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Introduction Increased levels of homocysteine (Hcy) may lead to endothelial damage and increase the risk of cardiovascular and renal malfunction. The current study aimed to evaluate the association of serum Hcy levels with gender, body mass index (BMI), duration of diabetes mellitus type 2 (DMT2), hemoglobin A1c (HbA1c), and blood pressure (BP). Methodology A prospective observational study was conducted at Hayatabad Medical Complex in Peshawar, Pakistan in the department of endocrinology from June 2020 to June 2021. All patients with diagnosed DMT2 above the age of 18 years were included in the study. Individuals with unconfirmed diagnoses with ages over 75 years were excluded from the study. All data including the patient's age, gender, and medical history were recorded. Height and weight were used to calculate the BMI. BP was examined thrice and a mean value was recorded for each patient. For laboratory investigation, a vial of 3 ml blood was extracted keeping sterile and aseptic conditions by a trained nurse. The sample was sent for the determination of HbA1c and serum Hcy levels. Measurement of serum Hcy was done by chemiluminescent microparticle immunoassay. All data were documented by the researchers on a predefined pro forma. Results A total of 188 patients with DMT2 were included in the study with a mean age ± SD of 54.65 ± 8.42 years. Normal (<15 micromoles per liter [mcmol/l]) serum Hcy levels were reported in 75 (39.89%) individuals, while in 47 (41.59%) individuals, there was severe (>100 mcmol/l) hyperhomocysteinemia. More than half of the patients, i.e. 157 (83.52%), had HbA1c of greater than 7%, which indicated poor glycemic control. The study revealed that the majority of the female patients, i.e. 37 (78.72%), had severe hyperhomocysteinemia (p<0.0001). Similarly, there was a direct correlation between HbA1c levels and serum Hcy. Severe hyperhomocysteinemia was found in over 80% of the patients with poor glycemic control, i.e. HbA1c >7% (p<0.0001). Furthermore, the duration of DMT2 and hypertension were both significantly associated with increased levels of Hcy with p-values of <0.0001 and <0.0001, respectively. However, no association was found between hyperhomocysteinemia and BMI. Conclusion The study revealed that increased levels of serum Hcy were associated with female gender, poor glycemic control (HbA1c >7%), BP, and duration of DMT2. However, the study failed to find an association between serum Hcy and BMI. It is recommended that patients with poor glycemic control or those with the duration of DMT2 of more than five years must be regularly checked for hyperhomocysteinemia and renal function tests. Large-scale and multi-center studies are required in order to determine the validity of these findings. The current study suggests that patients with diabetes mellitus and hypertension are likely to have increased levels of Hcy and, therefore, must be regularly screened for hyperhomocysteinemia.

The prognosis of coronary revascularization in patients has been significantly altered by the Interventional cardiology. With the advancement of the novel drugs and stent technology the new complications i.e., in-stent restenosis, have emerged. Objective: To analyze the predictors of outcome in the treatment of in-stent restenosis with drug-eluting balloons. Methods: It was a retrospective study conducted at Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat for the duration of one year from August 2021 to July 2022. The patients older than 18 years were eligible for the trial. The patients who have undergone coronary intervention with a drug-eluting balloon during the duration of the study were also eligible. This study received approval from the institution's research ethics board. The patient demographic features, procedure complications and operative results were recorded. Results: The mean age of patients was 65 years. There were 62 male participants. There were 54 patients that had history of diabetes mellitus, 87 had hypertension, 32 reported about smoking habits. There were 91 patients that reported about history of percutaneous coronary intervention (PCI), 72 about myocardial infraction (MI) and 30 reported about coronary artery bypass graft (CABG). Kidney related inflammation or infection was found in case of 19 patients.  Conclusions: This single center study showed significantly low rate of target lesion revascularization (TLR) for a period of one year and moderate rate was found at five years.

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.