Objective: To assess age, gender distribution and relative frequency of congenital heart disease (CHD) in children who underwent palliative or corrective cardiac surgery at Rehman Medical Institute, Peshawar. Methodology: This retrospective study was conducted in Department of Cardiac Surgery at Rehman Medical Institute (RMI), Peshawar from May 2008 till May 2010. One hundred and twenty three patients up to age group of 16 years with confirmed diagnosis of congenital heart disease admitted for Cardiac Surgery at Rehman Medical Institute, Peshawar were included. Results: Out of 123 patients, there were 71 males (57.7%) and 52 females (42.2%), with male to female ratio of 1.3:1. Sixty five (52.8%) of the total cases had acyanotic heart defects. Cyanotic heart defects were seen in 58 patients (47.1%). Ventricular Septal Defect (VSD) followed by Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD), were the commonest acyanotic heart lesions, 33.8%, 23.0% and 16.9% respectively. Tetralogy of Fallot (TOF) was the commonest cyanotic lesion. Conclusion : Majority of patients with congenital heart disease had acyanotic CHD with the commonest lesion being VSD. Tetralogy Of Fallot (TOF) was the commonest cyanotic lesion. Most of the patients were less than five years with no significant difference in sex distribution. Availability of expertise locally will lead to more patients getting surgical treatment at an earlier age thereby reducing morbidity and mortality and improving quality of life for these children.

Aims: To look for common indications and gastrointestinal pathologies observed on colonoscopy and to assess its diagnostic yield with respect to different clinical indications. Study design: Observational cross-sectional study Place and duration of study: Department of Medicine, Rehman Medical Institute from 1st January 2018 to 31st March 2019 Methodology: Five hundred and seventy three patients referred for colonoscopy were included. The demographic profile, indication of colonoscopy and colonoscopy findings were noted. Results: There were 231 (40.3%) males and 342 (59.7%) females with mean age 42.32±17.51 years. Bleed per rectum was most common indication noted in 284 (49.6%) followed by altered bowel habits 125 (21.8%) cases. Two hundred and fifty two (44%) colonoscopies were normal. One hundred and seventy three (30.2%) revealed significant lesions and 148 (25.8%) lesions were insignificant. Internal hemorrhoids were observed in 130 (22.7%) followed by colitis in 54 (9.4%). Abnormal computerized tomography abdomen revealed significant lesions in 62.2% of patients. Chronic diarrhea followed by constipation, altered bowel habits and iron deficiency anemia (IDA) showed 34.5%, 25.7%, 17.6% and <10% significant lesions respectively. Conclusion: Rectal bleed was the most common indication followed by altered bowel habits. Most common colonoscopy findings were hemorrhoids followed by colitis and abnormal growth. Abnormal computerized tomography abdomen gave the best diagnostic yield for colonoscopy. Keywords: Colonoscopy, Indications, Diagnostic yield

Dengue infection is an arthropod-borne Flavivirus infection that spread through female mosquitoes (Genus Aedes). Dengue infection is a major health challenge in the tropical and subtropical parts of the world. Methods: This is a retrospective study conducted at Rehman Medical Institute (RMI).  Data were retrieved from the Clinical test reports of confirmed dengue infection during the timeline; June to October (monsoon season) of the year 2021. Clinical as well as biochemical parameters were considered during the data assembling and assessment process. Results: Out of 156 suspected cases of dengue infection, 94 were confirmed through laboratory testing. 83 patients tested positive with Dengue NS1 antigen while after re-screening 94 cases (54 male patients and 40 female patients) were confirmed by Dengue serology (IgM antibodies) test. According to our study results, among a set of varied symptoms, malaise (99%) was the most common clinical presentation, along with 94% fever. Some patients with severe dengue infection developed serious illnesses including encephalopathy (8.5%), hypokalemic paralysis (6.3%). Moreover, 8.5% of patients were presented with Cholecystitis seen as Edematous Gallbladder wall on ultrasound scans, and 1% of the patient developed acute Pancreatitis. Fortunately, no casualty was reported due to dengue at RMI-General hospital. Conclusion: In our setup, Fortunately, no death was reported but a substantial number of patients suffered from serious complications such as neurological and hemorrhagic conditions along with communal clinical manifestations. Despite much reported data still, further investigation and monitoring are needed to comprehend the contemporary condition of the prevalence of dengue infection in Khyber Pakhtunkhwa, Pakistan.

