ABSTRACT
To determine the serum levels of troponin-l in identifying left ventricular ejection fraction [LVEF] of = 40% in patients with first anterior ST Elevation Myocardial Infarction [STEMI]. Case series. At the Tabba Heart Institute, Karachi, from May to November 2008. Consecutive patients presenting with first anterior STEMI were studied. Troponin-l concentration was measured by MEIA [microparticle enzyme immunoassay] method and LVEF was visually assessed. Analysis of relation between troponin-l levels and LVEF by the Receiver-Operator Characteristic [ROC] curve was performed to determine the cut off values of troponin-l in identifying LVEF of <40% in patients, who had received streptokinase or undergone primary Percutaneous Coronary Intervention [PCI]. Out of the 90 patients studied, 50 patients received streptokinase and the remaining 40 patients underwent primary PCI. Mean age was 54.6 +/- 9 years and 82% were male. Troponin-l levels of > 63.5 ng/ml predicted LVEF of <40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-l levels of > 87.5 ng/ml predicted LVEF < /=40% with a sensitivity of 86% and specificity of 100%. Troponin-l concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF = 40% in patients treated with either streptokinase or primary PCI respectively for first anterior STEMI. Troponin-l can be used as a non-imaging tool to identify patients with LVEF = 40% who need early aggressive therapy
Subject(s)
Humans , Male , Female , Troponin , Stroke Volume , Myocardial Infarction , Electrocardiography , StreptokinaseABSTRACT
We are reporting the case of a 48-year-old man hypertensive, and smoker presenting with acute inferoposterior ST elevation myocardial infarction [STEMI] with right ventricular infarction. He underwent diagnostic angiogram which revealed total occlusion of mid right coronary artery [RCA] by thrombus. Multiple runs of aspiration were performed using Export Aspiration Catheter-6F and thrombus was aspirated from RCA. Postaspiration stenting was deferred due to absence of any significant obstructive lesion. Some thrombus had migrated to distal right posteriolateral branch [RPLB]. He was started on glycoprotein [GP] IIb IIIa inhibitors which had to stopped after a few hours due to upper gastrointestinal bleed. After 48 hours a re-look angiogram demonstrated good flow in RCA with resolution of the residual thrombus
Subject(s)
Humans , Male , Angioplasty, Balloon, Coronary , Coronary Artery Disease , Coronary Thrombosis/therapy , Coronary Angiography , ThrombosisABSTRACT
Tuberculosis [TB] is the leading cause of death from an infectious disease in women worldwide especially in developing countries. There is limited number of literature available on factors associated with the relapse of TB and very few studies on gender differences in this regard. This study aimed to compare the factors associated with the relapse of TB in males and females. A cross-sectional study was conducted in the medical department of Civil Hospital in Hyderabad from August 2008 to November 2008. A total of 100 consecutive patients of any age or gender, diagnosed with relapse of TB who had positive sputum smear after completion of a standard course of anti-tuberculosis therapy [ATT] were included in this study. Those with newly diagnosed tuberculosis and cases of treatment failure or treatment defaulters were excluded from the study. Demographic variables, factors associated with the previous TB infection and underlying medical conditions were among the variables compared in both sexes. The mean age of patients was 36.84 +/- 17.40 years in males and 36.21 +/- 16.41 years in females. There were 38 females and 62 males. Among the factors associated with the relapse of TB, there were statistically significant differences between males and females in regard to addiction [p=0.01], employment [p<0.001], weight gain [p=0.01] and mean hemoglobin value [p=0.05]. Further studies with larger sample sizes are required for evaluation and comparison of factors associated with the reactivation of TB in males and females. This would provide solutions for TB control agencies in the future