Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

Objective: To determine the in-hospital outcomes after primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI) and develop sustained ventricular arrhythmia before revascularization. Methodology: This prospective observational study was conducted at the Department of Adult Cardiology, National Institute of Cardiovascular Diseases, from August 31, 2019, to February 29, 2020. All patients with STEMI who had developed sustained ventricular arrhythmias and underwent revascularization via primary PCI were included. The patients were kept under observation during their hospital stay to document in-hospital mortality. Data analysis was done using SPSS version 20. Results: Total 146 patients were included with a mean age of 54.41±12.75 years. There were 93 (63.7%) males and 53 (36.3%) females. When risk factors were assessed, hypertension was noted in 82 (56.2%) patients, diabetes mellitus in 62 (42.5%), 65 (44.5%) were smokers., and 49 (33.6%) were obese. There were 53 (36.3%) patients with a family history of ischemic heart disease. In-hospital mortality was documented in 28 (19.2%) patients. When stratification was done, significant associations were seen with hypertension (p=0.025), diabetes mellitus (p=0.002), and family history (p=0.003). Conclusion: It is to be concluded that mortality is considerably high after PCI in patients with STEMI who developed sustained ventricular arrhythmia before revascularization. Obesity, family history, and diabetes contribute directly to the development of MI. More epidemiological studies are necessary to evaluate risk factors of in-hospital mortality in this already compromised group of patients Keywords: Revascularization, Myocardial Infarction, Sustained Ventricular Arrhythmias, ST-Segment

Background: One of the leading causes for hepatocellular carcinoma is Nonalcoholic fatty liver diseases (NAFLD) that also increases incidence of mortality rates. Aim: To understand alterations biochemically and clinically in patients suffering from NAFLD since they are at stake of cirrhosis as well as nonalcoholic steatohepatitis (NASH) in case of Pakistani population. Methods: Patients suffering from NAFLD were selected for these case reaches that were all confirmed via ultrasonography. Candidates were tested negative for autoimmune or viral hepatitis serologic markers, no record was found with respect to liver disease related to metabolism, moreover candidates were also not administer any medication that has its impact on liver like Ursobil. Clinically and biochemically all the patients were tested for history, signs and symptoms and they depicted variables. Results: A enrollment of 80 candidates was carried out that included 38 female and 42 male, owing mean age of 40.4 years. The candidates with no diabetes and obesity were 26.4% and 18.3%, respectively. Late dinner sleep disorders and delayed sleep were the most detectable reasons in patients suffering from NAFLD. Moreover, thirst sensation, anxiety, bloating, and upper abdominal pain, warming sensation and defecation disturbances, were seen common in case of patients suffering from NAFLD. Conclusion: NAFLD is regarded as heterogeneous pathology with variety of clinical findings. It has been experienced that gastrointestinal problems as well as anxiety are most frequently seen in patients suffering from NAFLD. Keywords: NAFLD, hepatocellular carcinoma, cirrhosis

A 50 years old smoker male with arrhythmias and non-obstructive coronaries diagnosed as a case of coronary slow flow phenomenon.

Objective: To determine the frequency of failure of ST-segment resolution after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (MI). Methodology: This cross-sectional study was carried out at the CCU department of the National Institute of Cardiovascular Diseases (NICVD) Karachi, during six months from January 2017 to July 2017. All patients with ST elevation myocardial infarction admitted at CCC and undergoing primary PCI, the onset of typical pian of chest and related presentation in the last 12 hours that persists at least > 20 minutes, without the previous administration of fibrinolytic therapy assessed with history and previous reports, platelet glycoprotein IIb/IIIa inhibitors without prior administration and of either gender were included. All study subjects were shifted to Angiography department, the arterial sheath was inserted only through to the femoral route to prevent bias, and the interventional cardiologist with a minimum 05 years of professional experience was chosen. Angiography was performed, and the identified occlusion area was by interventional cardiologist ballooned/stented. ST resolution failure was seen after/within 30 minutes of primary angioplasty. All the information was collected via study proforma and SPSS version 26 was used for the data analysis. Results: Mean age of the patients was 56.18±8.70 years, average BMI was 25.56±4.76 kg/m2. Females were 25% and males were 77%. Complete resolution was achieved in 73% patients, while 22% patients Failure of ST-segment resolution post PPCI. Conclusion: Our findings show that ST-segment resolution in the ECG within 30 minutes, as opposed to the traditional 90-min successful PPCI, is a significant predictive predictor. The intriguing discovery that ST-segment resolution has limited predictive value in a cohort of STEMI cases managed by the PPCI deserves additional exploration, especially as it is already widely used as the surrogate end point in trials. Keywords: St-Segment Resolution; Failure; ST-segment elevation myocardial infarction; primary percutaneous coronary intervention; electrocardiogram.

