Objective: To determine the incidence and risk factors of forearm hematoma after trans-radial percutaneous coronary intervention (TRA-PCI). Methodology: In this observational study we included 450 consecutive patients who were referred to catheterization unit of Ch. Pervaiz Elahi Institute of cardiology between February 2019 and September 2019 were included. Patients planned for TRA were only included in analysis. We recorded demographic details, previous and presenting medical and clinical history, and renal parameters for each patient. Allen’s test was performed in each patient to determine the eligibility TRA. Incidence of forearm hematoma was noted immediately after the procedure. Results: Out of 450 subjects enrolled in this study included, 324 (72%) were men and 126 (28.0%) were women, the mean age of the patients was 54±10 years. Forearm hematoma was diagnosed in only 51 (11.3%) patients. out of 51, 24 (47.0%) had grade I, 17 (33.3%) had grade II and 9 (17.6%) had grade III and 1 (1.96%) patients had grade IV hematoma. On univariate analysis, being women [odds ratio 2.2 (1.2-4.0), p-value=0.01], obesity [odds ratio 2.8 (1.54-5.76), p-value=0.001], and >1 puncture attempt [odds ratio 4.5 (2.36-8.51), p<0.001], were independent risk factors of forearm hematoma. Conclusion: Incidence of hematoma after trans-radial percutaneous coronary intervention is 11.3%. Female gender, obesity and higher number of puncture attempts are independent risk factors of hematoma. Hematoma is mostly grade I-II in nature and can be managed easily only through conservative management.

Castration refers to induced sterility via physical, chemical, or hormonal methods. Chemical castration is an efficient and reliable technique in contrast to other sterilization procedures as it is less painful to physical methods and cost‑effective to hormonal methods. Azadirachta indica (neem), is a charismatic plant as its leaves possess anti-inflammatory, anti‑microbial, and anti-androgenic chattels. To abate the escalating human population in South Asia, neem oil and neem leaf extract have been effectively used as a contraceptive agent. The key determinant of the current study was to evaluate Neem as a chemical sterilizing agent, (either necrotic or apoptotic), in dogs injected intratesticular in comparison to a hypertonic saline solution. Pre- and post-injection testicular width size and blood samples for serum testosterone levels were collected on alternative days. Results disclosed substantial changes in testicular width size, histopathological profile, and serum testosterone level. A non-significant (P > 0.05) pre-injection testicular width readings in contrast to a significant increase (P < 0.05) three days post-injection was noted in all the competitive groups. The mean values recorded for testicular width size at the end of the trial study via neem leaf extract, 30% HSS and, control groups were 27.7362 ± 2.3315mm, 30.9594 ± 4.6861mm, and 24.5023 ± 2.5387mm, respectively. A declining trend, regarding serum testosterone level being statistically significant (P < 0.05) was recorded in treated groups (A, B) in contrast to the control group (C) as the values were 1.5357 ± 0.7819ng, 1.2669 ± 0.9095ng, and 2.4517 ± 0.1827ng in groups A, B, and C, respectively. Histopathological findings advocated the presence of apoptotic bodies in the neem treated group whereas the presence of degenerated interstitial cells, necrosed seminiferous tubules, damaged germinal epithelium, and ceased spermatogenesis was also studied in both competitive groups. Thus, the apoptotic effect and anti-inflammatory property of neem leaf extract resulted in less painful castration and verified Azadirachta indica as a better substitute for chemical castration in contrast to hypertonic saline solution.

Objective: To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Setting: Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. Study design: It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. Results: After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642(64.2%) while female patients were 358(35.8%). Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51(12%) in Group I patients, 46(16.6%) in Group II patients, 36(22%) in Group III patients, 35(27.7%) in Group IV patients and 5(35.7%) in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 (CI 2.2-12.1), moderate renal insufficiency OR 4.1 (CI 2.3-7.2) and mild renal insufficiency OR 1.9(CI 1.1-3.1) with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20(4.7%) patients in Group I, 17(6.1%) patients in Group II, 15(9.4%) patients in Group III, 16(12.6%) patients in Group IV and 4(28.6%) patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Conclusion: Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients.

Women with acute myocardial infarction have higher in-hospital mortalitythan men mainly due to greater age on presentation. Objective: To evaluate the age specific sex difference in inhospitalmortality of acute myocardial infarction. Design: Descriptive study. Place and duration: Coronary Care Unitand cardiology ward of Nishtar Hospital Multan from 15 of th September 2002 till 30th of April 2003. Material & Methods:Four hundred and fifty patients of acute myocardial infarction who fulfilled our inclusion criteria were studied while theywere admitted to the hospital. Patients were divided into four groups according to age and sex i.e. Group I (male <45years), Group II (male $45 years), Group III (female <45 years) and Group IV (female $45 years). In-hospital mortalitywas compared between different age groups by Chi-square test. Results: The total in-hospital mortality was76(16.9%).In Group III none of the patients expired. In Group I in-hospital mortality was 6(7.1%) patients followed byGroup II 50(18.3%) patients and Group IV 20(23.3%) patients p<0.019. In-hospital mortality was greater in Group IVthan in any other group. Group IV patients were more frequently diabetic and hypertensive than patients in any othergroup. Group IV patients presented late to the hospital. There was no significant difference in site of myocardialinfarction in different groups. Higher Killip class was observed in Group II and IV p<0.05. Streptokinase injection wasgiven less frequently in Group IV than in any other group p <0.012. Only 34(39.5%) patients in Group IV had nocomplication during hospital stay while more patients in other groups had uneventful hospital stay p<0.001.Conclusion: Female sex is associated with higher in-hospital mortality in older age group as compared to the malepatients of same age group.

No abstract