Background: The Methicillin resistant Staphylococcus aureus (MRSA) is accountable for community and hospital acquired infections. Due to over and misuse of antibiotics, MRSA isolates are becoming multidrug resistant even with linezolid and vancomycin. The objective of this study was to determine recent antimicrobial profile of MRSA, isolated from different clinical samples and current treatment options for MRSA, other than vancomycin and Linezolid. Methodology: This cross-sectional study was conducted at Foundation university medical college from Jan 2019 to Dec 2020. Total 918 samples of blood, pus swab, throat swab, tracheal swab, wound swab, endotracheal tube (ETT) tips, Catheter tips, axillary swab and suction tips received by using aseptic techniques, for culture and sensitivity in different hospitals of Rawalpindi and Islamabad, were taken. Isolated pathogens were identified using standard protocols and susceptibility testing was done by Kirby-Bauer disc diffusion method. Results: Out of 918 samples, MRSA was isolated in 96 (10.4%) samples and most frequently observed in 27% (n=26) blood samples. The mean age of enrolled patients was 52.02 (SD±16.1) years, the infection was largely seen in age group 46-55(24%) and in 57% (n=52) male population. MRSA showed higher resistance to levofloxacin 78.1% (n=75), ciprofloxacin 75% (n=72), erythromycin 70.8% (n=68) and gentamycin 62.5% (n=60).  The susceptibility of older drug chloramphenicol and Trimethoprim-sulfamethoxazole was found 61% & 49% respectively. MRSA isolates were highly susceptible to vancomycin (96.8%), linezolid (89.5%) and teicoplanin (70.85%). Alarmingly, 2.1% (n=2) MRSA isolates showed resistance to vancomycin. Conclusion:Vancomycin resistant MRSA is a matter of great concern, because of unawareness among health administrative departments and public, self-medication, lack of surveillance system and non-availability of antibiotic policy.   Keywords: Antibiotics, MRSA, Vancomycin, Chloramphenicol

Background: For identification of the coronary artery diseases the neutrophil to lymphocyte ratio is considered as a well-known marker. Objective: To evaluate the relationship of neutrophil to lymphocyte ratio (NLR) with CAD severity and to determine the reference value of NLR for prediction of the CAD. Study design: It was a cross-sectional study with statistical approach, Peshawar institute of cardiology and Punjab Institute of cardiology Lahore from May 2021 to October 2021. Material and Methods: The 132 patients visited the Peshawar institute of Cardiology and Punjab Institute of cardiology Lahore were included in this research. The patients who had undergone the coronary angiography for angina with ischemic ECG changes were selected. SYNTAX score was used to assess the CAD severity. The high, intermediate and low SYNTAX group was created on the basis of results. The BeneSphera analyzer was used to determine the neutrophil and lymphocyte count. The NLR was calculated. The Pearson’s correlation test, ANOVA and logistic regression analysis was performed for the statistical analysis. Results: Out of the 132 patients were selected, the average age range was between 24 years to 85 years. Among them 67 % of the patients were male and 40 % of patients had a low score of SYNTAX. On the other hand, 33 % of the patients had medium syntax scores. The range of the NLR was between 1.1to9.76 (median 2.54 and mean 3.31 ±1.90). The average standard deviations in low SYNTAX group was 57.12 ±12.018. While it was 61.92±12.23 in intermediate SYNTAX group and 63.01±12.54 high SYNTAX group. The dyslipidemia, diabetes mellitus were more commonly observed in the high SYNTAX group. This group also had low lymphocyte count and high neutrophil count. Conclusion: For the prediction of CAD, the ratio of neutrophils to lymphocytes can be considered. By the calculation of this ratio, it is easy to highlight the correlation between CAD and severity level. Keywords: Coronary angiography, SYNTAX, neutrophil to lymphocyte ratio (NLR), Cardiovascular diseases (CAD).

Background and Aim: Multiple organ diseases can cause chest pain. One of the most important differential diagnoses is acute coronary syndrome (ACS). The present study aim was to determine the incidence of ACS among patients presented with chest pain. Patients and Methods: This observational study was carried out on 168 patients presented with chest pain in the Department of Cardiology, DHQ Teaching Hospital / GKMC, Swabi and Punjab Institute of Cardiology Lahore. The duration of study was 6 months from October 2021 to March 2022. Chest pain, diabetes, hypertension, and smoking status from each individual were recorded. The incidence of ACS was determined. Patients presented with chest pain and had >16 years age were enrolled. Thoracic patients, traumatic chest pain, and local infectious patients were excluded. Nature of chest pain such as substernal pain, nitroglycerin relieved pain, and exertion provoked pain were assessed. ACS was diagnosed and confirmed by electrocardiograph (ECG), prior history, and cardiac biomarkers. Descriptive statistics was carried out in SPSS version 26. Results: Of the total patients, there were 116 (69%) male and 52 (31%) females. The prevalence of acute coronary syndrome was 62 (36.9%) among patients presented with chest pain. The overall mean age was 46.82±12.1 years with age range from 16 years to 80 years. The incidence of diabetes, hypertension, and smoker were 48 (28.6%), 66 (39.3%), and 38 (22.6%) respectively. Out of 168 patients, the prevalence of non-specific, atypical, and typical chest pain was 88 (52.3%), 50 (29.8%), and 30 (17.9%) respectively. Of the total 62 ACS patients, the incidence of STEMI, NSTEMI, and unstable angina were 28 (45.2%), 19 (30.6%), and 15 (24.2%) respectively. Conclusion: The present study found that the incidence of ACS was 36.9% among patients presented with chest pain. Acute coronary syndrome was the most important differential diagnoses in chest pain patients. If a patient is presenting with chest pain, the diagnosis of ACS needs to be strongly deduced, and prompt action taken so that the patient can undergo proper treatment as soon as possible. Keywords: Acute coronary syndrome, Chest pain, Prevalence

Hoarseness of voice is much frequent in recent times and it alters the normal quality of voice Objective: To understand and assess the etiological factors of hoarseness. Methods: A Non-randomized, longitudinal and cross-sectional study was conducted in the ENT Head & Neck Surgery, Lady Reading Hospital Peshawar and Al Nafees Medical College and Hospital, Islamabad for six months duration from September 2021 to February 2022. All subjects with a history of hoarseness underwent routine specific clinical evaluation to establish diagnosis. The simple manual analysis was applied for final outcomes assessment with percentage and frequency using SPSS 21.0. Results:  Participants enrolled were 150, amongst them, the patients of 21-30 and 31-40 years of age suffered from hoarseness. Likewise, 98 (72%) were males, 52 (28%) were females with a M: F proportion of 1.45: 1. According to the distribution, the utmost communal etiology observed in this study was acute laryngitis (30%), trailed by acid peptic laryngitis in 25.3%, laryngeal neoplasms in 8.7% and other includes laryngeal tuberculosis, intubation granuloma, and very rarely trauma. Conclusions: There was an etiological variability of hoarseness, varies from simple laryngitis to malignant neoplasms. For this reason, it is significant not to overlook hoarseness and a thorough examination, investigation and proper history should be taken