Negative repercussions of caregiving burden: poor psychological well-being and depression

Objectives: To compare depression and psychological well-being between caregivers of schizophrenic patients and non-caregivers and to study the burden of caregiving as a relative risk for depression and psychological well-being

Methods: This cross sectional comparative study was conducted at International Islamic university Islamabad from January to September 2017. Fifty informal caregivers of schizophrenic patients from 19 to 55 years of age were included in the study. The control group consisted of age and socio-economic status matched healthy volunteers who did not have any psychological or medical patient at home needing care and assistance. For measurement of study variables i.e., burden of caregiving, depression and psychological well-being, instruments used were Zarit Burden Interview [ZBI], The Beck Depression Inventory [BDI] and Warwick-Edinburgh Mental Well-Being Scale [WEMWBS] respectively

Results: Results were analyzed using MANOVA followed by One-Way ANOVA. Findings indicated that informal caregivers of schizophrenia have greater depression and poor psychological well-being in comparison to the non-caregiver controls. Association of caregiving burden with psychological well-being and depression was calculated using Chi Square test and relative risk

Conclusion: Caregiving adversely affects informal caregivers' mental health and wellbeing. Informal caregiving is a burden for the caregivers; health status of family members involved in caregiving should be routinely assessed to enhance their health-related quality of life

Effect of gender and physical activity on internet addiction in medical students

Objective: To determine the effect of gender and physical activity on internet addiction in medical students

Methods: In this cross sectional, analytical study Young's internet addiction test questionnaire was distributed to 350 MBBS students of Army Medical College, Rawalpindi. The study was conducted from January to May 2015. A dichotomous response from students regarding physical activity was obtained which was verified from the sports department of the institution. Based upon total score, internet addiction was categorized as no addiction if the score was less than or equal to 49, moderate addiction when the score was 50 to 79 and severe when the score was 80 to 100

Results: Out of 322 respondents 175 [54.3%] were males and 147 [42.7%] females with a mean age of 19.27 +/- 1.01 years. Total internet addiction score and frequency of internet addiction were similar between males and females [37.71 +/- 11.9 vs 38.63 +/- 14.00, p=0.18 and 25 vs 29, p=0.20]. However, total score and frequency of internet addiction were higher in students lacking physical activity as compared to those with regular physical activity [40.37 +/- 15.05 vs 36.38 +/- 11.76, p=0.01 and 30 vs 24, p=0.01]

Conclusion: Internet addiction is unrelated to gender however it is inversely related to physical activity

Association of depression with socio-demographic factors in patients undergoing hemodialysis

Objective: To determine the association of depression with socio-demographic factors in patients undergoing hemodialysis

Study Design: Cross sectional comparative study

Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi, from Jul 2014 to Jun 2015

Material and Methods: Eighty eight patients undergoing hemodialysis were included. Data were collected using the Hamilton Depression Rating Scale. Demographic data, including age, gender, status within the family, education, duration of dialysis and social support was documented. Patients were graded on the basis of Hamilton scoring as: 0-9: normal, 10-13: mild depression, 14-17: moderate depression, above 17: severe depression

Results: There were 61[69.3%] male and 27 [30.7%] female patients with mean age of 48.43 +/- 12.69 years. The mean duration of dialysis was 35 +/- 29.73 days. Sixty seven patients [76.1%] were identified as having depression. Out of these 28 [31.8%] had mild depression while 12 [13.6%] had moderate and 27 [30.7%] had severe depression. Mean depression score was higher in females [17.56 +/- 6.67] than in males [13.13 +/- 5.67] and the difference was significant [p=0.002]. No association of depression with age [p=0.75], duration of dialysis [p=0.07], marital status [p=0.500], status within the family [p=0.47] or education [p=0.59] was revealed, however it was strongly and positively correlated with social support [p<0.005]

Conclusions: A reasonably high percentage of patients undergoing hemodialysis is likely to suffer from depression and by providing social support their depression can be reduced. Female patients are more likely to have depression and need more social support for alleviation of their depression

Effect of computer based animations on learning of physiology

Objective: To find out the effect of computer based animations on learning of Physiology

Study Design: Randomized control trial

Place and Duration of Study: Army Medical College Rawalpindi, from Jan to Sep 2016

