comparative study of complications in patients of myocardial infarction managed with and without streptokinase

Background - Numerous meta-analysis have been published and on the basis of the results of the some or all of the more than 33 trials evaluating intravenous streptokinase for acute myocardial infarction. All of these reviews demonstrated a consistent, statistically significant reduction in mortality for patients with acute myocardial infarction who were treated with intravenous streptokinase. Objectives - Intravenous streptokinase clearly confers a protective effect against early mortality in patients with acute myocardial infarction, with this initial hope that the administration of thrombolytics to patients with evolving acute myocardial infarction will prevent infarct complications. We conducted prospective study to observe the rate of complications as a whole in patients who could not get the thrombolytic therapy. Setting - This study was conducted in the coronary care unit and out patient Department of Cardiology Bahawal Victoria hospital Bahawalpur affiliated with Quaid-e-Azam Medical College Bahawalpur. Methods - This observational study was carried out in 960 patients fulfilling the diagnostic criteria for acute myocardial infarction. These patients were prospectively followed for clinical end points during the hospitalization and 90 days follow up period. Streptokinase 1.5 million units was used as a thrombolytic agent in the patients fulfilling the eligibility criteria. Results - A total of 960[21.22%] patients with acute myocardial infarction were assessed for the complications of myocardial infarction with or without thrombolytic therapy. Male and female patients were 664 [69.16%] and 296[30.83%] respectively. Mean age of patients with myocardial infarction was 57.30 years. Anterior myocardial infarction was diagnosed in 680[70.83%] patients and inferior wall myocardial infarction was diagnosed in 280[29.16%] patients. Streptokinase was given in 500[52.08%] patients while 460[47.9%] did not get it. There was statistical significant difference of complications as a whole with p value of < 0.001. Conclusion - Thrombolysis is the first line between life and death and now it has become the established fact beyond doubt in the treatment of acute myocardial infarction. The advent of streptokinase has led to substantial changes in clinical practice of managing acute myocardial infarction especially evolving one. The magnitude of the treatment effect lowers the risk of mortality and hospital stay

Comparative study of frequency of cough with angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertension

Background-Hypertension is an important factor in premature death and contributes to several of the leading causes of the death including heart diseases, stroke and renal diseases. The effect of ACEIs' and ARBs' was studied for the development of cough beyond blood pressure control. Setting - Outpatient Department of Cardiology and Medicine Bahawal Victoria Hospital, Bahawalpur attached with Quaid-eAzam Medical College Bahawalpur. Method - Two hundred male patients with uncomplicated mild to moderate essential hypertension were randomized to the treatment with ACEIs' and ARBs' for a mean period of twelve weeks. During each treatment period, the incidence of cough which necessitated the withdrawl of drug, was studied after fulfilling the inclusion and exclusion criteria. Results - Two hundred male patients who were randomized to receive the drugs having mean age of 51.9 years, mean systolic blood pressure 164.55 mmHg and mean diastolic blood pressure 99.55 mmHg. The mean dose of enalapril was 13 mg and the mean dose of losartan potassium was 65 mg. After treatment of 12 weeks, mean systolic blood pressure was 124.55 mmHg and mean diastolic blood pressure was 92.55 mmHg. 25 patients [25%] with ACEIs' developed cough while 4 patients [4%] developed cough with ARBs' with significant difference of incidence of cough with <0.001. Conclusion - Now that numerous agents are available to manage hypertension, more research should be directed towards improving the compliance of patients with anti hypertensive therapy with less side effect profile. ARBs' may be preferred over ACEIs' in certain cases