Introduction Various researches have stated the correlation between serum uric acid (sUA) and cardiovascular disease (CVD); however, no local studies are available. In this study, we will determine the prevalence of hyperuricemia in patients with acute myocardial infarction and compare with the control group. Methods This case-control study was conducted from March to November 2019 in the tertiary care hospital in Pakistan. In all, 119 patients with acute myocardial infarction were enrolled in this study, and 119 controls were identified from the outpatient department. Their sUA levels were measured within 24 hours of acute myocardial infarction. Results The mean sUA levels were significantly higher in patients with acute myocardial infarction (AMI) in comparison to the control group (6.17 ± 2.12 vs. 5.51 ± 1.89, p-value; 0.01). Overall, there were more patients with hyperuricemia in the case group compared to the control group (47.89% vs. 33.6%, p-value = 0.04) Conclusion In this study, after adjustment of other known factors, hyperuricemia is associated with AMI. Efforts should be made to include screening for hyperuricemia in patients with a high risk of myocardial infarction.

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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Introduction: Studies in the last decade have shown an increased prevalence of Takotsubo syndrome (TTS); however, there is limited data on the prevalence and impact of TTS on hospitalizations among cancer survivors. Methods: We identified adult hospitalizations with prior cancer and TTS using National inpatient samples from 2007 & 2017. We then compared the demographics, comorbidities, and in-hospital outcomes between two cohorts 10-years apart. In addition, we also performed multivariable analysis to evaluate the composite outcomes of MACCE (all-cause mortality, cardiac arrest, arrhythmia and stroke) after adjusting for sociodemographic, type of admission, hospital characteristics, comorbidities, current cancer, and prior chemo/radiotherapy. Results: Prevalence of TTS per 100,000 hospitalizations among cancer survivors increased about 8-fold from 23 to 163 (p<0.001) between 2007 and 2017 (Fig. 1a) . There was high prevalence of TTS among Caucasian, elderly and females in both cohorts, female (38 to 261/100,000 hospitalizations) and geriatric cancer survivors (24 to 174/100,000 hospitalizations) showed nearly 7-fold increase in TTS in 2017 vs. 2007 (p<0.001). Traditional cardiovascular risk factors, heart failure, chronic pulmonary disease, depression, renal failure and other neurological disorders also increased in the 2017 cohort vs. 2007 cohort. Along with higher rates of atrial tachyarrhythmias (Fig. 1b) , There was nearly 40% (OR 1.39, 95%CI: 1.06-1.82, p=0.016) higher risk of composite MACCE in the 2017 TTS cohort compared to 2007 cohort among cancer survivors Conclusions: Prevalence of TTS among hospitalized cancer survivors increased 8-fold in 2017 compared to 2007. Despite increased awareness about etiopathogenesis and access to improved diagnostic measures, this analysis of TTS cohorts among cancer survivors showed increasing comorbidities with nearly 40% higher risk of composite MACCE across two cohorts selected a decade apart.