Due to the high frequency of in-stent restenosis, repeat coronary angiography and left main percutaneous coronary intervention is recommended. But Computed Tomography Angiography is a noninvasive procedure for evaluating coronary arteries. Objectives: To assess the proportion of InStent restenosis in left main per-Cutaneous coronary intervention and to evaluate diagnostic efficacy of Computed Tomography Angiography in detecting In stent Restenosis. Methods: We assessed 263 consecutive LM PCI patients; 130 patients were chosen for this study procedure as they meet our criteria. CTA was conducted three months following the LM PCI. Results: The vast majority of patients (73.8 %) had PCI from LM to LAD and 16.2 % from LM to LCX. Only 10% of patients had bifurcation PCI, and all patients had DES (100%). The average period for ISR development was 125 months, with ISR rates of 32.2 % in the LM to LAD cohort and 38 % in the LM to LCX cohort. The median time between PCI and CTA was 194 days, with a mean basal heart rate of 69 ± 12 beats per minute. CTA exhibited a positive predictive value of 84.7%. Conclusion: CTA enables an accurate noninvasive assessment of selected patients following LM PCI. And CTA can be used as a first-line treatment instead of coronary angiography.

Patients having esophageal cancer can experience psychological, emotional, physical, social, financial and spiritual changes following surgery. Exploration of such challenges, particularly from the Patient’s perspective has been limited in Pakistan. Objective: To explore the experiences of post-esophagectomy patients admitted in Lady Reading Hospital Peshawar Pakistan. Methods: A qualitative phenomenological study was conducted on ten patients having esophagectomy admitted at Lady Reading Hospital Peshawar. Participants were selected through None Probability purposive sampling technique. Permission was taken from concerned departments as well as from participants before data collection. An interview topic guide was used for Face-to-face individual, in-depth interviews. Audio recorded, transcribed, and analyzed through thematic analysis. Results: Five major themes were constructed i.e., Physical changes, psychological effects, social issues and support, financial issues, acceptance, and adjustment to a new changed way of life. Conclusions: Post-esophagectomy patients need full support in adjustment to their physical, psychological, emotional, social, financial, and spiritual aspects of life. Family, friends, and society could be an effective channel in this regard. Government should provide medical and financial support to such patients for their treatment as well as for their rehabilitation.

It's kind of mysterious how complementary and alternative medicine (CAM) is being used more and more in developed, "established" Western countries. There hasn't been much study or good understanding about it. The National Center for Complementary and Alternative Medicine (NCCAM) defines "complementary and alternative medicine" (CAM) as a collection of various medical and health systems, procedures, and objects that are not currently regarded as corresponding to traditional medicine. Over the past 15 years or so, CAM use has grown significantly, and it is without a dispute significant from a medical, economic, and sociological perspective. Even though there are literally hundreds of therapies that fall under the broad definition of CAM, only about 15-20 have definitive proof of their efficacy and safety to be taken seriously (Tiran, 2001). The NCCAM divides complementary and alternative medicine (CAM) into five primary categories: whole medical systems, mind-body healthcare, physiologically based, manipulative and body-based therapies, and energy fields [1]. CAM is frequently used to supplement conventional treatment. Back issues, melancholy, sleeplessness, intense headaches or migraines, stomach or intestinal diseases, and back problems were the most frequent symptoms linked with CAM, according to a review of the worldwide CAM literature by Frass et al. [2]. A few earlier studies looked into the use of CAM for particular diseases or health issues, like cancer and multiple sclerosis. According to Menniti-Ippolito et al., herbal medicine was more frequently used to enhance life expectancy while acupuncture and manipulative treatments were mainly used to treat pain in Italy. Homeopathy, in comparison, was not linked to any particular health issues [3]. Other common reasons people turn to complementary and alternative medicine (CAM) are dissatisfaction with biomedicine, frustration with the doctor-patient relationship, relaxation, enhancements in subjective wellbeing, preventative medicine, a preference for natural care over biomedical medicine, and an eagerness for more individualized and holistic care. People in Pakistan who believe in quacks, pastors, hakeems, homoeopaths, or other psychic healers have used alternative treatments. For issues like infertility, seizures, psychosomatic issues, melancholy, and many other illnesses, these are the first line of defense. The proximity, reasonable cost, accessibility, family obligation, and the positive perception of the community are the primary justifications for visiting a CAM healer. Pakistan has a long history of using medicinal herbs to cure a variety of illnesses. The people's health-seeking behavior, particularly in emerging nations, necessitates integrating all CAM healers into society by giving them access to appropriate training, tools, and referral support.

