, and kidney. The major cause of hospitalizations in patients with diabetes mellitus (DM) is diabetic foot ulcers (DFU). The purpose of the present study was to evaluate the peripheral arterial disease in diabetic foot ulcer patients presented to endocrine clinic. Patients and Methods: This descriptive cross-sectional study was carried out on 206 diabetic foot ulcers patients presented to the endocrine clinic in Peshawar from January 2021 to December 2022. Patients were enrolled after taking written informed consent from each individual. Patient’s details such as gender, age, peripheral artery disease (PAD), diabetes types, heart failure, wound size, diabetes duration, end-stage renal disease, DFU history, prior history of amputation, and peripheral neuropathy were recorded. Angiography and revascularization may be required if arterial Doppler ultrasound confirmed PAD. Additionally, wound debridement and topical dressings were applied. In the treatment of wound ischemia, pentoxifylline, and calcium blockers were recommended along with diabetes control procedures and appropriate antibiotics. SPSS version 27 was used for data analysis. Results: Of the total 206 DFU patients, there were 142 (68.9%) male and 64 (31.1%) females. The prevalence of peripheral artery disease (PAD) was 58.3% (n=120). Age-wise distribution of patients were as follows: 31 (15%) in 25-45 years, 107 (52%) in 46-65 years, 60 (29.1%) in 66-85 years, and 8 (3.9%) >85 years. Out of 206 DFU patients, the prevalence of type-I diabetes mellitus and type-II diabetes mellitus was 8 (3.9%) and 198 (96.1%) respectively. PAD prevalence was significantly associated with Type 2 diabetes. The incidence of PAD in plantar foot, non-plantar foot, and heel was 66 (55%), 42 (35%), and 12 (10%) respectively among 120 cases. Out of 206 DFU cases, the incidence of peripheral neuropathy, DFU history, amputation history, heart failure, and chronic renal failure was 142 (68.9%), 104 (50.5%), 54 (26.2%), 46 (22.3%), and 42 (20.4%) respectively. Conclusion: The present study concluded that the prevalence of peripheral artery disease (PAD) was 58.3% among diabetic foot ulcers. Results indicate that DFU and PAD are significantly related. It has been found that male patients with DFU were more likely to suffer from PAD as compared to women with statistically insignificant association. Keywords: Peripheral artery disease, diabetic foot ulcers, type-II diabetes mellitus

Background: The clinical profile of severity of acute pancreatitis ranges from modest pancreatic inflammation to an unusually fatal acute necrotizing pancreatitis rightly known as severe acute pancreatitis (SAP). For the evaluation of clinical spectrum of pancreatitis, a more accurate models that is also cost-effective is required. Here, we sought to evaluate the contribution BISAP scoring systems to the diagnosis of severe of acute pancreatitis by comparing it with CT severity index. Settings and duration: This observational study was carried out at medicine department, Jinnah hospital, Lahore from 16th July 2022 to 15th January 2023. Sampling: Patients diagnosed with acute pancreatitis were registered. Acute pancreatitis was labelled based triad of classic epigastric pain, blood markers and imaging tool. BISAP score ≥3 was meant SAP and CT severity index for SAP included findings like necrosis and collection. Diagnostic accuracy was determined. Results: The patient's age ranged from 20 to 60 years with mean age of 36.41 + 9.362 years. The ratio of male to female participants was 2.3 to 1. For the diagnosis of SAP, the BISAP score's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were each 95.8%, 55.2%, 85.2%, 83.3%, and 84.8%, respectively. Conclusion: Simple clinical tools like BISAP score could be helpful in diagnosing severe acute pancreatitis, precluding the need for expensive and technically complex imaging modalities. Keywords: Severe acute pancreatitis (SAP), BISAP Score, Diagnostic accuracy