Material and Methods: Sixty students of first year MBBS class were selected through simple random sampling and then randomly assigned into two groups of 30 each; group I and II. A pre-test was given to both the groups to assess their basal knowledge about the systems to be taught. In 1st teaching session, experimental group was taught with and control without animations. In 2nd teaching session, control group became experimental and previously experimental group became control. After both the teaching sessions MCQ tests of C2, C3 and C4 level were given to the groups and marks obtained were compared

Results: There were 20 [33.3%] male and 40 [66.7%] female students with mean age of 18.92 +/- 0.56 years. Comparison of pre-test scores confirmed that basal level of knowledge was equal between the two groups [p-value=0.19]. Post-test score comparison showed that experimental group scored significantly higher marks as compared to the controls [p-value=0.001 for post-test I and 0.02 for post-test II]

Conclusion: Level of understanding of student increases if they are shown computer based animations during the physiology lectures. Hence, animations have positive effect on student's academic performance

Gender differences in reflective practices of medical students for learning anatomy

Objective: To assess the personal reflection ability of first year medical students who self-selected different strategies for learning gross anatomy

Study Design: Cross-sectional analytical study

Place and Duration of Study: Army Medical College Rawalpindi from Mar 2016 to Apr 2016. Material and Methods: We described the purpose of the study [to assess students' ability for personal reflection] and called students of first year MBBS to participate in the study. Divided in two groups, Group A who self-selected the models for learning anatomy [response rate] and - of group B who self-selected the cadaveric specimens for learning anatomy. Those who agreed to participate signed an informed consent form and completed the questionnaires. The Groningen Reflection Ability Scale is a fully validated one-dimensional scale to measure personal reflection. It has 23 items rated on a 5-point Likert scale from 1 [strongly disagree] to 5 [strongly agree]. Scores on the Groningen can range from 23 to 115, and persons with greater abilities for personal reflection have higher scores on the scale

Results: Total 60 male students opted for the modalities of anatomy models for learning gross anatomy. Their accumulative reflective score was 4853. While 28 female students opted for the anatomy models for learning gross anatomy with the accumulative score of 2328. Out of 168 students 88 preferred the gross anatomy models for learning. Total 14 male students opted for the modalities of a dissection for learning gross anatomy. Their accumulative reflective score was 1193. While 16 female students opted for the dissection specimens for learning gross anatomy with the accumulative score of!387. Out of 168 students 20 preferred the dissection specimens for learning. Total 19 male students opted for the both modalities of anatomy models and dissection specimens for learning gross anatomy. Their accumulative reflective score was 1580. While 30 female students opted for both the anatomy models and dissection specimen for learning gross anatomy with the accumulative score of 2328. Conclusion: Majority of the students with higher reflective score identified learning strategy preference for gross anatomy models

Association of specialty and working hours with compassion fatigue

Objective: To find out association of speciality and working hours with compassion fatigue

Study Design: Cross sectional comparative study

Place and Duration of Study: Military Hospital and Combined Military Hospital Rawalpindi, Combined Military Hospital Sialkot, from December 2013 to July 2014

Material and Methods: Fifty four doctors from departments of Medicine, Surgery, Anesthesia and Gynaecology participated in the study. Other health care related personnel, not directly related to patient care, were excluded from the study. The data collection tool was a questionnaire "Professional Quality of Life Measure version 5". Data was analysed by SPSS version 22. Chi Square test for goodness of fit was used to determine difference in the frequency distribution of various categories of a single variable whereas Chi square test for independence was used to find association between two categorical variables. The p-value was kept at < 0.05 for significance

Results: Results showed 11 females and 43 males with mean age of 37.69 +/- 9.72 years. Cronbach's alpha was 0.81. Eleven participants [20.4%] showed low compassion fatigue, 37 [68.5%] showed average whereas only 6 participants [11.1%] showed high compassion fatigue scores and the difference was significant [p-value < 0.001]. Working hours were associated with compassion fatigue [p-value = 0.03] but speciality was not [p-value = 0.41]

Conclusion: Chances of suffering from compassion fatigue are significantly higher if working hours are 12 or more, however the disorder is not associated with speciality

Role of skill laboratory training in medical education - students' perspective

Objective: To evaluate the perceptions of medical students regarding their training utilizing facilities provided in the skill laboratory of a public sector medical college. Study Design: Cross-sectional study. Place and Duration of Study: Army Medical College, Rawalpindi, from October to December 2014

