Aim: The correlation of cardiopulmonary bypasses (CPB) and cardiac troponin I (cTnI) in predicting arrhythmia remain unclear. Aim of this study to investigate the correlation of cardiopulmonary bypasses duration and cardiac troponin I with the type of arrhythmias. Methods: This is a retrospective observational study took place in our hospital between May 2020-December 2021.The study included a total of thirty-three patients who underwent open-heart surgery. Patients between the age of 2 months and 14 years of both genders with the diagnosis of ventricular septal defect (VSD), atrioventricular defect (AVSD) and tetralogy of Fallot (TOF) were included in this study. Patients with preoperative a history of major intraoperative events and high-level of cardiac troponin I were excluded from the study. The accuracy was calculated using sensitivity and specificity. The area under the ROC curve (95% CI) and p-value were also calculated. Results: Out of thirty-three patients undergoing open-heart surgery, 58.1% were male and were one year of age or more (71%). A statistically significant correlation among arrhythmia, cardiac troponin I and cardiopulmonary bypasses was observed (p < 0.05). Cardiac troponin I predicted high-level sensitivity for arrhythmias, hospital stay, and intensive care unit stay, while low specificity was reported for cardiac troponin I compared to cardiopulmonary bypasses. Conclusion: The higher level of cardiac troponin I was correlated with the underlying burden of arrhythmias. A novel high- sensitivity cardiac troponin I assay can protectively recognize patients at low risk of arrhythmias. Keywords: Arrhythmia, Cardiac troponin I, Cardiopulmonary bypass, Sensitivity, Specificity

Background: Soft tissue abscesses is one of the most commonly observed complication in children. This infection may impart the longer stay at hospital and also increase the cost of medical care. Objective: The study was carried out to find the pattern of organisms and the sensitivity of drugs from the pus produced in soft tissue abscesses among patients. Study design: It is cross-sectional study conducted from January 2020 to November 2022. Material and Methods: The study was conducted at the pediatric department of the Div. HQ teaching hospital Mirpur, Azad Jammu and Kashmir. The study was carried out on 160 patients having at least one abscess on their body. The study also collected information about the predisposing factor that could have led to abscess formation. The site of distribution of the abscess was also analyzed. The abundance of microorganisms that were isolated from the samples of abscesses was also studied. Results: it was found that in most of the patients (45.5%) the blunt trauma was the main cause of formation of abscess. The common cause of abscess at extremities was blunt trauma. The common cause of abscess at head and neck site was upper respiratory tract infection and lymphadenitis. The head and neck area along with lower limb was the site that had most of the abscess. Conclusion: In our study the blunt trauma at extremities was found to be main factor leading to pus formation from smooth tissue abscess among infants. The most common region where pus was formed was extremities, head and neck area and lower limb area. Keywords: klebsiella pneumonia and Soft tissue abscesses.

This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric in-

Background: The most common issue with transradial cardiac catheterization is radial artery vasospasm. The patient experiences pain and discomfort as a result, the procedure is prolonged, and the interventionist may even be unable to continue. Aim: The aim of the study is to determine the effectiveness of Verapamil, a calcium channel blocker and nitrate, when used together to prevent radial artery spasm during coronary angiographies. Methods: This case control study was held in the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera and Peoples University of Medical and Health Sciences for Women PUMHSW (SBA) Nawabshah for six-months duration from July 2021 to December 2021 including 120 cardiac patients undergoing coronary angiography. The patients were selected by non-probability sampling technique. Patients who were enrolled in the study provided written informed consent. Two groups of patients—control (60) and experimental—were formed (60). Heparin/nitrate was administered to one group and labelled as a control group, while heparin/nitrates/verapamil (a calcium channel blocker) was administered to the other group considered as an experimental group. During the angiography procedure, the radial spasm, discomfort, and catheter resistance were assessed in both groups. A predesigned questionnaire was used to collect all other demographic data and patient’s history. SPSS version 23.0 was used to collect and analyse the data. Results: It was found that 68.3% of cardiac patients were over 50 years old, 41.7% of patients were female, and 58.3% of patients were male. Verapamil, a calcium channel blocker, and nitrate did not significantly affect radial spasm, according to this study with a p value of 0.762. According to the study, there was no obvious difference noted in radial spasm, outcome, discomfort, catheter resistance, or procedure time when cases and controls were compared for various variables. However, the test group have a 100% success rate of the procedure compared to the control group's 95%. Conclusion: Verapamil, a calcium channel blocker when combined with nitrate did not significantly reduce radial spasm during coronary angiography. The theory that calcium channel blockers could prevent radial artery spasm during angiography was nullified. It is best to avoid the financial burden that comes with using calcium channel blockers and nitrate during coronary angiography. Combining nitrate and calcium channel blocker (Verapamil) has no additional advantages. Keywords: Angiography, catheterization, calcium channel blocker, radial spasm, nitrate, and verapamil are some of the related terms.

Introduction: It is not clear whether patients receiving oral anticoagulants (OC) during surgery involving access to the common femoral artery would experience more adverse effects than those not receiving OC. In this analysis, we determine whether patients receiving oral anticoagulants undergoing cardiac catheterization are at high risk of complications related to femoral site than subjects not receiving OACs. Study Settings: This study was held in the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera and Peoples University of Medical and Health Sciences for Women PUMHSW (SBA) Nawabshah for one-year duration from January 2021 to December 2021. Methods: A total of 300 patients were selected for the study. We regularly reviewed data from patients undergoing cardiac surgery at the same tertiary care center. A patient was classified as fully or partially anti-coagulated (Group A) if his international normalized ratio (INR) was greater than 1.6 on the surgery day or if he received new OAC or warfarin within 48 hours or less after surgery. The group without anticoagulants (Group B) had an INR of 1.6 or had stopped the new OAC and warfarin more than 48 and 24 hours prior to surgery, respectively. Results: A total of 300 patients (mean age 65.6±12.2, 60% male) were registered in the study. 20 (6.7%) were in Group A and Group B included 280(93.3%) patients. The intervention was done among 162/300 (54%) patients and received treatment with Intra-procedural anticoagulation with heparin (50.0%), bivalirudin (23.3%) or both (3.3%). GpIIb/IIIa inhibitors were used infrequently (1%). Conclusions: Compared to patients who did not receive anticoagulants during the procedure, OAC patients experienced no major serious adverse events after 30 days. Keywords: Oral anticoagulant, Common femoral artery, complications, access site.