Frequency of aspirin resistance in patients with cardiovascular diseases

To find out the frequency of aspirin resistance, as measured by the inhibition of platelet aggregation, using Whole Blood Aggregometery, in patients with cardiovascular diseases presenting to out patient department of a tertiary care hospital. This study was conducted in the outpatient department of Cardiology, Lady Reading Hospital Peshawar, from October 2007 to January 2008. A total of 105 normal individuals not taking aspirin and 136 patients taking aspirin for cardiovascular diseases were randomly included. Blood was taken for measuring platelet aggregation using whole blood aggregometer. Result of each individual was noted on a proforma. Patients who were on any other ante-platelet like clopidogrel; or on warfarin and heparin were excluded from the study. Chi -square and independent t-test were used to find significant differences between different groups and variables. Platelet aggregability in 105 normal subjects, not taking aspirin was 9.28 +/- 3.23ohms. So cutoff for aspirin non responsiveness was taken as 9.28-3.23=6.0 ohms. Mean aggregability of 136 cardiovascular patient, taking aspirin was 5.81 +/- 5.47 ohms. Mean age was 52.66 +/- 10 years.Male were 80[58.8%]. Patients having aggregability >/= 6 ohms were 47.1%[n=64]. Mean aggregability of male patients was 5.66 +/- 5.45 ohms. Mean aggregability of female patients was 6.03 +/- 5.54 ohms[p=0.69]. When age was correlated with aggregability, both have a weak negative correlation [Pearson correlation coefficient= - .109 [p=0.205]. Mean age of patients having aggregability /= 6 was 51.46 +/- 10.36 [p=0.19]. Aspirin resistance as defined by inhibition of platelet aggregation measured with Whole Blood Aggregometry, is a common problem. Gender and age has no significant affect on platelet aggregability

Study of pericardial disease with ten year follow up in a tertiary care hospital

To study etiology, morbidity and mortality of pericardial disease and frequency of constrictive pericarditis with long term follow up of ten years. This descriptive study was conducted at Cardiology Unit Lady Reading Hospital Peshawar. All serial cases with moderate and large pericardil effusions presenting to Echo Room were enrolled in the study after fulfilling the inclusion and exclusion criteria. The cases were worked-up etiologically for the causes of pericardial effusion and planned to be followed up for ten years. 102 cases of moderate and large pericardial effusions were studied etiology wise in detail and were followed up for ten years. End points were death or 10 years of follow-up. On work-up it was observed that 36% were having proven tuberculous, another 26% cases were highly suggestive of tuberculosis. Contribution of other etiologies was pyogenic 8%, idiopathic 8%, rheumatic heart disease 5%, cardiomyopathies 5%, malignancy 4%, uremia 3%, rheumatoid arthritis 2%, pneumonia 1%, Dressler 1%, post cardiotomy 1%. Follow-up revealed that over all mortality was 21.56% at one year. Mortality and constriction was most common in the group with proven tuberculosis 30% and 27% respectively. Similarly malignant and uremic pericardial effusions had also a worst prognosis soon after the diagnosis. Mortality after one year and follow up was not found to be related to the initial disease process. Pericardial constriction mostly occurred in the group with proven tuberculosis so was the mortality. After the initial one year period, none developed constriction in the 10 years period

Rheumatic heart disease in urban school children of Peshawar

To conduct a survey of male school going children of Peshawar to find the prevalence of Rheumatic Heart Disease [RHD] in young population. School children of Peshawar city in the premises of school were screened by a team including a Cardiologist for RHD by physical examination and confirm the diagnosis by Echocardiography During 8 visits of different schools, children of lower socioeconomic status of city of Peshawar were screened. Relevant history of Rheumatic Fever and RHD along with physical examination including, BP, height, weight and CVS was performed 1773 school children were screened. 3 children were found to have RHD. One boy had severe MR/AR, one had moderate degree of MR and last one had severe AR. Only one boy was aware of his cardiac problem and was taking prophylaxis. 3 boys were found to have Congenital Heart Disease, one had a TGA with PS, one had mild AS and one had mild AS/AR RHD is on decline in urban male school going children of Peshawar and the prevalence is on decline since last four decades. The prevalence of RHD 3/1773, which seems to be lower than reported previously

Pattern of valvular lesions in rheumatic heart disease

To evaluate relative frequency of cardiac lesions in Rheumatic heart disease [RHD] in patients presenting to cardiology department, Lady Reading Hospital, Peshawar. This retrospective study was conducted at Cardiology Department Lady Reading Hospital Peshawar. The data on patients undergoing transthoracic two-dimensional echo and Doppler studies were retrieved from the computerized database from July 2003 to July 2006. The data was analysed with SPSS 11 window. Out of 3060 patients of RHD [1278 male and 1782 female], 1723 [56.3%] had mixed valvular lesions. Mean age was 22 + 6 years. Mitral stenosis [MS] was the predominant valvular lesion affecting 2141 [70%] patients [1040 pure MS and 1101 in combination]. Of those, 525 [24.5%] patients had severe MS, and 811 [37.9%] had moderate MS. Mitral regurgitation [MR] affected 1793 [58.59%] patients [245 pure MR, 1548 mixed] while 404 [22.5%] patients had severe MR and 497 [27.1%] had moderate MR. Aortic regurgitation [AR] was present in 1438 [47%] patients and almost always [98 85%] in combination. One hundred and eight [7.5%] patients had severe AR. Aortic stenosis [AS] was noted in 48 [1.56%] patients, of which 30 [62.5%] were in isolation and 18 [37.5%] in combination. Out of 1723 mixed lesions, MS+MR+AR were found in 826 [47.94%] cases and MR+AR in 428 [24.84%] cases. Most of the patients had mixed Valvular lesions. The predominant lesion was mitral stenosis followed by mitral regurgitation, aortic regurgitation and aortic stenosis respectively