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Objective: To assess whether maternal diabetes mellitus (MDM) is associated with an increased risk of congenital heart defects (CHD) in offspring. Research design and methods: A population based cohort study was conducted by using information from the National Health Services and long term care of Punjab (Pakistan) health care administrative databases. The researcher identified all women with a MDM diagnosis with a live birth singleton delivery between June 2020 and May 2022. MDM was defined based on laboratory test results and diagnosis coding. Results: A total of 17,335 people with CHD remained allocated to embryologically relevant heart phenotypes. CHD recurrence was 328 per 11,500 live births (n=236) in offspring of women having gestational diabetes mellitus, associated to a baseline danger of 81 per 11,500; attuned comparative danger for CHD remained 5.01 (96 percent confidence range, 4.52–5.54). The connection was unaffected by birth year, maternal age at diabetes beginning, or diabetes extent, in addition CHD dangers associated with type 1 and DM type-2 were not substantially different. Individuals born to females who had previously experienced acute exacerbations had a higher risk of CHD than just those born to women who had not previously experienced acute diabetes complications (hazard ratio, 8.63; 96 percent confidence interval, 6.24–11.7, and relative risk, 4.48; 96 percent confidence interval, 3.92–5.14, respectively; P=0.0005). Maternal gestational DM remained related to all particular CHD phenotypes (adjusted hazard range, 3.75–15.9). Conclusion: In a large observational study, MDM was associated with an increased risk of CHD. Therefore, diabetes screening during pregnancy is suggested to identify women at risk for CHD. Keywords: Maternal diabetes mellitus, Congenital Heart defects and Offspring

Objectives: The mainobjective of study was to explore the effect of re-exploration after coronary artery bypass (CABG). Material and Methods: This was descriptive cross sectional study conducted at cardiac surgery department during the period of 1st January to 30thJune, 2017. A pre design questionnaire was used to collect data on outcomes of all re-explored cases for post-operative bleeding that underwent CABG surgery. The data was analyzed by SPSS 20. Statistical test like chi- square test was applied to obtain the required results. Results: Findings of current study showed that the average age of patient was 38.2±4.2 years (age range 21-50 years). The male and female participants were 38(66%) and 20(34%), Low output syndrome 9(16%), IABP Support 5(9%), Arrhythmias 11(19%), Post-operative lung dysfunction 6(10%) and 3(9%) Stroke. Conclusion: Delay in re-exploration and massive amount of allergenic blood products are associate with a worse clinical outcome and an increase in mortality. Keywords: Re-exploration, Coronary Artery Bypass Grafting (CABG), intra-aortic balloon pump (IABP)

Background: Hypertension is main highest source of global illness proportion, impacting approximately 2.38 billion individuals worldwide. Although treatment guidelines can help with the appropriate care of this frequent illness, there are differences amongst clinical practice guidelines (CPGs), the amount of which is uncertain. Assessing the discrepancies in CPG recommendations across socioeconomic levels should help explain several of the worldwide variances in patient outcomes associated with hypertension. Objective: The objective of study is to examine the worldwide variance in hypertension CPGs. It intends to evaluate variance in 3 areas: diagnosis criterion, staging, therapy and targeted BP guidelines in hypertension. Methods: From July 2020 to June 2021, the MEDLINE database has been searched for national and international hypertension CPGs. An extra country-precise grey-literature search remained performed for altogether World Bank-identified nations and territories. Information from CPGs have been retrieved to describe the assessment, staging, therapy, and goal blood pressure, and changes across CPGs for all these areas have been examined. Results: For the assessment, 48 CPGs from all World Bank-given situations and the implications were chosen. Ninety-six percent of recommendations classified hypertension as the hospital-based BP of 145/95 mmHg, and 89 percent suggested a goal blood pressure of 140/90 mmHg. Nine dissimilar first-step, 18 dissimilar second-step, also seven distinct third-step medication suggestions have been found in pharmacological therapy of hypertension. In the first-step therapy, low-income nations preferred diuretics (65%), whereas high-income countries provided greater options among antihypertensive categories. At BP 166/110 mmHg or higher, 44% of recommendations, including 72% from higher-income environments, suggested starting therapy with double treatment. Conclusion: According to the result of this research, CPGs were substantially similar in diagnosis, staging, in addition target BP guidelines for hypertension. Clinical guidelines differed greatly, especially for second-line treatment. There was heterogeneity across economic levels; low-income nations administered cheaper pharmaceuticals, provided fewer prescription options to clinicians, and launched dual treatment later than higher-income ones. Future studies into the true reasons for this heterogeneity may enhance results for hypertension customers in a variety of therapeutic settings. Keywords: Hypertension, Threshold, Staging, Blood pressure and Guidelines.