Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics

Background and Aim: Depression is associated with hypothyroidism. Somatostatin and serotonin are known to influence the hypothalamus-pituitary-thyroid axis, resulting in depression in hypothyroid patients. Neurological symptoms such as behavioral disturbances, anxiety, and depression can be associated with thyroid hormone deficiency. The present study aimed to evaluate the depression illness in primary hypothyroidism patients presented to endocrine clinics. Patients and Methods: This descriptive cross-sectional study was carried out on 124 primary hypothyroidism patients presented to the endocrine clinic of Hayatabad Medical Complex, Peshawar during the period from February 2022 to January 2023. Patients of either gender aged >17 years and diagnosed with hypothyroidism based on T3 or T4 lower level (<1.71 pg/mL or T4 <0.7 ng/dL), higher TSH level (>4.94 uIU/mL), and TSH lower levels (<0.35 uIU/mL) were enrolled. Besides obtaining sociodemographic information, status of thyroid function status, and depression associated factors were noted. Patient Health Questionnaire (PHQ-9) was used for screening the depression among hypothyroidism patients. Moreover, the laboratory results were obtained from the patient's medical records. SPSS version 27 was used for descriptive statistics. Results: The overall mean age was 40.16 ± 10.52 years with an age range from 18 to 70 years. There were 115 (92.7%) females and 9 (6.3%) male. About 8.2% of patients were illiterate. There were 86.7% (n=85) married. The prevalence of varying degree depression illness was 36.7% (n=36). Fatigue, hair loss, memory problem, and gland enlargement were the most prevalent depression associated symptoms. The incidence of normal, low, and elevated TSH levels were 56.1% (n=55), 7 (7.1%), and 36.8% (n=36) respectively. The most common symptoms of hypothyroidism were fatigue and reproductive issues, followed by hair loss, weight gain, thyroid gland enlargement, and cognitive difficulties. The incidence of mild, moderate, moderately severe, and severe depression was 39.8% (n=39), 12.2% (n=12), 20.4% (n=20), and 5.1% (n=5) respectively. Among hypothyroid patients, the prevalence of most stressful issues such as family, social, emotional issues, and stressful life conditions were 29 (29.6%), 22 (22.4%), 18 (18.4%), and 62 (63.3%) respectively. Conclusion: The present study concluded that hypothyroid patients are more likely to suffer from depression and outlined the symptoms most commonly associated with depression. The incidence of depression in hypothyroid patients was 36.7%. Pregnancy, economic problems, educational problems, emotional problems, and social problems were the most common stressful situations among hypothyroid people. Patients with hypothyroidism are inclined to depression regardless of their TSH level or other risk factors such as socioeconomic problems. Keywords: Depression, Primary hypothyroidism, Treatment-resistance depression, Patient Health Questionnaire-9

Background: The clinical profile of severity of acute pancreatitis ranges from modest pancreatic inflammation to an unusually fatal acute necrotizing pancreatitis rightly known as severe acute pancreatitis (SAP). For the evaluation of clinical spectrum of pancreatitis, a more accurate models that is also cost-effective is required. Here, we sought to evaluate the contribution BISAP scoring systems to the diagnosis of severe of acute pancreatitis by comparing it with CT severity index. Settings and duration: This observational study was carried out at medicine department, Jinnah hospital, Lahore from 16th July 2022 to 15th January 2023. Sampling: Patients diagnosed with acute pancreatitis were registered. Acute pancreatitis was labelled based triad of classic epigastric pain, blood markers and imaging tool. BISAP score ≥3 was meant SAP and CT severity index for SAP included findings like necrosis and collection. Diagnostic accuracy was determined. Results: The patient's age ranged from 20 to 60 years with mean age of 36.41 + 9.362 years. The ratio of male to female participants was 2.3 to 1. For the diagnosis of SAP, the BISAP score's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were each 95.8%, 55.2%, 85.2%, 83.3%, and 84.8%, respectively. Conclusion: Simple clinical tools like BISAP score could be helpful in diagnosing severe acute pancreatitis, precluding the need for expensive and technically complex imaging modalities. Keywords: Severe acute pancreatitis (SAP), BISAP Score, Diagnostic accuracy