Comparison of risk factors profile in patients below and above forty years of age presenting with acute myocardial infarction

To compare the frequency of conventional risk factors in patients below and above forty years of age presenting with acute myocardial infarction. It was a three years retrospective comparative descriptive study conducted in Cardiology Department, PGMI, Lady Reading Hospital, Peshawar. Computerized data of patients admitted with acute myocardial infarction [AMI] from 1st September 2006 to 31st August 2009 was reviewed. Patients with age <40 years were assigned Group-I while those with >/= 40 years as Group-II. Conventional risk factors were age, sex, pertinent family history, smoking, hypercholesterolemia, hypertriglyceridemia, hypertension and diabetes mellitus. Using SPSS version 16, data was analyzed. A total of 4935 patients were admitted with AMI over the study period. Mean age was 58.4 +/- 12.37 [20 to 99] years. Group-I had 252 patients [79.4% males], while Group-II had 4683[65.9% males].Positive family history in Group-I vs. Group-II was 43[17.1%] vs. 426[9.1%], [p<0.001], respectively. Hypertension in Group-I vs. Group-II was 57[22.6%] vs. 1666[35.6%], [p<0.001], respectively. Diabetes mellitus in Group-I vs. Group-II was 29/252[1.5%] vs. 1059[22.6%], [p<0.001], respectively. Hypercholesterolemia in Group-I vs. Group-II was 63[25%] and 583[12.4%], [p<0.001], respectively. Hypertriglyceridemia in Group-I vs. Group-II was 68[27%] vs.1188 [25.4%], [p<0.001], respectively. Smokers in Group-I vs. Group-II were reported in 24[9.5%] vs. 76[1.6%], [p<0.001], respectively. Positive family history, hypercholesterolemia, hypertriglyceridemia and smoking were more frequent in younger age group while hypertension and diabetes mellitus were the predominant risk factors in older age group

Functional and radiological outcome of percutaneous pinning for fractures of distal radius

To evaluate functional and radiological outcome of close reduction and percutaneous pinning and plaster for fractures of distal radius. This was prospective study was carried out at Department of Orthopedics surgery at Mercy teaching Hospital ,Peshawar Medical College and Hayatabad Medical Complex, Peshawar, KPK, Pakistan from June 2010 to April 2012. It included 50 patients of age more than 15 years with AO type A and C1 and Fernandez type I and III distal radius fracture. After close manipulation and percutaneous K wiring, plaster cast was applied for 6 weeks. Immediate postoperative and at 6th week X ray of wrist taken for measurement of radial height and volar tilt. Subjective satisfaction of every patient according to Saito chart was evaluated after 6 months. Data was analyzed with SPSS v14. Out of 50 patients, 34 [68%] were males and 16 [32%] females. Mean age was 36.46 years [range 17-60 years]. Immediate postoperative radiographs showed that the average radial height was 10.80 mm [range = 8-14 mm] and volar tilt was 4.50 [degree sign] [range = ?411[degree sign]]. At the time of removal of pin-in-plaster and percutaneous K-wires, the average radial height was 10.00 mm [range = 7-13 mm], and the volar tilt was 4.32[degree sign] [range = ?411[degree sign]]. Subjective satisfaction frequency was excellent in 44[88%] cases and good and fair in 6 [12%]. Pin and plaster is good minimal invasive technique for close reduction and its maintenance during healing process with excellent functional outcome

Treatment of nonunion of long bone fractures with surgical implant generation network nail

To evaluate the efficacy of surgical implant generation network [SIGN] nail in treatment of nonunion of long bone fractures. Descriptive case series. Orthopedics Unit Mercy Teaching Hospital, Peshawar Medical College Peshawar, from June 2009 to December 2011. The study included 50 patients of age 15 year to 70 year of either sex and established nonunion after either surgical or nonsurgical intervention. All patients were managed by reamed SIGN nail and bone graft was performed. The follow up was done for the union. The data was analyzed with SPSS version 14. There were a total 50 patients with 46 [92%] males and 4 [08%] females. Mean age was 34.84 year. Average duration of nonunion was 16.16 months [range 06-48 months]. Among 50 cases tibia was involved in 30 [60%], femur in 16 [32%] and humerus in 4 [08%]. Thirty- eight [76%] cases were operated before SIGN nailing, with 16 [32%] having external fixator, 14 [28%] intramedullary nailing and 8 [16%] DCP. Twelve [24%] cases were managed conservatively. Average follow up was 21.12 [range 6-31] months. Forty-six [92%] cases were united fully in follow up, 2 [4%] were infected, 1[2%] had broken implant and 1[2%] was persistent nonunion case. Results of reamed solid intramedullary nail were good in terms of union and stability