Methodology: Students of final year MBBS who had underwent skill laboratory training were recruited through convenience purposive sampling. Students not exposed to skill laboratory training were excluded. Data collection tool was a questionnaire having 23 questions with responses on Likert Scale as strongly disagree, disagree, agree and strongly agree coded as 1, 2, 3 and 4, respectively. Data was analysed on SPSS version 22

Results: There were 78 [57%] male and 59 [43%] female students out of 137, with mean age of 22.59 +/- 0.74 years. The response rate was 68.5%. Cronbach's Alpha test was 0.84 showing high reliability. The mean of sum of all the 23 items was 63.85 +/- 8.71, whereas item means was 2.78 +/- 0.38, reflecting a high inclination of students towards skill laboratory training. Frequency of students responding in favour of skill laboratory training was significantly high [p < 0.05]

Conclusion: Medical students perceived skill laboratory training as a favoured learning strategy as compared to practising on real patients for acquisition of various aspects of clinical skills, knowledge and attitude

Effectiveness of case-based learning during small groups sessions at army medical college

A pragmatic and sequential mixed method study was conducted at Army Medical College, from October to December 2014 to determine medical students' perceptions regarding effectiveness of small groups during the CBL [case-based learning] sessions. Tutorial Group Effectiveness Instrument [TGEI] was used after written and informed consent. Free text comments about CBL were invited from the respondents and common ones, and were tabulated. The mean scores were calculated and compared among different subgroups of respondents using appropriate independent sample t-test. Content analysis of qualitative segment was done. A p-value of less than 0.05 was taken as statistically significant. The analysis of qualitative and quantitative variables was integrated in the final interpretation phase to draw conclusion. The average age of the participants was 19.33 +/- 0.657 years. The difference in scores was statistically insignificant for cognitive [p = 0.537], motivational [p = 0.868], and demotivational [p = 0.125] effectiveness between males and females. Insignificant difference was also observed for qualification of the overall group productivity among male and female students [p = 0.162], and exposed and non-exposed groups [p = 0.272]. The perceptions of overwhelming number of participants were in favour of small group discussion as a component of CBL

quest for normal values of serum aminotransferase and its association with age and body mass index

Objective: To determine the reference range for serum alanine arninotransferase [ALT] levels for young healthy individuals in our population and to find out effects of age and body mass index on alanine arninotransferase

Study Design: Descriptive cross sectional study

Place and Duration of Study: Military Hospital Rawalpindi; from Dec 2009 to April 2010

Material and Methods: Five hundred and fifty three young healthy adults were included in the study. Detailed history was taken. Parameters like Age, height and weight were measured. Relevant investigations were carried out for each subject which included blood complete picture, Chest X-Ray, ECG, Urine routine examination, liver function tests, serum urea, serum creatinine, serum uric acid, plasma glucose [F], Anti HCV antibodies, HBsAg, HIV antibodies and VDRL. Data was analyzed using SPSS version 22

Results: Age of subjects ranged from 19 to 50 years [29 +/- 6] years, BMI 15.59 to 29.8, [21.58 +/- 2]

Serum alanine arninotransferase ranged from 17 to 81 IU/1, [29.9 +/- 8] IU/1. Serum alanine arninotransferase for subjects with body mass index more than 25 Kg/m2 was 29.6 +/- 7 IU/L. There is no significant difference in value of mean ALT overall and in those with BMI of more than 25 [p=0.149]

Conclusion: Mean serum alanine arninotransferase value in young healthy adults included in this study was 29.9 +/- 8 IU/L which is lower than normal reference provided at present which is 40 IU/1. Statistical analysis revelaed that serum ALT is not significantly influenced by age and BMI

Association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hyperten

Objective: To determine the association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hypertension

Study Design: Cohort retrospective study

Place and Duration of Study: Department of Cardiac Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi from 11[th] Nov, 2014 to 10[th] Nov, 2015

Material and Methods: Sixty four patients with systemic arterial hypertension were divided into two equal groups on the basis of left ventricular hypertrophy. Patients with acute or old myocardial infarction, diabetes mellitus, cerebrovascular accident, heart failure, structural heart disease, bundle branch block and cardiomyopathies were excluded from the study. DMS 300 4L Holter monitors were used to obtain 3 channel signal averaged ECG recording. CardioScan premium luxury software was used for analysis of ventricular late potentials