Hypokalemic periodic paralysis (hypo KPP) is a rare form of autosomal dominant channelopathy characterized by muscular weakness and paralysis caused by decreased potassium levels. Precipitating factors are a diet rich in starches and sweets, and rest after an unusual degree of exercise. Paralytic attacks are more common between the ages of 15 and 40 years. The presentation can be a total paralysis or severe quadriplegia or mild weakness in certain group of muscles. During the acute episode of weakness proximal muscles are involved initially with gradual spread to the distal muscles. Deep reflexes are decreased or absent but the cognitive functions and sensory systems are intact. The paralysis may last for few hours to several days, but recovery is usually sudden in most patients. Hypo KPP is usually associated with thyroid disorders and distal renal tubular acidosis (DRTA). Here we report a case of young female patient who presented in emergency with two days history of weakness of all four limbs. The patient also had two episodes of similar illness in the last two and half years. On examination she had decreased tone and power in all four limbs with absent deep tendon reflexes, and plantar reflexes were down going bilaterally. On initial laboratory workup, patient was diagnosed to have hypokalemic, hyperchloremic metabolic acidosis with alkaline urine secondary to hypothyroidism. Features of hypokalemia with metabolic acidosis and failure to acidify urine was consistent with DRTA. Intravenous potassium chloride and bicarbonate replacement resulted in biochemical and clinical improvement.

The leading cause of death worldwide is coronary heart disease (CHD). In patients with chronic heart failure, hemographic markers have been associated with clinical outcomes. Hemographic indices, or measures of white blood cells, are easy and useful, clear and simple predictors of both subclinical and systemic inflammation. Methods:A retrospective study was conducted on the hospitalized patient for HF from April 2019- May 2020. Total 170 patients were enrolled in current study. The inclusion criteria of the study was patients above 18 years, hospitalized patient for HF, having an EF< 40% and having two or more symptoms of HF as well as be discharged alive from the hospital. The hemograhic indices were taken for each patient at the time of admission. The hemographic indices were defined as WBC count, neutrophil count, RL, NLR, and PLR. The neutrophil-platelet ratio (NLR) and the platelet-lymphocyte ratio (PLR) were derived as the ratios of neutrophil and platelet counts to lymphocyte counts, respectively. The entire test was performed by the hospital biochemistry lab under standard protocol. Patients were followed till six months. At the time of admission complete medical history and hemographic indices was recorded. Data was entered and analyzed using SPSS 25.0. The quantitative variables were presented by mean and standard deviation and qualitative with frequency/percentages. All the qualitative variables were compared among both by using Chi-square test and all quantitative variables by independent sample t test. The p-value less than 5% were considered as significant. Results:Total 170 patients were enrolled in current study among which 123(72.3%) survived and 47(27.64%) were died during 6 month follow up. The mean age among survived were 57.55+7.5 and dead was 59.96+7.9 (P-value= 0.06). According to gender male have dominance, in survived patients there were 98(79.7%) and in dead 38(80.9%) males (P-value= 0.86). 53(43.1%) patients were smokers in survived patients and 27(57.4%) in dead (P-value= 0.09). Status of comorbidities showed that the diabetes mellitus showed quite common among groups. The neutrophil count, WBC, lymphocyte count and NLR were elevated in deceased patients. The Platelet counts and hemoglobin levels were low in deceased. Conclusion: It was concluded from current study that the increased neutrophil count, WBC, lymphocyte count and NLR were associated with the mortality of HF patients