Correlation of C-reactive protein and cardiac enzymes with angiographic severity of coronary artery disease in Pakistani patients with acute coronary syndrome

Objective: To determine the correlation of C-reactive protein [CRP] levels with the severity of coronary stenosis on angiography and the association of cardiac enzymes with the degree of stenosis in acute coronary syndrome [ACS] patients. Secondly, to compare association of angiographic severity of vascular stenosis with CRP in patients with ST segment elevation myocardial infarction [STEMI] and non-STEMI / Unstable angina [UA]

Study Design: Prospective, descriptive study

Place and Duration of Study: Khan Research Laboratories [KRL] Hospital, from October 2014 to March 2015

Methodology: CRP was measured on diagnosis of ACS in 70 patients. Cardiac enzymes were measured 6 hours after the onset of chest pain. Angiographic scoring for degree of stenosis and number of culprit vessels was done. Two groups consisting of patients with STEMI [group 1] and with NSTEMI/UA [group 2] were made

Results: No correlation was found between CRP levels and angiographic stenosis in patients with ACS [r=0.162, p>0.05]

No association was found between eosinophil count and severity of stenosis [p=0.88]. Rise of cardiac enzymes and degree of coronary stenosis showed a positive correlation [p <0.001]. There was significant difference in the means of coronary artery stenosis scores between the two groups [Gensini score of groups 1 and 2: 35.9 +/- 4 and 14 +/- 8, respectively] p<0.001, but there was no significant difference in CRP levels

Conclusion: CRP is a marker of inflammation in ACS rather than a risk factor for determining the severity of vascular stenosis. Rise in cardiac enzymes still grade high in predicting severity of vascular stenosis than eosinophil count or CRP levels

Tension-free vaginal taping in Pakistani women with stress urinary incontinence

Objective: To evaluate the effectiveness and determine the peroperative and postoperative complications of tension-free vaginal tape [TVT] sling for urinary stress incontinence [USI] and contributing factors to complications

Study Design: Descriptive study

Place and Duration of Study: Kidney Centre Postgraduate Institute, Karachi, from January 2009 to December 2010

Methodology: One hundred consecutive patients underwent TVT as per Ulmsten Technique for urinary stress incontinence and patients were followed for 3 years. The subjective cure rate and improvement rate was based on the international consultation on incontinence questionnaire for evaluating female lower urinary tract symptoms [ICIQ - PLUS]

The subjective cure was defined as the statement of the woman not experiencing any loss of urine upon physical stress and improvement rate was defined as occasional leakage during stress

Results: Patients at 1- and 3-year up follow-up showed subjective cure rate and improvement rate of 98% and 2%, and 95% and 5%, respectively. Mean operative time was 32 minutes. UTI was the commonest complication observed in 7 [7%] patients

Women with voiding dysfunction preoperatively had 9-fold odds of difficulty postoperatively [0<0.001]

There was a significant association of preoperative symptoms of overactive bladder [OAB] with the same postoperative symptoms [p<0.0001]

Preoperative hysterectomy had a significant [p< 0.005] 15.63 fold odds of intraoperative bladder perforation

Conclusion: Tension-free vaginal tape sling is an efficacious and secure surgical procedure for the treatment of urinary stress .incontinence. Bladder perforation, voiding dysfunction, supra-pubic discomfort and UTI are the commonest complications. Risk factors for perforation include preoperative hysterectomy. Pre-existing voiding dysfunction and UTI lead to persistent similar postoperative problems

Sleep Deprivation and its associated factors among general ward patients at a Tertiary Care Hospital in Pakistan

To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. In all, 50 [46.3%] respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 [43.5%] patients; most of these had SD [70%] [p<0.001]. Other patients' noise disturbed 31.5% of study subjects and a significant majority [68%] of these had SD [p=0.003]. Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD [68%] compared to those with no SD [32%]; again the difference was significant [p=0.003]. Physical discomfort and presence of cannula were reported as disturbing factors by 41.7% and 28.7% of the study subjects respectively but these were not significantly associated with SD. Our study revealed that sleep deprivation occurs commonly among general ward patients in tertiary care setting. Factors found to be associated with SD were amenable to modification to a greater extent

Para-testicular rhabdomyosarcoma

We are presenting the case report of a young male, aged 19 years, who presented with a scrotal swelling and loss of weight and was ultimately diagnosed to have a rare tumour viz. Para-testicular rhabdomyosarcoma