Clopidogrel and Aspirin are widely used antiplatelet agents in the prevention and treatment of isch- emic heart disease (IHD). Many patients have been noticed with recurrence of major ischemic events, due to resistance of these drugs. Different platelet function tests can be used to evaluate the de- gree of achieved platelet inhibition in patients treated with clopidogrel. The objective of this study was to determine frequency of clopidogrel resistance in patients of ischemic heart disease. Seventy one patients of IHD were selected from out-patient department of Punjab Institute of Cardiology Lahore. Platelet aggregation studies were performed on Diamed Impact R. Clopidogrel response as- say was performed with DiaAdin(ADP 110μmol/L). Chi-square test was applied to measure statistical significance. Resistance to Clopidogrel was observed in 17% (12 out of 71). Clopidogrel resistance was significantly associated with female gender (p=0.046). In our study no statistically significant as- sociation was observed between clopidogrel resistance and risk factors like diabetes mellitus, family history ischemic heart disease, hypertension and smoking. We concluded that resistance to Clopido- grel therapy is seen in significant number of patients and female patients are at high risk of develop- ing the resistance to clopidogrel therapy. These patients can be identified by performing platelet aggregation studies on Impact R

Background and Aim: Chronic obstructive pulmonary disease (COPD) is related to a number of comorbidities that contribute to various phenotypes, including increased mortality rates and decreased physical activity. The present study aim was to determine the incidence of obstructive sleep apnea among chronic obstructive pulmonary disease patients. Methodology: This prospective study was carried out on 250 obstructive pulmonary disease patients at the department of Medicine/ Pulmonology, Fauji Foundation Hospital, Rawalpindi and Avicenna hospital, Lahore from February 2021 to July 2021. Out of 250 patients, 128 patients were enrolled based on clinical examination, medical history and pulmonary tests. Ethical approval was taken from the respective institutional ethical committees. Written informed consent was taken from all the patients. All the patients with sputum production, history of disease exposure and risk factors, chronic cough and forced vital capacity with volume of post-bronchodilator forced expiratory presence in first capacity <70% were enrolled. Patients with thyroid dysfunction, decompensated heart failure, hepatic and renal impaired, Obstructive sleep apnea (OSA) caused by ENT, and acute COPD patients (forced vital capacity <30% or <50% anticipated were excluded. Based on BMI, COPD patients were categorized into two groups: Group-I had 64 obese patients of chronic obstructive pulmonary disease (BMI≥ 29 kg/m2) and non-obese COPD patients (BMI≤ 29 kg/m2) in Group-II. SPSS version 21 was used for data analysis. Results: Of the total 128 COPD patients, male and female patients were 84 (65.6%) and 44 (34.4%) respectively. Out of 128 COPD patients, the incidence of mild, moderate, and severe COPD was 28 (21.9%), 68 (53.1%), and 32 (25%) respectively. The severity of obstructive sleep apnea was 9 (32.1%) in mild, 28 (41.2%) in moderate, and 27 (84.4%) in severe respectively. Based on body mass index (kg/m2), incidence of mild, moderate and severe cases in Group-I (Obese) and Group-II (non-obese) were 3 (2.3%), 20 (15.6%), and 41 (64.1%) and 26 (20.3%), 33 (25.8%), and 5 (3.9%) respectively. Conclusion: Our study found that sleep-disordered breathing diagnosed in moderate and severe in COPD patients. Obstructive sleep apnea are more likely to develop in Obese COPD patients. Keywords: Obstructive sleep apnea, COPD, Obesity

Introduction: The World Health Organization declared the COVID-19 epidemic an international public health emergency on January 30th, 2020. Many patients required ICU admission for advanced respiratory support, including high flow nasal oxygen, and non‐invasive, and invasive mechanical ventilation. Lower Ct values may be associated with disease severity Objective: To observe the Cycle threshold (Ct) value and outcome of the COVID-19 patients admitted in Intensive Care Unit (ICU). Methods: Nasopharyngeal/ oropharyngeal samples were collected via swabs from suspected COVID-19-positive patients admitted to Corona ICU of Teaching Hospital, Dera Ghazi Khan (DG Khan). Samples were proceeded for RNA extraction and amplification and were declared positive on basis of the S-shaped amplification curve at FAM (ORF1) and ROX channel, and a Ct value of ≤40. Results: Out of 59 ICU admissions, 17 were females and 42 males. The highest percentage of mortality was observed in the 60 and above years of age group (78.98%). Ct values were lower in patients who expired as compared to the patients who were discharged (mean 21.052 vs 23.739). Conclusion: Males were more frequently admitted to ICU for management of severe infection by COVID-19 than females. Mortality is associated with increasing age. Cycle threshold (Ct) values were lower in patients who expired than those who recovered Keywords: Cycle threshold, RT-PCR, COVID-19, ICU