OBJECTIVES To determine the efficacy of accelerated streptokinase (SK) in patients with acute ST-elevation myocardial infarction (STEMI). METHODOLOGY This Descriptive study was done in the Department of Cardiology, Hayatabad Medical Complex over a period of 6 months from august 2020 to February 2021. Age ranged between 35-70 years. Both males and females presenting with acute ST elevation MI, patients within 6 hours of the onset of chest pain were included in the study. RESULTS Among 144 patients age distribution was analyzed as 50(35%) patients were in age 35-50 years, and 94(65%) patients were in age 51-70 years. The mean age and standard deviation were 61± 8.19. Gender distribution was analyzed as 88(61%) patients were male and 56(39%) patients were female. Status of BMI was analyzed as 69(48%) patients had BMI ≤27 Kg/m2 and 75(52%) patients had BMI >27 Kg/m2. CONCLUSION The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in-hospital and 1-year mortality rates in acute STEMI.

Objectives: Rheumatic heart disease causes significant morbidity and mortality among the cardiovascular diseases. Mitral stenosis (MS) is the commonest of all rheumatic heart disease. MVR was the definitive treatment for symptomatic mitral stenosis. But after the introduction of percutaneous transvenous mitral valve commissurotomy (PTMC), it is emerged as a safe and effective procedure for the treatment of symptomatic mitral stenosis. To determine the pre and post changes in right ventricular function among patients subjected to percutaneous mitral valve commissurotomy for mitral stenosis. Methodology: This Quasi experimental study was conducted in the Department of Cardiology Hayatabad Medical Complex Peshawar from April, 2021-Oct, 2021. TTE was performed at baseline and PTMC was done in all patients. After PTMC, all patients were kept in CCU for next 24 hours and another TTE was performed at 24th hour after PTMC for measuring changes in the RV function in terms of RVSP, RVOT-FS, RV TEi index, RV wall thickness, pulmonary artery systolic pressure. Results: As per changes in RV parameters before PTMC and 24 hours PTMC, mean and SDs for RVSAP was 5.70+4.50 with P Value 0.000. Mean and SDs for RVOT-FS was -1.22+3.02 with P Value 0.003. Mean and SDs for RV ETi index was 0.14+0.015 with P Value 0.000. Mean and SDs for RV wall thickness was 0.10+0.03 with P Value 0.000.  Mean and SDs for pulmonary artery systolic pressure 17.099+4.20 with P Value 0.000. Conclusion: PTMC has significant effect on pre and post changes in right ventricular function amongst patients subjected to percutaneous mitral valve commissurotomy for mitral stenosis.

Objectives: To address the association between Lipoprotein (a) and coronary artery disease risk in young patients & to evaluate whether high levels of lipoprotein (a) is a predictor of risk and is related to the severity of coronary artery disease. Methodology: This retrospective study was carried out at Cardiology Deptt of Hayatabad Medical Complex Peshawar between June and December 2021. Total 160 patients referred to the cardiac catheterization lab of either gender, aged 20-45 years who underwent coronary angiography for various clinical indications were enrolled in the study. Lipoprotein (a) level, lipid profile, fasting blood glucose, anthropometric and clinical parameters of the patients were analyzed. Results: Statistically significant differences were observed in the mean of serum lipoprotein (a) concentrations between group “A” (58.6 ± 3.20 mg/ dl) and group “B” (19.6+0.10 mg/ dl) P value <0.001. Mean HDL was 32.6 ± 0.30 in group “A” and in group B it was 40.4 ± 0.39 (p value >0.005), total cholesterol was 199 ± 2.00 in group “A” & 152 ± 1.80 in group “B” (p value <0.005), triglycerides (TGL) in group “A” (182.76 ± 43.86 mg/dl) & in group “B” (124.14 ± 44.01 mg/dl) P value <0.001, LDL in group “A” was (130±4.28 & in group “B” (84.4±3.00) p value <0.001, VLDL between group “A” (36.03 ± 9.19mg/dl) and group B (24.68 ± 8.89 mg/dl) P value > 0.003. However total Cholesterol / HDL was significantly lower in group “B” 3.5 as compared to group “A” 5.8 P value < 0.002. Conclusion: Irrespective of other traditional risk factors, increase in Lipoprotein (a) is an independent risk factor for coronary artery disease in young adults with positive family history. Thus elevated levels of Lipoprotein (a) may serve as an important criterion to identify the individuals who need to undergo lipoprotein (a) lowering treatment, thereby preventing them from myocardial infarction.

