Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following st elevation myocardial infarction

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A [successful thrombolysis] and group B [unsuccessful thrombolysis] using ECG criteria. Total number of patients were 200. Group A included 136 [68%] patients and group B included 64 [32%] patients. There were total 88 [44%] patients of anterior MI with 47 patients in group A and 41 patients in group B [34.6% vs 64.0%, p<0.001]. There were total 110 [55.0%] patients of inferior MI with 88 patients in group A and 22 patients in group B [64.7% vs 34.4%, p<0.001]. Lateral myocardial infarction was diagnosed in 2 [1%] patients with 1 patient each in group A and group B [0.7% vs 1.6%, p=0.583]. Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Frequency of coronary heart disease risk factors among nurses

To find out frequency of various risk factors for coronary heart diseases in nurses. This was a cross-sectional study. Nurses working in three shifts at Lady Reading Hospital, Khyber Teaching Hospital, Nursing school of Lady Reading Hospital Peshawar, were included in the study. All participants were interviewed in detail including their family history, past medical history, smoking and dietary history. Pulse, blood pressure, body mass index [BMI] and waist: hip ratio was determined. Their random blood sugar and total cholesterol was checked. Data was analyzed for cardiovascular risk factors using SPSS version 16. A total of 165 nurses were screened and interviewed. Mean age was 40.75 +/- 8.577 years. Mean BMI was 28.80 +/- 4.77. Mean systolic BP was 124.82 +/- 20.91 mm Hg, while mean diastolic BP was 82.45 +/- 13.07 mm Hg. Mean random blood sugar was 128.39 +/- 52.74 mg /dl. Diabetic nurses were 18[10.9%],hypertensive nurses were 31[18.8%], nurses having high cholesterol were 4[2.4%], nurses having documented CAD were2[1.2%], other than above risk factors or conditions were present in 34[20.6%] of the nurses, not having any of the mentioned risk factors or diseases were present in 76[46.1%]. Nurses not having any regular exercise schedule were 104 [63%]. We noticed that among modifiable risk factors hypercholesterolemia, diabetes and hypertension were less frequent in nurses while obesity, physical inactivity and sedentary life style with more duty hours and smoking were more prevalent

Efficacy and safety of percutaneous transvenous mitral commisurotomy [ptmc] performed through patent foramen ovale [pfo]

The aim of this study was to assess efficacy and safety of PTMC in patients with severe mitral stenosis [MS] perform through patent foramen ovale. All symptomatic patients with severe MS were included in the study from January 1998 to December 2010, at Cardiology department, Lady Reading Hospital, Peshawar. Transthoracic and trans-esophageal echocardiogram was performed to exclude left atrial appendage/left atrial clot and check the anatomy of interatrial septum. Severely calcified mitral valve and severe mitral regurgitation were excluded. Patent foramen ovale was crossed in majority of cases to reach left atrium. Stenosed mitral valve was dilated with Inoue balloon. Total number of patients was 1818. Females were 74% [p<0.05]. The mean age was 26.51 +/- 7.82 years and mean Body Mass Index [BMI] was 2 19.05 +/- 1.2kg/m[2]. The number of patients who had PTMC through PFO were 2 92.08%. Mean valve area was 0.9 +/- 0.19cm[2] on 2D Echocardiography, which 2 increased to 1.82 +/- 0.17cm[2] [p<0.05], mean mitral valve gradient decreased from 18 +/- 4.04mmHg to 7 +/- 0.25mmHg [p<0.005] and mean right ventricular systolic pressure decreased from 70 +/- 17.4mmHg to 48 +/- 13mmHg [32% drop] [p<0.05] at 24hours after PTMC. Mean time of crossing interatrial septum via PFO was 17 +/- 05minutes. Post PTMC severe MR in PFO group was 3.6% and 2.8% in inter atrial septum group [p=0.21]. Pericardial effusion was noted in 0.11% patients in PFO group and 0.27% in interatrial septum group [p>0.05]. Stroke was present in 1.5% patients. PTMC through patent foramen ovale [PFO] is a safe procedure, with few complications

comparative analysis of in-hospital left ventricular function in patients with successful or unsuccessful streptokinase thrombolysis following acute myocardial infarction

To compare in-hospital left ventricular function in patients with unsuccessful and successful thrombolysis presenting with acute myocardial infarction treated with streptokinase. This comparative study was conducted at department of Cardiology, Lady Reading Hospital Peshawar, from October 2006 to October 2007. Two hundred patients with first acute myocardial infarction were divided into two groups: group A [successful thrombolysis] and group B [unsuccessful thrombolysis], using ECG criteria. To determine Left Ventricular Function, 2-D Echo was used. Group A included 136 [68%] patients and group B included 64 [32%] patients. Impaired left ventricular function was found in 41 [30.1%] patients in group A and 41 [64.1%] patients in group B [p< 0.001]. Left ventricular failure was present in 31 [22.8%] patients of group A and 30 [46.9%] patients of group B [p=0.001]. Cardiogenic shock was diagnosed in 2 [1.5%] patients in group A and 6 [9.4%] patients in group B [p-0.008]. Presence of LVF is strongly associated with unsuccessful thrombolytic therapy in this group of patients

Changing trend of presentation of acute coronary syndrome in peshawar over the last sixteen years