For Procedural Sedation, sedative and Analgesic agents are frequently used in Emergency Department but titration of anesthetic doses should be performed with care, and patients should be continuously monitored. The use of Ketamine, Propofol and their combination (Ketofol) is in common practice, but there is currently no intravenous anesthetic agent that is ideal. Therefore, this review was conducted to analyze the efficacy as well as the potential side effects of these anesthetic agents during procedural sedation. Method: For this purpose, Medline, EMBASE, CCRCT and CINAHL were searched and systematically analyzed and the meta-analysis included all English-language randomized control trials (RCTs) comparing K-P vs propofol for procedural sedation in ED. The study included the data of ED patients who received procedural sedation for non-elective unpleasant procedures. Results: As a result of the removal of duplicate citations and studies that did not fulfill eligibility requirements, a total of 06 RCTs involving 932 patients (412 in the propofol group and 520 in the K-P group). Very high levels of inter-rater reliability (j = 0.88; 95% CI = 0.68 to 1.0) were found in the final selection of included trials, with 95.2% agreement. Conclusion: Data revealed that the combination of Ketamine with propofol was the most effective anesthetic combination in the larger randomized, prospective studies carried out in the ED that had sufficient power to use the maintenance of vital signs and the success of the procedure as endpoints are still required

ST-elevation myocardial infarction (STEMI) has a poor long-term prognosis associated with early ventricular tachycardia (VT). Objective: To find out the frequency of ventricular tachycardia in the first 48 hours of ST-elevation myocardial infarction. Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1^st October 2020 to 31^st March 2021. All the patients having new onset ST-elevation Myocardial infarction as per Operational definition, both genders, aged between 40 and 75 years and who have given consent were included in the study. Non-probability consecutive sampling technique is being used for the sampling. Results: Standard deviation was ±1.357 years, while the average age was 51.56. Gender-wise distribution among patients male was 89(53.6%) and female was 77(46.4%). Distribution of duration of disease among patients 12-24 hours 80(48.2%) and more than 24 hours 86(51.8%) was 100(52.4%). Family History of coronary artery disease (CAD) 84(50.6%), diabetes mellitus 93(56.0%), hypertension 110(66.3%) and smoking status was 118(71.1%). Distribution of ventricular tachycardia was present among 103(62.0%) patients and was absent in 63(38.0%) patients. Conclusions: Ventricular tachycardia is the most common tachycardia occurring in patients in the first 48 hours who sustained myocardial infarction. It was shown that bradyarrhythmia was more common in patients with inferior wall myocardial infarction while ventricular tachycardia was found to be more in patients with anterior wall myocardial infarction.

The use of modern technology infrastructure is regarded as critical for the successful adoption of innovative teaching approaches. Objective: To determine the attitudes and concerns of medical and dental faculty about the use of E-learning as a medium of instruction during the Covid-19 outbreak. Methods: This cross-sectional study included 368 faculty members from Medical and Dental Colleges of Punjab province was conducted utilizing a questionnaire developed following a thorough literature review and analysis of questionnaires from previous studies. A 5-point Likert scale was used to record knowledge, attitude, and practice, and the questionnaires were graded. SPSS version 22 was used to enter the data. The mean and SD of quantitative variables such as age and total score for knowledge, attitude, and practice score was calculated. Gender, education level, knowledge, attitude, and practice were all represented as frequency (%). Results: Zoom was shown to be the most commonly utilized software (69.0%). E-learning was deemed a beneficial tool in medical education by 56% of the respondents. An equal percentage of individuals (35%) agreed and disapproved the use of E-learning approaches over traditional ones. Only 30% participants resisted the change from traditional educational methods. Technological infrastructure was considered crucial for successful implementation of E-learning by 46% of the participants. Conclusion: Faculty members are using the available infrastructure to implement E-learning teaching modalities to the best of their knowledge and abilities.

