This study assessed the pattern of drug abuse and the reasons for relapse of addiction among male drug addicts seeking rehabilitative services in different centres in Lahore, Pakistan. A cross-sectional survey was conducted on male drug abusers from April to December 2016. Nonprobability purposive sampling was done to collect a sample of 119 participants. A structured questionnaire and in-depth interviews were used for data collection. Out of 119 participants, 71.4% were in the age group 15-35 years. Educational levels were low in the majority, with 68.1% below secondary education. Unmarried (51.3%) and unemployed (44.5%) participants were at the greatest risk of using drugs. The age of addiction in 45% of patients was < 18 years and 40% had been abusing substances for > 5 years. Reasons for starting drug abuse were recreation (37%), curiosity (34.5%), and lifechanging events (14.3%). Reasons for relapse included association with former addicts, negative reactions from family, inability to manage the craving and work/social stress. Schéma de dépendance et de rechute parmi les toxicomanes habituels à Lahore, PakistanRÉSUMÉ La présente étude avait pour objectif d'évaluer les schémas d'abus de substances psychoactives et les causes de rechute parmi les hommes toxicomanes recherchant des services de réadaptation dans différents centres de Lahore, au Pakistan. Une enquête transversale a été conduite sur les utilisateurs de substances psychoactives de sexe masculin entre avril et décembre 2016. Un échantillonnage non probabiliste par choix raisonné a été réalisé afin d'établir un échantillon de 119 participants. Un questionnaire structuré et des entretiens approfondis ont été utilisés pour la collecte de données. Sur les 119 participants, 71,4 % appartenaient au groupe d'âge des 15-35 ans. Les niveaux d'éducation étaient faibles dans la plupart des cas, 68,1 % n'ayant pas atteint l'enseignement secondaire. Les hommes célibataires (51,3 %) et chômeurs (44,5 %) étaient exposés à un risque accru de toxicomanie. L'âge de la mise en place de la dépendance était inférieur à 18 ans chez 45 % des patients, 40 % d'entre eux consommant des substances psychoactives depuis plus de 5 ans. L'aspect récréatif (37 %), la curiosité (34,5 %) et les changements de vie (14,3 %) comptaient parmi les raisons pour lesquelles les patients commençaient à utiliser des substances psychoactives. Les causes de rechute incluaient le regroupement avec d'anciens toxicomanes, les réactions négatives de la famille, l'incapacité à gérer le manque, et le stress professionnel et social.

Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.

Introduction Primary percutaneous coronary intervention (PPCI) is now a well-established treatment of acute ST-elevation myocardial infarction (STEMI). For the first time in Pakistan, various offsite satellite centers are established to perform PPCI 24-hours. Our population mainly resides in the rural area with low literacy rate and poor socioeconomic conditions. The majority of the patients who are presented in the satellite center had either never received any long-term treatment plan or were non-compliant to their medication. The objective of this study was to determine the outcome of patients at six months who underwent primary PCI at a rural satellite center of Sindh, Pakistan. Methods This study was conducted at Larkana satellite center of National Institute of Cardiovascular Diseases, Karachi. Patients who underwent PPCI for STEMI from October 2017 to March 2018 were enrolled in the study. In case of death of the patient, data were obtained from the attendant of the deceased. Patients, on follow-up visits, were interrogated for post-procedure symptoms.

Lightning strikes are rare and uncommon cause of admissions into the hospitals of Pakistan. It affects every organ of the body but cardiac effects of lightning can be benign to life threatening. This case report account a case of healthy young female, who was struck by lightning in Mithi Tharparkar, developed electrocardiographic changes and prolongation of QT interval along with moderate left ventricular systolic dysfunction with segmental wall motion abnormalities on echocardiography with positive cardiac biomarkers. Angiography was done to rule out any coronary injury but it revealed normal coronaries. We kept her on follow-up which was uneventful and these changes reverted back to normal over a course of three months.

Objective: Acute pulmonary edema (APE) is a common problem presenting in emergency department of cardiology units. For decades, the mainstay of treatment in APE has been loop diuretics; mainly furosemide. Studies regarding mortality benefits of diuretics in APE patient have not been conducted in our population, where other drugs of heart failure are not frequently available. Therefore, results of our study may provide justification for continued use of diuretics as mainstay treatment of APE. Aim of this prospective study was undertaken to determine the relationship between dose of furosemide and mortality. Methodology: This prospective study was conducted at department of cardiology, SMBBMU, Larkana from June 2017 to December 2017. Patients of either gender, aged between 18 to 75 years presenting with diagnosis of APE were included in the study. Patients were followed up till time of discharge or death. Outcome variable i-e mortality was noted and recorded. Results: A total of 402 patients were included in this study out of which 234 (58.2%) were males. In-hospital mortality was 17.9% (77). Total amount of diuretics used was significantly lesser among the patients who died (209.28 ± 134.15 ml vs. 295.18 ± 151.43 ml; p-value <0.001). Patients who received less than 300mg/day diuretics had increased mortality as compared to those who received more than 300 mg/day (59 (20.3%) vs. 13 (11.7%); p-valve 0.045). Conclusion: Patients who received less diuretic had more mortality than those who received more diuretic.