High degree atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement

To determine the influence of time on development of high degree Atrioventricular [AV] block in patients with inferior Myocardial Infarction [MI], its association with Right Ventricular [RV] infarction and its ultimate morbidity and mortality. A descriptive study. The Emergency Department [ED] and the units of adult cardiology at National Institute of Cardiovascular Diseases [NICVD], Karachi, from October 2006 to March 2007. Patients presented at ED with typical chest pain and subsequently diagnosed by standardized diagnostic criteria as having inferior MI were recruited prospectively. Patients were first analyzed on the basis of absence [Group A] or presence [Group B] of high degree AV block regardless of RV infarction Then after patients were divided into two groups, those without RV infarction [Group I] and with RV infarction [Group II]. Each group was further sub-divided as Ia, IIa and Ib, IIb depending on absence or presence of high degree AV block respectively. Each group was analyzed for comparisons with different variables for prediction of influence of time, proportion of RV infarction, association of AV block with RV infarction, complication profile and immortality. Of the 220 patients with inferior MI, 52 [23.6%] had high degree AV block and 83 [37.7%] had RV infarction. They were older in age [p < 0.003]. Patients who took more time to seek medical treatment from onset of symptoms were more prone to develop AV block [p < 0.001]. Among patients with block, 73% received thrombolytic therapy [p < 0.009] and temporary pacemaker [TPM] was implanted in 75% [p < 0.0001]. Mortality was significantly high in those patients [p < 0.0001]. In group II, 61.4% presented with sinus rhythm [p < 0.001]. TPM was implanted to 31.3% [p < 0.0001]. In the 4 days of hospital course, 8.4% of patients with RV infarction developed AV block [p < 0.005], whereas 10.8% of patients without RV infarction experienced post MI angina [p < 0.031]. Mortality was found significantly high when block was associated with RV infarction [p < 0.007]. No significant difference was found in response to atropine, volume replacement or streptokinase administration and reverting of block to sinus rhythm. Patients with inferior MI who took more time to seek medical treatment were found to be more prone to develop high degree AV block. RV infarction was found in about 38% of patients defined a high risk subgroup. High degree AV block significantly influenced the outcome when associated with RV infarction, leading to high mortality

Fine needle aspiration cytology of thyroid nodule; diagnostic accuracy and pitfalls

To evaluate the utility of FNAC in patients with Thyroid Nodule. Records of all patients treated surgically for thyroid nodule[s] at Aga Khan University Hospital from January 2000 to December 2004 were reviewed. The patients who had pre operative FNAC as first line of the evaluation and the final post operative histopathology report available were included in the study. 125 patients [90 female 35 male] had thyroid surgery. The cytological diagnosis was made according to following categories: Benign, Follicular lesion, Malignant and Inadequate sampling. Among 63 [Benign cases], 57 were benign and 6 turned out to be malignant. Among 44 cases from [Follicular group], 31 were benign and 13 were malignant. Out of 15 patients from [Malignant] group, 14 were malignant and 1 was benign. Among three patients from the [Inadequate sampling group], 2 turned out to be benign and one was malignant. The overall results showed a sensitivity of 98%, specificity of 70%, and positive predictive value of 91%, negative predictive value of 93% and diagnostic accuracy of 91%. We conclude that FNAC is an invaluable and minimally invasive procedure for pre operative assessment of patients with a thyroid nodule in our setting as well. FNAC has high sensitivity in picking up malignancy in thyroid and also has high diagnostic accuracy in the evaluation of thyroid nodules

Association of leukocyte count with albumin excretion in type 2 diabetes mellitus

In type 2 diabetes Mellitus albumin excretion rate correlates with leukocyte count. One of the major components of chronic sub clinical inflammation associated with both insulin resistance and other sclerosis. The aim of this study was to determine the relationship between leukocyte count and Albumin excretion in patients with type 2 diabetes Mellitus. A prospective study conducted on patients with type 2 diabetes during 2004 at BMSI Jinnah Post graduate Medical Centre Karachi. A total of 100 subjects of either sex were included, out of which 75 type 2 diabetics were selected from diabetic clinic Jinnah post graduate Medical Centre Karachi and 25 non diabetics as control from general population. Each subject was interviewed, examined and investigated for blood pressure measurements, body weight, fasting serum glucose urinary volume, urinary albumin, albumin creatinine ratio, urinary albumin excretion and leukocyte count. Patients having acute illness and proteinuria due to cardio vascular disease and other causes were excluded. Leukocyte count was significantly high [P<0.001] in all patient groups as compared to control group, also it shows significant increase in smoker diabetics as compared to non smoker diabetics. A strong relation ship was found between leukocyte count and albumin excretion r =0.786, P< 0.001 in type 2 diabetes Mellitus. Albumin excretion rate correlates with leukocyte count in patients with type 2 diabetes Mellitus

Serum uric acid levels in female patients of ischemic heart disease

To find out possible relationship between serum uric acid and incidence of ischemic heart disease. Comparative study of serum uric acid in 30 patients of IHD with 11 age and body mass index matched control subjects. Basic Medical Science Institute, JPMC, Karachi. Serum uric acid was found to be significantly high [P<0.001] in hypertensive with ischemic heart disease and in hypertensive. The mean values were also found to be high in normotensives with IHD but the difference was statistically non-significant. Serum uric acid levels is strongly related to incidence of ischemic heart disease

Effects of diazepam and promethazine on uterine contractions induced by prostaglandin E2 [PGE2]

This study was conducted at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. It was done to observe the inhibitory effects of diazepam and promethazine, on uterine contractions induced by prostaglandin E2 [PGE.2]. The drug interaction, in vitro, proved that both diazepam and promethazine are tocolytic in vitro