It has been recognized that soft drinks have become the third most consumed beverage worldwide. In contrast, it has a detirmental effect on health. Objective: To assess the knowledge, attitude, and practices of soft drink consumption and determine its association with gender among nursing students in Karachi, Pakistan. Methods: This cross-sectional study was accomplished at three nursing institutions in Karachi from 1^st January 2018 to 30^th June 2018. In this study, there was a total of 369 students of male and female gender were enrolled for the study. Subjects were approached by a non-probability convenient sampling method. Self-structured and pretested questionnaire was used for the collection of data. Results: Among 369 subjects, the majority of 261 (70.7%) were male, and 315 (85.4%) were single. 310 (84%) participants knew the deleterious effects of soft drinks. More than 85% admitted that soft drinks are bad for health. Two knowledge questions heard about soft drinks and the idea of the bad effects of soft drinks showed statistically significant associations with gender variables (p-values < 0.05). Whereas only attitude questions regarding the amount of drink students prefer and one practice question related to favorite drink were found to be significantly associated with gender variable (p-values < 0.05). Conclusion: Most nursing students had a fair knowledge of soft drink and their hazardous effects on their health. Despite knowing the harmful consequences, nursing students consume soft drinks.

Menopause is a stage in life in which female periods are stopped, as it is a normal part of ending of your fertile, reproductive years. Objective: To assess the knowledge, attitude and practices regarding menopause among elderly women of Lahore. Methods: A cross sectional study was conducted in the Tertiary Health Care Centers in Lahore, Pakistan. Data were collected by non-probability convenient sampling technique. Inclusion criteria includes all females age between 45 to 60 and above. Whereas the exclusion criteria include non-cooperative individuals, women on any drug therapy. After taking informed written consent, data were collected by using self-structured questionnaire. Results: According to the study, 70% women had prior knowledge of menopause. 60% believe menopause is life-altering. Additionally, 67% believe menopause causes weight gain, 67% believe that food changes assist manage menopause. In addition, 65% practice the lifestyle changes help managing menopause. 44% had mild hot flashes and sweating episodes, 23% had severe symptoms, 45% of women had mild sleep issues. 36% were suffering from mild depression, and 30% had no symptoms. In 29% women had osteoporosis, 46% women have joint pain 25% of women made dietary modification for menopause. Conclusions: The majority of women were aware of menopause and its symptoms because they were educated, but they did not live a healthy lifestyle that included dietary practices and physical activities such as yoga and exercise. Providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women

Nonalcoholic fatty liver disease (NAFLD) is one of the most important causes of liver disease. NAFLD is commonly associated with obesity, insulin resistance and other metabolic abnormalities such as hypertriglyceridemia and hyperuricemia. Patients with NAFLD can be properly rationalized and with early exploration and management of fatty liver the progression and complications of NAFLD in relation to liver fibrosis can be reduced on priority basis because the APRI is noninvasive and a simple calculation of two laboratorial variables. Objective: To determine the frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease. Methods: This cross-sectional descriptive study was conducted upon 164 patients with NAFLD, presented at Department of Medicine, Liaquat University Hospital, Hyderabad. All the patients with NAFLD were evaluated and explored for liver fibrosis through APRI by taking 2cc venous blood sample in a sterilized syringe by principal investigator and send to laboratory for analysis to get the AST and platelet count. An APRI score greater than 0.7 was set cut off for significant hepatic fibrosis. The data were collected on pre-designed proforma.  The study lasted 6 months from 26^th February 2020 to 31^st August 2020. Results: The mean age of the patients was 48.15±11.13 years. Frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease was 10.98% (18/164). The mean APRI score was found to be 1.8±0.6. Conclusions: It was concluded that APRI is noninvasive and a simple calculation of two laboratory variables and can easily be used at the bedside or in an outpatient setting to assess the liver fibrosis. In this way, the management of NAFLD can be improved.

Diarrhea is one the most common symptoms encountered in emergency department in children specially and needs prompt management. There are many disastrous complications and hypokalemia is one and most important of them. Hypokalemia warrants urgent diagnosis and expert management. Objective: To determine the frequency of hypokalemia among children having acute malnutrition with diarrhea. Methods: This cross-sectional study was done in Department of Pediatrics, Khairpur Medical College from 1^st November 2021 to 30^th April 2022. A total of 134 patients fulfilling the inclusion criteria were included. Informed consent was taken from attendants. The data were collected on prepared proforma. Results: There were 134 patients in this study with The mean age of the cases was 2.4 ± 3.13 years. Male children 84 (62.6%) and were in majority while females comprising of 50(37.3%). Frequency of hypokalemia was 57 (42.5%). Conclusions: Our results showed that children with acute diarrhea and dehydration have an increased risk of developing hypernatremia and hypokalemia. Significant correlations were found between electrolyte imbalance and mortality.