Background: Once considered as disease of the affluent and developed countries, coronary artery disease is emerging as epidemic in the developing world in general and South Asia in particular. Objective: To observe the trend of presentation of acute coronary syndrome in the local population over the last 16 years. Material and Methods: Clinical audit from 1995 to 2010 was carried out in which the data was retrieved from the computerised database of the Department of Cardiology, Lady Reading Hospital Peshawar. The period was divided into four quartiles, and the data of each quartile was analyzed for the total number of admissions, the type of ACS, whether ST-elevated MI or non-ST elevated ACS [comprising unstable angina and non-STEMI], age, gender and mortality. Results: The total admissions into the unit in the first quartile [1995–1998] were 23, 827, in the second quartile [1999–2002] 29, 005, in the third quartile [2003–2006] 33, 206 and in the fourth quartile [2007–2010] were 40, 110. Total ACS brunt constituted 8340 [35%], 10, 384 [35.8%], 12, 180 [36.68%] and 14, 920 [37.2%] patients respectively. The mean age of patients was 49.70 +/- 6.4 years, 48.21 +/- 7.2 years, 47.38 +/- 7.1 years and 46.81 +/- 6.2 years respectively. Women were 2356 [28.25% of the total ACS burden] in the first quartile, increasing to 3554 [34.225%], 4817 [39.55%] and 6281 [42.1%] in the following quartiles. STEMI constituted 45.88% [3826] of the total ACS presentations in the first quartile, 47.24% [4905] in the second, 49.55% [6035] in the third and 49.87% [7440] in the last quartile. The mortality rate, however, remained constant throughout [8.4% to 8.8%]. Conclusion: An increasing trend is seen in the burden of CAD in the local population with increasing presentation as STEMI. It is also evident that CAD is occurring at younger ages and more so in the female population

Frequency of cardiovascular disease risk factors among doctors

To find out frequency of risk factors for cardiovascular disease amongst doctors. This was a cross-sectional study involving doctors [working at Lady Reading Hospital] recruited in Peshawar Heart Study [PHS]. All participants were interviewed in detail including present and past medical history, family history, smoking, drug and dietary history. Pulse, blood pressure, body mass index [BMI] and waist/hip ratio were measured. Random blood sugar and total cholesterol was checked. A supine resting ECG was recorded. Data was analyzed for frequency of cardiovascular risk factors using SPSS Version 16. A total of 208 doctors were interviewed. Mean age was 30.33 +/- 7.0 years. Mean BMI was 24.69 +/- 4.73.Mean waist size was 84.68 +/- 10.571cm. Mean waist/hip ratio was 0.86 +/- 0.068. Mean systolic BP was 121.82 +/- 13.70 mm Hg while mean diastolic BP was 78.89 +/- 09.36 mm Hg. Mean random blood cholesterol was 163.97 +/- 27.93 mg / dl. Mean random blood sugar was 95.79 +/- 24.57 mg /dl. Most [98.55%] of doctors had random blood sugar of less than 180 mg /dl. The big majority of the doctors was not performing any regular exercise [n=157, 75.5%]. Mean duty hours per day were 8.98 +/- 2.073.Active smokers were 39 [18.8%], while 9 [4.3%] were using Naswar. None of the doctors enrolled in study was drinking alcohol. Among modifiable risk factors hypercholesterolemia, diabetes, and hypertension were less frequent amongst doctors while physical inactivity, obesity, unhealthy eating, and smoking were relatively more frequent

comparative analysis of frequency of in-hospital arrhythmias in patients with successful versus failed thrombolysis following acute myocardial infarction

To compare frequency of in-hospital arrhythmias in patients with successful and failed thrombolysis using streptokinase in patients presenting with acute myocardial infarction [AMI]. This was a comparative study conducted at department of Cardiology, Lady Reading Hospital,Peshawar from October 2006 to October 2007 .Two hundred patients with first AMI were divided into two groups: group A [successful thrombolysis] and group B [failed thrombolysis] using ECG criteria. A total of 200 patients were studied. Group A included 136 [68%] patients while group B included 64 [32%] patients. Among these 24 [12.0%] patients developed arrhythmias. Of these 8 patients were in group A and 16 patients were in group B [5.9% vs. 25.0%, p=0.003].Ventricular tachycardia was the most common arrhythmia. It was documented in 9 [4.5%] patients, with 2 patients in group A and 7 patients in group B [1.5% vs. 10.9%, p=0.003]. The other arrhythmias which included atrial fibrillation, ventricular fibrillation and supraventricular tachycardia were statistically insignificant between the two groups [p=0.174]. In hospital mortality was more common in patients with failed thrombolysis [6 [9.4%] vs. 3 [2.2%] [p=0.023]]. Failed thrombolysis is associated with complex arrhythmias and high in- hospital mortality

Intelocking versus kuntscher nails in the management of femoral shaft fractures

To compare the outcome of Femoral shaft fractures managed with Interlocking and Kuntscher intramedullary nails, in terms of healing time, full weight bearing and post-operative complications. Prospective, quasi-experimental study from March 1999 to May 2002. Orthopaedics Unit I, Civil Hospital, Karachi. A total of 200 cases of Femoral shall fractures. Half [100] the cases of Femoral shaft fractures were treated with Kuntscher intramedullary nails and the other half [100] with Interlocking nails, the cases being assigned randomly. The detailed data of the patients was recorded, computed and analyzed using Chi-square test and Students t-test. The main parameters compared included fracture healing time, full weight bearing time and post-operative complications. There was no significant difference between the two groups in terms of demographic data, fracture type and associated co-morbidities. The average operating time was 110 +/- 25 minutes for the Interlocking nail and 80 +/- 15.8 mins for the K-nail. All patients of K-nail group needed blood transfusion, while only 17 patients of interlocking group needed blood transfusion. The fill weight bearing time was significantly shorter [p < 0.005] in cases of Interlocking nail. Out of 200 fractures 182 [91%] healed with in six months while 18 [9%] did not. The latter included 6 [3%] cases treated with Interlocking nails and 12 [6%] with Kuntscher nails, p < 0.005. Interlocking intramedullary nailing is better than Kuntscher nailing in every respect