Results: There were 49 [76.6%] males and 15 females [23.4%] with the mean age of 60 +/- 11.83 years. Ventricular late potentials were revealed in 10 [31.3%] out of 32 patients with left ventricular hypertrophy whereas in patients without hypertrophy only 1 [3.1%] patient showed it. Ventricular late potentials were strongly associated with left ventricular hypertrophy [p-value=0.03] and the relative risk of developing ventricular late potentials was 10 times higher in patients with left ventricular hypertrophy as compared to those without left ventricular hypertrophy

Conclusion: Ventricular late potentials were strongly associated with left ventricular hypertrophy

Compassion fatigue amongst health care providers

To find out the frequency of compassion fatigue in health care providers in military hospitals. Cross sectional comparative study. Armed Forces Post Graduate Medical Institute [AFPGMI] CMH Rawalpindi, MH Rawalpindi and CMH Sialkot from December 2013 to July 2014. Two hundred and fifty four health care professional participated in the study. The participants included doctors, nurses and male nursing assistants. The instrument for collecting data consisted of [Professional Quality of Life Measure version 5] [Pro QOL-5] questionnaire. Data was analyzed by using IBM SPSS version 22. The alpha value was set at <0.05 for significance. There were 128 male and 126 female participants with mean age of 31.72 +/- 8.28 years. Reliability of the questionnaire was determined by Cronbach's alpha which was calculated to be 0.81. Seventy nine participants [31.1%] showed low compassion fatigue, 168 [66.1%] showed average compassion fatigue whereas only 7 participants [2.8%] showed high compassion fatigue scores. The difference in frequency of three compassion fatigue levels was significant [p-value < 0.001]. Compassion fatigue was significantly different amongst doctors, nurses and nursing assistants [p-value < 0.01]. Compassion fatigue is higher in doctors as compared to para medical staff irrespective of gender

Association of ventricular late potentials with mitral regurgitation in patients with mitral valve prolapse

To determine association of ventricular late potentials with mitral valve regurgitation in patients with mitral valve prolapse. Descriptive cross sectional study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2006 to February 2007. Thirty Seven Patients with confirmed diagnosis of mitral valve prolapse on 2 dimensional echo echocardiography were selected for the study. Patients having myocardial infarction, ischemic heart disease, hypertension and diabetes mellitus were excluded. Signal Averaged ECG of every patient was recorded using 1200 EPX High Resolution Electrocardiograph and was analyzed for the presence or otherwise of ventricular late potentials. Male to female ratio of study patients was 23:14 with mean age of 26.27 +/- 6.18 years. Twelve patients out of 37 had mitral valve regurgitation. Out of these, 8 [67%] patients had ventricular late potentials on signal averaged ECG. Only 1 [4%] patient without mitral valve regurgitation showed ventricular late potentials. Association between ventricular late potentials and mitral regurgtation was found statistically significant [p = 0.001]. Ventricular late potentials are hghly associated with mitral valve regurgitation in patients with mitral valve prolapse. These can act as noninvasive predictors of ventricular tachyarrhythmias and sudden cardiac death in these patients

Comparison of case based learning with conventional teaching-students' perspective

To compare case based learning with conventional teaching from student's perspective. Cross sectional comparative study. Army Medical College, Rawalpindi from May 2012 to November 2012. A closed ended self-administered questionnaire with twelve questions was prepared and distributed to 427 students of 2[nd] to final year MBBS classes. The responses to the questions were dichotomous either in favour of case based learning or conventional teaching. It included both the genders and all the categories of students from 17 to 23 years of age. Duly filled questionnaires were returned by 397 respondents which were included in the study. Univariate analysis of each question was performed by applying Binomial exact test. Reliability was determined through internal consistency by applying Cronbach's alpha test. A total of 294 [74%] male and 103 [26%] female students with mean age of 19.83 +/- 1.41 years participated in the study. Difference in frequency of respondents was significant for all the questions [p-value < 0.05] except question number 1 and 2. Value of Cronbach's alpha was 0.83 showing high reliability. Case based learning is a preferred instructional strategy as compared to conventional teaching from students' perspective

Arrhythmogenesis in mitral valve prolapse; risk stratification - role of high resolution ECG, Holter monitoring and Mitral leaflet geometry

