Skeletonization of left internal mammary artery in coronary artery bypass grafting

Objective: To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery [LIMA] in patients undergoing coronary artery bypass grafting [CABG] surgery

Study Design: Randomized control trial

Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan from February to August, 2013

Methodology: Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMA harvesting. Free flow was checked just before anastamosis of each LIMA to the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. A specialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18

Results: The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group [p=0.04]

Conclusion: Skeletonized IMA had superior flow to pedicled IMA in addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization

IL-6 dependent effect of oral warfarin in heart valve replacement patients by measuring interacting clinical and demographic variables

Objective: To examine an inflammatory effect of warfarin and comparing with IL-6 levels along with different demographic and clinical variables

Study Design: Qusai experimental study

Place and Duration of Study: Center of Research in Experimental and Applied Medicine [CREAM], Army Medical College/National University of Sciences and Technology, Islamabad from Oct 2013 to Oct 2015

Material and Methods: The study design was Quasi Experimental study. Samples were collected by Nonprobability convenience sampling. Total 76 patients were included according to warfarin dose response in warfarin therapy patients, i.e. 32[42%] were taking <5mg/day, 37[49%] had been put on dose 5-10mg/day and 7[09%] were taking>10mg/day of warfarin dose. Patient's demographic and clinical variables were noted i.e. age, gender, BMI, duration of therapy, INR history, hepatic, gastrointestinal and diabetic complications. Human IL-6 ELISA assay was performed

Results: The statistically significant difference was found between age groups [in years] and different levels of warfarin dose [p=0.046] along with IL-6 production. There is a negative correlation between warfarin dose and age group i.e. as age increases, the dose of warfarin decreases. Among the inter and intra-patient variability age and serum IL-6 levels were found to be statistically significant with warfarin dose response. BMI and warfarin dose were found to be weak positively correlated

Conclusion: A marked immunomodulatory response of warfarin was noted by measuring IL-6 levels. IL-6 levels retained a significant association with warfarin dose

Topical application of tranexamic acid reduces postoperative bleeding in open-heart surgery: myth or fact?

To determine the efficacy of topical application of Tranexamic acid in controlling postoperative bleeding in open-heart surgery. Double blind randomized control trial. Departments of Cardiac Surgery and Intensive Care of Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan, from May to October 2011. A total of 100 consecutive adult patients fulfilling the inclusion criteria undergoing elective on-pump cardiac surgeries were randomly divided in groups [A] and [B]. A study solution that contained 2.5 g of Tranexamic acid in 250 ml normal saline in group-A and equal amount of normal saline [placebo] in group-B was poured in the pericardial cavity over the mediastinal tissues before sternal closure. Postoperative bleeding was measured in both groups for 24 hours in the cardiac surgical ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms of mean postoperative bleeding in ml. Kindly again include these lines which seem to have been omitted in the final proof. There was significant difference in the mean postoperative bleeding within 24 hours among the two groups 340.1 +/- 112.4 ml in Tranexamic acid group vs. 665 +/- 187.28 ml in placebo group [p < 0.001]. Patients who did not have topical Tranexamic acid before chest closure had a significantly higher postoperative bleeding. Topical Tranexamic acid application is an effective and economical way for controlling non-surgical bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass

Assessment of the knowledge and factors affecting safe injection practices among health care providers in public and private sector health facilities of tehsil gujar khan Rawalpindi Pakistan

The study aimed at assessing the knowledge of health care providers and identifying the factors affecting knowledge about safe injection practices. A cross sectional study. This study was carried out at Gujar Khan, District Rawalpindi from July, 2011- October, 2011. 37 health care facilities [72.7% private and 27.3% public] were selected conveniently. 110 Health Care Providers [HCP's] were selected on the basis of availability. HCP's who were involved in clinical work for more than six months were included. Permission was obtained from ethical committee of Health Services Academy and the owners of the health care facilities. The knowledge of the HCPs was assessed through specifically developed scoring scheme and was categorized into good, fair and poor, while the factors affecting knowledge were assessed by applying Chi-square tests. .[p

Ibuprofen versus acetaminophen premedication on success of inferior alveolar nerve block in irreversible pulpitis

To compare impact of ibuprofen and acetaminophen premedication on the efficacy of inferior alveolar nerve block in irreversible pulpitis. Randomized controlled trial. Operative Department, AFID Rawalpindi from 18 September 2007 to 17 September 2008. Three hundred and sixty patients with irreversible pulpitis were divided into two groups. At base line patients pain was recorded. Ibuprofen was given to patients in group A and acetaminophen to group B patients. Patients were given drugs in tablet form. After 30 minutes cold test with ethyl chloride was done and patient pain was recorded on visual analogue scale. Inferior alveolar nerve block was administered. Forty five minutes from base line cold test was performed and pain was recorded. Access to the endodontic cavity with round bur in high speed handpiece was made and patient response was noted. Inferior alveolar nerve block was successful if patient had no pain to cold test at 45 minutes and on access to cavity preparation. Data was analyzed by SPSS version 12. There was no statistically significant difference between ibuprofen and acetaminophen on success rate of inferior alveolar nerve block in patient with irreversible pulpitis. Ibuprofen and acetaminophen premedication has similar efficacy on success of inferior alveolar nerve block in patients with irreversible pulpitis.

