Health impact of 2010 flooding in Pakistan

The recent flooding in Pakistan is considered to be the worst in the last 80 years in the region. A total of 21 million people are affected

Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi

Coronary Artery Bypass Grafting [CABG] with cardiopulmonary bypass [CPB] on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass [OPCAB]. Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG. Consecutive CABG cases operated between 1[st] June 2003 and 31[st] May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability [p value]. Six hundred and eighty-four cases were divided in group-A [on-pump, n=574] and B [OPCAB, n=97]. Conversion rate was 11.8%. Intraoperative dysrythmias [A, 3.5%, B, 15%, p<0.0001] and use of inotropic support was higher in group-B [A, 15.3%, B, 30.3%, p<0.0001]. Actual mortality in group-B was higher than the predictive value [A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively]. OPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG

Modified Ultrafiltration: Role in adult cardiac surgical haemostasis

During cardiac surgery, cardiopulmonary bypass [CPB] leads to haemodilutional anaemia and activation of inflammatory mediators, affecting haemostasis. Modified Ultrafiltration [MUF] is being increasingly favoured for haemoconcentration without blood transfusion and reducing post operative bleeding. Aim of this study was to record the impact of modified ultrafiltration on haemoconcentration and postoperative bleeding during adult cardiac surgery. This randomized control trial included 100 patients, divided into 2 groups; MUF and control group. Serial blood samples were drawn to evaluate haematological indices. Postoperative chest drainage was recorded for 24 hours. Results were expressed in terms of percentages, means and p value [p < 0.05 was taken as significant]. Four patients were excluded and 96 patients were analyzed [MUF n=50, control n=46]. According to American society of anaesthetist [ASA] classification, MUF group was higher risk group [p=0.02] with longer extracorporeal perfusion time [p < 0.001]. Haemoconcentration was successfully achieved in MUF group [final haemoglobin=10.7 +/- 1.25, haematocrit=33 +/- 3.64%, p < 0.001] with lower blood loss [MUF=395 +/- 153 ml, control=755 +/- 435 ml, p < 0.001] and transfusion requirement [p < 0.001]. Re-exploration rate was 4% and 6.5% in MUF and control group respectively [p=0.57]. Mortality in both groups was comparable [MUF=4%, control=4.3%, p=0.94]. Modified ultrafiltration is a safe procedure which successfully achieves haemoconcentration, lowers blood loss and transfusion requirement after cardiac surgery in adult population

Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours

Objective: To evaluate bronchial wash cytology with histology in our set up

Material and Methods: Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains

Results: A total of 73 patients were studied. The age range was 21 to 80 years . Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 [77.4%] cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 [32.9%] as malignant and 29 [39.8%] as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity [80.5%], specificity [96.6%] and accuracy [87.3%]. Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma

Conclusion: It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage

Is there a correlation between degree of viremia and liver histology in chronic hepatitis C?

To determine the correlation between degree of histological liver damage and serum HCV RNA level in patients of chronic hepatitis C, in order to evaluate the usefulness of HCV RNA estimation as an alternate to liver biopsy. This non-interventional descriptive study, was carried out at the department of Pathology, Army Medical College, Rawalpindi, Pakistan between April and September 2002. Core needle liver biopsies of fifty five patients of chronic hepatitis C were evaluated according to Knodell's histological activity index system. The patients were categorized into four subgroups depending upon the grade and stage of disease according to Desmet's classification, and into three groups according to degree of viremia. Five patients had mild viremia, 43 moderate and 7 had severe viremia. Seven patients had minimal disease, 9 mild, 22 moderate and 17 had severe chronic hepatitis. Eight patients had no fibrosis, 20 had fibrous portal expansion, 19 bridging fibrosis, and 8 patients had cirrhosis. No significant correlation was found between serum HCV RNA levels and grade or stage of the disease, with correlation coefficients of rs = -.054 and rs =.034 respectively. Moreover, no individual component of the HAI correlated with serum HCV RNA levels. Serum HCV RNA level does not determine the degree of hepatic injury precisely and liver biopsy is necessary to accurately evaluate the extent of liver damage

autopsy study of hypertrophic cardiomyopathy

To see the pathological features of this disease in our set up and to emphasise the importance of morphological examination in making the diagnosis of hypertrophic cardiomyopathy [HCM] especially in cases of sudden cardiac death. A retrospective, descriptive study of 15 autopsies of this particular disease was carried out at the Armed Forces Institute of Pathology [AFI] Rawalpindi during the period from 1990 to 1995.The hearts along with blood vessels were fixed in 10% formalin and were dissected according to the modified Virchow's method for eliciting the gross appearance of cardiac chambers and valves. Representative sections were taken for histological examination. All the cases were young adult males. The age range was from 17-34 years [mean, 26-6 years] Ten cases died suddenly and five cases had an evidence of moderate to severe exertion preceding their death. Symmetrical as well as asymmetrical hypertrophy was noted in this study. The thickness of inter ventricular septum [mean 20 mm] and left ventricular wall [mean 22.5 mm] was increased. All the specimens revealed disarray of hypertrophic myocardial fibres and patchy interstitial fibroses. Sudden death is usually the first manifestation of disease. The hearts showed asymmetric as well as concentric hypertrophy. Myofibre hypertrophy and disarray was an important pathological findings in our cases. While carrying out post-mortem examination of a case of sudden cardiac death one should also keep in mind the possibility of this disease