Mitral valve prolapse is generally considered a benign condition, however, a subset of patients remains at high risk of arrhythmogenesis which may lead to sudden cardiac death. To stratify risk of arrhythmogenesis in patients with mitral valve prolapse on the basis of high resolution ECG, Holter monitoring, resting heart rate and mitral leaflet geometry. Cross sectional comparative study. Armed Forces Institute of Cardiology [AFIC]/National Institute of Heart Diseases, Rawalpindi and Army Medical College, Rawalpindi, Pakistan Mitral leaflet displacement and thickness were measured on echocardiography in 37 patients with mitral valve prolapse. Resting heart rate and time domain indices of heart rate variability of each patient were recorded from 24 hours Holter monitoring. High resolution ECG of all the patients was carried out to record ventricular late potentials. Statistical analysis was performed using SPSS and the alpha value was set at <0.05 for significance. The mean values for resting heart rate, leaflet displacement and leaflet thickness were 77.19 +/- 6.29 per minute, 3.64 +/- 0.92 mm and 4.96 +/- 0.79 mm respectively. Ventricular late potentials were present in 8 [21.62%] whereas heart rate variability was reduced in 5 [13.51%] patients. Leaflet thickness was significantly greater in patients with ventricular late potentials as compared to those without [p-value 0.004]. Patients with reduced heart rate variability had significantly higher resting heart rate as compared to those with normal variability [p-value 0.02]. One patient [2.7%] had ventricular late potentials, reduced heart rate variability, resting heat rate of 88 beats per minute and leaflet thickness over 5 mm. Combined effects of high resolution ECG, holter monitoring and leaflet geometry identified the high risk subset, comprising of 2.7% of the study population

Dual effect of atorvastatin on endothelium; reduction In LDL And TXA2 levels but unaltered HCY levels In obese hyperlipidemic rats

Objective: The objective of the study was to observe the effect of lipid lowering therapy on homocysteine and TXA[2] concentration in obese hyperlipidemic Sprague Dawley rats

Design: Randomized Control Trial [RCT]

Place and Duration of study: The study was conducted in Department of Physiology and Centre for Research in Experimental and Applied Medicine [CREAM], Army Medical College, Rawalpindi; and National Institute of Health [NIH] Islamabad over a period of 12 months

Methodology: Ninety healthy Sprague Dawley rats divided into three equal groups. Group I [n=30] were healthy controls, group II [n=30] were made obese and group III [n=30] were obese treated [atorvastatin 10 mg/kg/day orally by gavage method for three weeks]. Body weight was recorded thrice weekly, lipid profile was measured by colorimetric method on microlab and homocysteine and TXA2 were measured by Enzyme Linked Immunosorbant Assay

Results: Serum low density lipoproteins and TXA2 decreased after three weeks of atorvastatin administration, elevated HCY concentration in obese hyperlipidemic rats however was not significantly affected

Conclusion: Atorvastatin apart from lowering lipid levels in the body also reduces TXA[2] concentration which is a vasoprotective. Elevated HCY concentration which is deleterious to the endothelium however is not affected

Qt interval prolongation and ventricular arrhythmias in patients with chronic heart failure

To determine the association of QTc interval prolongation with ventricular arrhythmias in patients with chronic heart failure. Descriptive study. This study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan from April 2013 to August 2013. Fifty three heart failure patients were monitored for 48 hours using ambulatory holter electrocardiography recorders. Digital ECG data was analyzed for QTc interval along with frequency and severity of arrhythmias. Association of prolonged QTc interval with ventricular arrhythmias and severity of arrhythmias was analyzed. Cardiac arrhythmias were observed in 79.2% patients. QT analysis revealed that 69.8% patients had prolonged QTc interval, 86.4% patients with prolonged QTc had ventricular arrhythmias. Of these 66% patients were found to have severe ventricular arrhythmias. Comparison of mean QTc interval of our study population with a reference value showed significantly higher QTc interval of our study group than the test value. Arrhythmia frequency and severity significantly increases with an increase in QTc interval in heart failure demonstrating association of prolonged QTc interval with high risk of severe ventricular arrhythmias and sudden cardiac death in chronic heart failure

Screening of High Risk Patients with Mitral Valve Prolapse - Role of Heart Rate Variability

To screen out patients with Mitral Valve Prolapse at high risk of ventricular arrhythmogenesis, based upon Heart Rate Variability. Department of Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. This cross sectional study included 37 patients with mitral valve prolapse. Patients with acute or old myocardial infarction, diabetes mellitus, ischemic heart disease and systemic hypertension were excluded. Patients were holtered for 24 hours and time domain analysis of heart rate variability was carried out. Statistical time domain measures of heart rate variability i.e. SDNN, SDANN and RMSSD were calculated. Descriptive statistics were used to calculate frequencies and percentages of categorical variables using SPSS version 22. Mean values of SDNN, SDANN and RMSSD were 141.62 +/- 30.80, 125.16 +/- 25.58 and 28.40 +/- 8.06 milliseconds respectively. Two patients [5.40%] had reduced HRV in all the three indices. In one patient [2.70%] values of SDNN and SDANN were reduced whereas in another one patient [2.70%] the values of SDNN and RMSSD were reduced. In remaining one patient only SDNN was found to be reduced. There is a subset of patients with mitral valve prolapse with reduced heart rate variability which may be at risk of ventricular arrhythmogenesis