Predictive value of euroscopre in Pakistani cardiac surgical patients

To evaluate the predictive value of European System for Cardiac Operative Risk Evaluation [EuroSCORE] of early mortality in Pakistani cardiac surgical population in a single cardiac center. A prospective, single institution, observational cohort study. Department of Cardiac Surgery AFIC Rawalpindi from 1st January, 2009 to 31st December 2009. A total of 1064 consecutive adult patients undergoing cardiac surgical intervention at department of adult cardiac surgery from 1st January 2009 to 31st December 2009 were included in the study. The logistic EuroSCORE score was estimated for all the patients and compared with the observed 30 day mortality. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model and the area under the receiver operating characteristic [ROC] curve was measured to analyse the EuroSCORE discriminative power on individual death prediction. Expected mortality was compared to observed or actual mortality. Mortality was defined as death from any cause within 30 days of operation or within the same hospital admission. The Hosmer-Lemeshow test revealed a good calibration power [p = 0.73] and the area under the ROC curve was 0.753, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients [18.18%] was very high as compared to predicted mortality [8.14%]. EuroSCORE is a reasonably good relevant predictor of immediate post-operative mortality in low and intermediate risk groups after cardiac surgery in Pakistani population, but is less predictive for high-risk patients

Efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children

To compare the efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children presenting at CMH Murree. Randomized control trail [RCT] Departments of Paediatrics and Pathology CMH Murree from August 2009 to March 2010. Forty one children diagnosed with iron deficiency anemia on the basis of hemoglobin, red cell indices and morphology and serum iron levels were included. Patients were randomized into two groups with group I of 18 receiving oral ferrous sulphate and group II of 23 receiving parenteral iron sorbitol therapy. Response was assessed by reticulocyte count at 1 week, change in hemoglobin, MCV and serum iron levels at 4 weeks post treatment. The reticulocyte response at 1 week time was significantly more with intramuscular iron as compared to oral iron. Mean hemoglobin change and serum iron level increase were also significantly more with intramuscular iron therapy. Mean MCV level change was insignificant between the two modalities. Parenteral intramuscular iron sorbitol treatment with better compliance shows early improved responses in children with iron deficiency anemia as compared to oral ferrous sulphate therapy and should be used as a preferred modality for treatment

Post exposure effectiveness of varicella vaccine

To asses the post exposure effectiveness of varicella vaccine in children. Quasi Experimental. CMH Murree from Jan 2008 to Jan 2010. A hospital based study, in which the siblings of children who presented with chickenpox were given option of vaccination. Those who opted were placed in study group while those who did not opt for vaccination were placed in control group. Both groups were observed for symptoms of chicken pox and outcome results were compared. Out of 74 children who received chicken pox vaccine only four children developed chicken pox, while twenty eight children out of 42 in control group developed chicken pox. Vaccine effectiveness was 91.9% and statistically significant difference was found among vaccinated and non vaccinated groups as regards to occurrence of varicella. Varicella vaccine is very effective if used within five days after exposure

Efficacy of gluma desensitizer[TM] and duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions

The objective of this study was to compare the efficacy of Gluma Desensitizer[TM] and Duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions by a randomized control trial. 196 patients having hypersensitive non-carious cervical lesions were divided into two groups. Gluma Desensitizer[TM] was applied to patients in Group A and Duraphat[TM] to patients ingroup B. Patient's pain response to compressed air was recorded on the visual analogue scale at baseline, 5 minutes, 7 days and 30 days after treatment. Data were analyzed using SPSS version 12. Comparison of sensitivity between the two treatment groups on application of compressed air showed a statistically significant difference. The results of this study showed that Gluma Desensitizer[TM] showed better results in relieving dentinal hypersensitivity than Duraphat[TM] in non-carious cervical lesions

Peripheral arteriovenous malformations

Arteriovenous malformation [AVM] is an anomaly characterized by abnormal vascular communications between arteries and veins in the different organs of the body. It may be congenital or acquired. Microsurgical resection, endovascular embolization and radiosurgery [irradiation] are the three effective modes of treatment currently available. However, no objective criteria have been established for which mode[s] of treatment should be selected for individual patients with AVMs

Is mechanical bowel preparation really necessary in colorectal surgery?

To determine the outcome of colorectal surgery without mechanical bowel preparation. Design: A descriptive, analytical and observational study. Place and Duration of Study: Combined Military Hospital, Kharian and Pano Aqil, from September 1998 to April 2003. Subjects and Forty-seven patients underwent debridement/resection and repair/ primary anastomosis of colon and upper rectum without bowel preparation. Of these,16 patients were operated in emergency. The anastomosis was carried out with polyglactin [vicryl] interrupted, full thickness single layer and no patient had defunctioning colostomy. Third generation cephalosporin, cefotaxime or ceftazidime and metronidazole were given perioperatively, repeated during surgery if lasted for more than 2 hours and continued for 3-5 days postoperatively. Anastomoses were ileocolic in 29.7%, colicocolic in 61.7% and colorectal in 14.8% cases. Anastomotic failure was seen in 4.2% and wound infection in 8.5% cases. There was one mortality [2.1%] due to unrelated cause. Mechanical bowel preparation is not necessary for safe colorectal surgery

Role of serum c-reactive protein in the papid diagnosis of neonatal sepsis

To assess the role of serum C-reactive protein in the rapid diagnosis of neonatal sepsis, a prospective study has carried out on pediatric patients. The study was carried out at the neonatal ICU of CMH Sialkot from July 2000 to March 2001. All patients were assessed by a thorough history and examination and then segregated into various groups. Their intravenous blood samples were taken and then subjected to battery of investigations. Statistical analysis of the observations was carried out in the form of sensitivity, specificity, positive predicative value and negative predicative value. Significance of the tests was also computed in form of p value. Serum CRP has got the highest sensitivity and negative predictive value when compared with total leukocyte count, platelet count and erythrocyte sedimentation rate From this study, it was inferred that serum CRP helps in the early and rapid diagnosis of neonatal sepsis