In hospital mortality of acute myocardial infarction in patients with and without renal dysfunction

To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642[64.2%] while female patients were 358[35.8%]. Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51[12%] in Group I patients, 46[16.6%] in Group II patients, 36[22%] in Group III patients, 35[27.7%] in Group IV patients and 5[35.7%] in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 [CI 2.2-12.1], moderate renal insufficiency OR 4.1 [CI 2.3-7.2] and mild renal insufficiency OR 1.9[CI 1.1-3.1] with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20[4.7%] patients in Group I, 17[6.1%] patients in Group II, 15[9.4%] patients in Group III, 16[12.6%] patients in Group IV and 4[28.6%] patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients

Q-probes study of replicate specimens at the clinical laboratory, the Agea Khan University Hospitals, Karachi

The aim of this Q-probes study was to evaluate the precision of replicate specimens. This Q-probes study done at the Clinical Laboratory, The Aga Khan University Hospital Karachi is about routine chemistry analytes because of their importance in critical care patients. The analytes data was collected for six months from April to September 2002.There were total 358 samples, which were given for reanalysis during this period under the constant working conditions. After analysis, results of both the runs on different days, were compared to determine the percent difference between the results. After calculating the percent difference, the results were either accepted or rejected on the basis of guidelines set by CLIA 88[Clinical Laboratories Improvement Amendment 1988]. Among 358 results, 5 were rejected according to the criteria selected. All of these results were then subjected to statistical analysis for calculating statistical significance. As our Null hypothesis was that the prevalence of rejected results were more than 2% with an acceptable limit of less than or equal to 2%. We failed to accept the Null hypothesis that means that it did not exceed the acceptable limits [p-value= 0.962930] with the Confidence Interval range of 0.2 -2.6 where Upper Confidence Interval is still less than 5% for a p-value of 0.05. The rejection of null hypothesis favors high precision between the two sets of results in our studied population. It is concluded that Q-Probes study of replicate specimens at the Clinical Laboratory at The Aga Khan University Hospital is within the acceptable limits. These figures show that a high quality precision is maintained among the observed specimens. This is an ongoing exercise and studies like these should be a continuous process to maintain and enhance the quality of Laboratory results