Colonoscopy is a procedure which depends upon the quality of bowel preparation. Polyethylene glycol(PEG) is commonly used laxative for bowel preparation .The method of PEG administration affects the quality of bowel preparation. We designed this single-blinded randomized controlled trial to evaluate same day PEG regime vs split dose PEG regime in patients undergoing colonoscopy. METHOD: Total of 156 patients taken for the examination. They were divided randomly in two groups A & B. The patients in the group A (same day group) took 2 L of PEG between 6:00 AM and 8:00 AM on the same day of colonoscopy. The patients in the other group B ( split dose group ) took 1L of PEG between 6:00 PM and 8:00 PM on the preceding day and another liter between 6:00 AM and 8:00 AM on the day of colonoscopy. These patients had to stay in hospital for about 24 hours.The accuracy of preparation was assessed on Boston Bowel Preparation Scale (BBPS). A sum total of ≤ 5 points shows poor bowel preparation & ≥ 8 shows very good bowel preparation. Side effects were recorded by asking symptoms of nausea ,vomiting ,abdominal pain & bloating. Results: In same day dose group, 62 patients were having BPPS preparation score of >8 . While in second split dose group 64 patients were having BPPS preparation score >8. Chi square test revealed that there was no significant difference in BPPS score between both groups. However there was significant difference in patient satisfaction and willingness to repeat the same procedure between both groups. . Group A same dose regime were more satisfied & willing to repeat the procedure. They reported less interference in their sleep . Conclusion: Same- day morning PEG regime should be used which is more easy & tolerable for our patients population and its efficacy is same as other regimes for adequate bowel preparation.

Introduction: Higher levels of troponins >10 folds of upper normal limits (UNL) are considered as high-risk patients on coronary angiography sufferers having high levels of troponin-I (>10 folds upper limit normal level) had extra three-vessel coronary artery disease involvement. Objectives: To determine the frequency of degree of cardiovascular disease with Troponin-I level >10 folds ULN in NSTEMI patients at tertiary care hospital. Methodology: It is a cross-sectional study comprising of a total 800 patients recruited from the Department of Cardiology, National Institute of Coronary Disease, Karachi Pakistan based on Exclusion/Inclusion criteria. Results: There are 678 male as well as 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. There have been 678 male and also 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. Conclusion: The higher troponin level found significantly associated with extent of CAD and three vessel disease. To understand the cardiovascular troponin condition of the sufferer as soon as feasible is crucial. Keywords: Extent of Coronary Artery Disease, NSTEMI, Troponin-I Level >10 Folds ULN

Hypertension is strongly related to body mass index (BMI). Obesity has been the single main contributor to hypertension. Furthermore, the clinical manifestations are normally associated with BMI in hypertensive patients. This study aimed to evaluate the relationship between clinical features and BMI among hypertensive patients in both males and females. Methodology A retrospective cross-sectional study was conducted among 296 patients having a self-reported history of hypertension and on anti-hypertensive medication. The study was conducted in the medical outpatient department of a secondary care hospital in Karachi during six months (January 2020 to June 2020). A detailed history was taken from each patient about hypertension-related symptoms, and clinical examination was performed. Blood pressure was measured using a sphygmomanometer with a stethoscope. Results Of the 296 patients, 156 (52.2%) were males and 140 (47.3%) were females; 16 (5.4%) of them were underweight, 91 (30.7%) were normal weight, 129 (43.6%) were overweight, and 60 (20.3%) were obese; in addition, 106 (35.8%) reported edema and 71 (24.0%) reported nausea and so on. As far as the association of clinical features and BMI was concerned, our study results showed that only edema (p=0.017) and nausea (p=0.044) were significantly associated with the BMI of the patients. Patients with edema were more likely to be obese than those without edema (29.2% vs. 15.3%), whereas patients with nausea were more likely to be overweight than those without nausea (57.7% vs. 39.1%). Conclusions Our study showed that among the clinical features, edema and nausea were significantly associated with the BMI of the patients, whereas the relationship with others was insignificantly related to BMI of the patients in both male and female patients.