Introduction Healthcare services all over Pakistan are facing an ever-growing patient flow. Rapid urbanization and a population boom are mainly responsible for this phenomenon. This is most evident in the emergency department. Not only are the patients in dire need of medical management but they require it within a certain time frame lest it is too late. It is difficult in such situations to deliver satisfactory services. Many studies have analyzed satisfaction levels in doctors, nurses, postgraduates, and patients in the emergency department. But little data is available on the satisfaction levels of attendants that accompany the patients most of the time. Attendants are an integral part of the doctorpatient relationship and their perspective may offer some insight into the shortcomings and issues afflicting the system, especially with regards to emergency medicine.

Introduction Metabolic syndrome (MetS) is defined as a syndrome of truncal obesity, insulin resistance, hypertension, hypertriglyceridemia, and dyslipidemia. It is well known that MetS increases the risk of cardiovascular disease and adverse events. Each of its components is associated with an increased risk of cardiovascular disease, but data on the association with ischemic stroke are scarce. At the international level, a significant body of research has been conducted on this issue, but the situation is very different in Pakistan. Very little data are present on the subject matter. This study is an endeavor in this direction, generating data, that can be used in early identification and developing treatment services for patients with ischemic stroke having MetS. Aims To determine the frequency of MetS in ischemic stroke patients admitted to a tertiary care hospital in Karachi, Pakistan.

Energy is an important element in human daily life. In Malaysia, about 80% of electrical energy produced from burning fuels that will cause of carbon dioxide emission to atmosphere. The effect could be reduced with less energy consumption. This project focuses on energy management strategies for energy saving that can be done on the HVAC system, air-cond, lighting and office equipment in Emergency Department, Block C Hospital Sungai Buloh. The annual profit, total cost and payment period for each research method are also studied. To implement for all major system must be link to chapter by Buiding Automation System. Major studies for this topic is to implement energy saving, calculate energy comsumption, power, area specific room, return of investment, analysis for daily cost for used, total for kWh for monthly usage.

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Background: We hypothesize that a change in lung ultrasound score (LUS) can assist in the early diagnosis of weaning-induced respiratory failure (RF). The objective of this study was to determine the utility of LUS in weaning patients with mitral regurgitation (MR) from mechanical ventilation (MV). Methods: This prospective observational study included patients with acute coronary syndrome (ACS) who required invasive MV after angiography/angioplasty. Echocardiography was performed and MR was recorded. When the patient was considered ready for extubation, a spontaneous breathing trial (SBT) was performed and pre- and post-SBT LUS was calculated. Patients who successfully passed the SBT were extubated and followed up for 48 hours for the signs of RF and outcomes. Results: We enrolled 215 patients, out of which MR occurred in 51(23.7%) patients. On post-SBT lung ultrasound, patients with MR were more likely to have B2 lines compared to those without MR; 15.7% vs. 3.7%; p=0.002 and mean LUS was significantly higher for patients with MR as compared to patients without MR; 2.75±3.21 vs. 1.37± 2.02; p<0.001. Post-extubation RF and mean CCU stay were significantly higher in MR patients, 49.0% (25) vs. 32.3% (53); p=0.030 and 3.53±1.54 days vs. 2.41±1.1 days; p<0.001 respectively. However, re-intubation and coronary care unit (CCU) mortality rate were not significantly different between patients with and without MR; 7.8% (4/51) vs. 3.7% (6/164); p=0.215, and 5.9% (3/51) vs. 3% (5/164); p=0.35 respectively. Conclusions: Bedside LU is a convenient tool to detect changes in cardiopulmonary interactions during weaning for patients with MR post-ACS.