Objectives: Cardiovascular disease (CVD) is considered as one of the important priorities in the health systems of all countries. Approximately 550,000 first episodes and 200,000 recurrent episodes of acute myocardial infarction occur annually worldwide. Globally, ischemic heart disease has become the leading contributor to the burden of disease as assessed on the basis of disability-adjusted life-years. To determine the efficacy of accelerated streptokinase in patients with acute ST elevation myocardial infarction. Methodology: This Descriptive study was done in the Department of Cardiology, Hayatabad Medical Complex Peshawar from August 2020 to February 2021. Total 144 patients were observed. All patients were subjected to SK in a dose of 1.5million units over 60 minutes. All patients were under strict observation and a repeat ECG was performed to determine the efficacy of accelerated SK. Results: Our study shows that among 144 patients mean age and standard deviation was 61± 8.19. 88(61%) patients were male and 56(39%) patients were female. More over accelerated streptokinase was effective in 92(64%) patients and was not effective in 52(36%) patients. Conclusion: The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in-hospital and 1 year mortality rates in acute STEMI.

A Technology Advancement of Multi-Laterals (TAML) level-4 completion was installed in the South China Sea in 2022. The unique design of this multilateral completion system increased efficiency and reliability in drilling and completing the well and enabled selective production from the main bore, the laterals, or both. It also incorporated a safe way of combining an openhole gravel pack job with a multilateral application. The main bore was completed with 9.625-in. casing. An 8.5-in. sidetrack was drilled and completed by the TAML level-4 junction and 7-in. liner was cemented in place. The key components of this multilateral completion system are an anchor packer system to temporarily isolate the main bore; a sidetrack whipstock and milling system to drill through 9.625-in. casing for 8.5-in. lateral bore; a robust 9.625 in. × 7 in. TAML level-4 junction system that combines a main bore production tieback assembly, main bore junction assembly, lateral bore junction assembly, and a junction drilling diverter isolation system. A 6-in. horizontal lateral bore was drilled through junction. An anti-swab openhole gravel pack system was installed in the 6-in. horizontal section to prevent sand production. For selective production from target zones in each lateral, a 3.5-in. intermediate string was installed. A specially designed multilateral well shrouded shearable tieback seal assembly was run back into the lateral bore. A standard sliding sleeve (SSD) and landing nipple were installed above the tieback assembly. Comingled production is achieved by leaving the SSD open, and selective production is achieved from the lateral bore by closing the SSD. Selective production from the main bore is achieved by leaving the SSD open and setting an intervention plug into the landing nipple. The upper production string was completed with an electrical submersible pump system. In early 2022, the full system was successfully installed for the first time in the region with zero health, safety, or environmental incidents and zero non-productive time. The lateral bore 7-in. liner and TAML level-4 multilateral junction were installed in a single trip, and the 7-in. liner cementing operation and excess cement cleanout were completed efficiently in that same trip. The 6-in. slim-hole drilling tool and openhole gravel pack sand control system both passed the multilateral junction with no hang up issues. The intermediate tieback string was successfully run back into lateral bore. The successful installation of entire well completion verified the high reliability and efficiency of this robust 9.625-in. ×7-in. multilateral well completion system. A traditional multilateral junction only hangs one 7-in. liner inside the 9.625-in. main bore casing. In contrast, this robust new TAML level-4 junction system enables designing the main bore junction assembly and the lateral bore junction assembly separately; the two assemblies can be installed in the same single trip together with cementing operation. The openhole gravel pack operation was then performed in a conventional way through the 7in cemented lateral liner. This drastically reduced the overall operational risk, by separating the operational risk of installing the multilateral junction and the open hole gravel pack job. This newly designed junction system and separate gravel pack operation were key enablers to complete this well smoothly and safely.