Control of Oral Anticoagulant Therapy using INR in Patients with Artificial Heart Valves

To determine frequency of patients with artificial heart valves who are optimally anticoagulated, over anticoagulated or under anticoagulated based upon INR values. Descriptive, cross sectional study. Pathology Department, Armed Forces Institute of Cardiology, Rawalpindi. Five hundred patients who underwent heart valve replacement at AFIC were selected according to convenience sampling. Prothrombin time along with International Normalized Ratio [INR] was done in every case on automated Coagulation Laboratory [ACL]. Patients were grouped into adequately anticoagulated, under anticoagulated and over anticoagulated according to INR values. Descriptive statistics were used to describe the frequencies and percentages. One way ANOVA followed by post Hoc Sheffe test was applied to compare mean values of INR across the three groups. The p-value less than 0.05 was considered significant. A total of 300 patients [60%] were adequately anticoagulated whereas 175 [35%] and 25 [5%] were under and over anticoagulated respectively. Fifteen patients [60%] of the over anticoagulated group had hemorrhagic complications. INR values of all the three groups were significantly different from each other p-value [<0.005]. Dose of oral anticoagulant [warfarin] should be adjusted according to the results of INR to avoid thromboembolic or hemorrhagic complications

Impact of Functional Class of Heart Failure on Severity of Ventricular Arrhythmia

To study the impact offunctional class of heart failure [NYHA] on the severity of ventricular arrhythmias in patients with heart failurebased upon 48 hours ambulatory ECG [Holter] recordings. Descriptive cross sectional study. Study was conducted at Armed Forces Institute of Cardiology/Nationallnstitute of Heart Diseases, from April2013 to August 2013. A descriptive cross sectional study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from April 2013 to August 2013. In 53 heart failure patients' detailed history and 2 dimensional echocardiography were recordedto assess the functional class and left ventricular ejection fraction. Patients were then subjected to 48-hour Holter monitoring using ambulatory [Holter] electrocardiography recorders. Digital ECG data was acquired and manually edited. Arrhythmias were analyzed for frequency, type and severity. Statistical analysis was done to determine associations between arrhythmia severity and NYHA class of heart failure. Male: female ratio was 3.4: 1with mean age of 60 years. Mean ejection fraction was 21.69% and 86% patients had NYHAclass Ill and IV. 57% of these patients also had severe cardiac arrhythmias. Prevalence and severity of arrhythmias in heart failure is dependent upon degree of ventricular dysfunction and presenting NYHA functional class.There is a significantly higher prevalence of severe ventriculararrhythmias amongst patients with reduced ejection fraction and advanced NYHA functional class

Heart rate variability from 24 hours versus 72 hours holter monitoring in patients with mitral valve prolapse

To compare recorded heart rate variability from 24 hours with that recorded from 72 hours holter monitoring in patients with mitral valve prolapse. Cross sectional study. Department of Clinical Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. Patients from 15 to 38 years of age with confirmed diagnosis of mitral valve prolapse on 2 dimensional echocardiography were included. Patients with acute myocardial infarction [MI], Ischemic heart disease, diabetes mellitus or hypertension were excluded. Total 37 patients were included in the study through non-probability consecutive sampling. All these patients underwent 72 hours holter monitoring using Reynolds medical holter monitors 'life card CF'. Statistical time domain measures of heart rate variability i.e. standard deviation of all NN intervals [SDNN], standard deviation of the averages of NN intervals [SDANN] and square root of the mean of the squares of differences between adjacent NN intervals [RMSSD]. Mean values of SDNN, SDANN and RMSSD from 24 hours holter monitoring were 141.62 ms, 125.16 ms and 28.40 ms whereas those recorded from 48 hours of holter monitoring were 136.94 ms, 122.37 ms and 26.46 ms respectively. Difference between none of the variables from the two recordings was significant. Heart rate variability remains the same irrespectively of the length of holter monitoring