Background and Aim: The most frequently used technique for percutaneous coronary intervention (PCI) is the transradial approach (TRA). The purpose of the present study was to determine the prevalence of upper extremity function following transradial percutaneous coronary intervention. Patients and Methods: This cross-sectional study was conducted on 280 patients hospitalized for percutaneous coronary intervention in the Cardiology Department of MTI Lady Reading hospital, Peshawar and Lahore General Hospital from March 2022 to December 2022. Patients with palpable radial artery and non-occlusive flow confirmed by Doppler ultrasound examination were enrolled. Patients were divided into two groups: Group-I (underwent transradial approach (TRA)) and Group-II (treated with transfemoral PCI (TF-PCI). All the clinical outcomes were measured after 6 months follow-up. SPSS version 27 was used for data analysis. Results: Of the total 280 patients, the Group-I and Group-II had 220 and 60 patients respectively. During follow-up, the Group-I patients had higher incidence of upper extremity dysfunction (UED) (34.8%) than control or group-II patients (12.8%). Wrist extension, flexion, and elbow extension was the prime reasons for the upper extremity dysfunction. Smokers were three time at higher risk of developing upper extremity dysfunction. Conclusion: It has been observed that UED appears to occur twice as frequently in group-I as in group-II. Reduced rate of site complication and enhanced patient’s satisfaction has been found in group-I as compared to group-II. Keywords: Upper extremity function, percutaneous coronary intervention, transradial approach

Background: By lowering LDL cholesterol levels, the risk of coronary heart disease (CHD) and other serious vascular events can be significantly reduced. In order to prevent cardiovascular illnesses (CVD), mainly coronary heart disease, LDL-cholesterol (LDL-C) levels must be tightly controlled on both a primary and secondary level (CHD). Despite the fact that patients in primary prevention experience a higher absolute number of atherosclerotic cardiovascular (CV) events than those in secondary prevention of CVD, subjects in primary prevention frequently receive little attention when it comes to the clinical management of LDL-C levels. Aim: To summarise the research supporting LDL cholesterol reduction treatments for elderly people. Method: For this meta-analysis, we searched PubMed, GOOGLE SCHOLAR, SCI.HUB, MEDLINE, and Embase for publications released between January 1, 2017, and December 28, 2021. As recommended by the 2018 American Academy of Cardiology and American Heart Association guidelines, randomised controlled trials evaluating cardiovascular outcomes of an LDL cholesterol-lowering medicine with a median follow-up of at least 2 years and data on older patients (aged 75 years).The search for literature source was limited to randomized controlled trials (human being). This meta-analysis, comprised of 24 trials from the Cholesterol Therapy Trialists' Collaboration meta-analysis plus five other trials, used data from six journals. 21492 (8%) of the 244090 participants in 29 studies, were over the age of 75. Among them, 11750 (54%) came from statin trials, 6209 (28%) from ezetimibe trials, and 3533 (16%) from PCSK9 inhibitor trials. We conducted network meta-analyses for the statins and non statin treatments. Results: Of the 244090 participants in 29 studies, 21492(8%) were over 75. These included 3533 (16%) from PCSK9 inhibitor studies, 11750 (54%) from statin trials, and 6209 (28%) from ezetimibe trials. A median follow-up period of 2 to 6 years was used. Without statistically differentiating from the risk reduction in patients under the age of 75 (085 [078-092]; pinteraction=037), LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) by 26% for 1 mmol/L reduction in LDL cholesterol (RR 074 [95% CI 061-089]; p=00019).In older patients, there was no statistically significant difference in the RRs for statin (0.82 [0.73-0.91] and non-statin (0.67 [0.47-0.95]; pinteraction=0.64) treatment. Reduced LDL cholesterol in older persons was shown to benefit all components of the composite, including coronary revascularization (080 [066-096], stroke (073 [061-087], and myocardial infarction (080 [071-090]. Practical implication: This meta analysis can be used to improve the treatment of people withlowering LDL cholesterol. Conclusion: The viability and security of diminishing LDL cholesterol in more seasoned adults are now supported by further research provided by this meta-analysis. By non-statin and statin LDL cholesterol-bringing down medication, we identified a risk reduction for major vascular events that were at least as effective as that observed in younger patients Keywords: LDL, Meta-analysis, Cardiovascular, Cholesterol,Atherosclerosis, Primary and secondary prevention.