Assessing the efficacy of danshenform compound in patients with stable angina pectoris

To assess the efficacy of danshenform compound in patient with angina pectoris already on optimal dose of anti anginal therapy assessed by exercise tolerance test. Thirty eight patients with stable angina were included in the study. Patients were exercised on treadmill according to Bruce protocol at baseline and one week later. At second week, Danshenform compound 500 mg was prescribed bid for four weeks. At the end of 4 weeks, exercise tolerance test was performed. Duration and number of anginal episodes before and at the end of 4[th] week recorded. Total exercise time, onset of chest pain during exercise, onset of ST segments depression before and after treatment with Danshenform compound was recorded. The number of anginal episodes after 4 weeks treatment with danshenform was reduced significantly from 4.2 +/- 2.4 to 1.4 +/- 1.6/ week [p=0.001]. Time of onset of chest pain improved from 4.63 +/- 2.4 to 5.4 +/- 3.7 minutes [p=0.35] on exercise tolerance test. Duration of exercise increased from 6.52 +/- 1.9 minutes to 8.32 +/- 2.3 [p=0.001]. Time of onset of ST depression increased from 5.8 +/- 1.7 to 7.7 +/- 1.6 minutes [p=0.001] on stress test. Anginal class improved significantly after 4 weeks of treatment with danshenform compound [p=0.001] with no significant effect on resting heart rate [p=0.58] and systolic blood pressure [p=0.07] respectively. Danshenform compound is useful in reducing anginal episodes, increasing exercise duration, improving functional anginal class, delaying the onset of ST depression on exercise tolerance test in patient with ischemic heart disease

Study of pericardial disease with ten year follow up in a tertiary care hospital

To study etiology, morbidity and mortality of pericardial disease and frequency of constrictive pericarditis with long term follow up of ten years. This descriptive study was conducted at Cardiology Unit Lady Reading Hospital Peshawar. All serial cases with moderate and large pericardil effusions presenting to Echo Room were enrolled in the study after fulfilling the inclusion and exclusion criteria. The cases were worked-up etiologically for the causes of pericardial effusion and planned to be followed up for ten years. 102 cases of moderate and large pericardial effusions were studied etiology wise in detail and were followed up for ten years. End points were death or 10 years of follow-up. On work-up it was observed that 36% were having proven tuberculous, another 26% cases were highly suggestive of tuberculosis. Contribution of other etiologies was pyogenic 8%, idiopathic 8%, rheumatic heart disease 5%, cardiomyopathies 5%, malignancy 4%, uremia 3%, rheumatoid arthritis 2%, pneumonia 1%, Dressler 1%, post cardiotomy 1%. Follow-up revealed that over all mortality was 21.56% at one year. Mortality and constriction was most common in the group with proven tuberculosis 30% and 27% respectively. Similarly malignant and uremic pericardial effusions had also a worst prognosis soon after the diagnosis. Mortality after one year and follow up was not found to be related to the initial disease process. Pericardial constriction mostly occurred in the group with proven tuberculosis so was the mortality. After the initial one year period, none developed constriction in the 10 years period

Rheumatic heart disease in urban school children of Peshawar

To conduct a survey of male school going children of Peshawar to find the prevalence of Rheumatic Heart Disease [RHD] in young population. School children of Peshawar city in the premises of school were screened by a team including a Cardiologist for RHD by physical examination and confirm the diagnosis by Echocardiography During 8 visits of different schools, children of lower socioeconomic status of city of Peshawar were screened. Relevant history of Rheumatic Fever and RHD along with physical examination including, BP, height, weight and CVS was performed 1773 school children were screened. 3 children were found to have RHD. One boy had severe MR/AR, one had moderate degree of MR and last one had severe AR. Only one boy was aware of his cardiac problem and was taking prophylaxis. 3 boys were found to have Congenital Heart Disease, one had a TGA with PS, one had mild AS and one had mild AS/AR RHD is on decline in urban male school going children of Peshawar and the prevalence is on decline since last four decades. The prevalence of RHD 3/1773, which seems to be lower than reported previously

new technique for treatment of permanent pacemaker [PPM] erosion

To evaluate the safety and efficacy of a new technique for treatment of late erosion and infection of permanent pacemaker [PPM] system pocket. Material and This retrospective observational study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from 1994 to 2005 on patients presenting with eroded or near erosion PPM. The operative procedure entailed formation of a new pocket medial and inferior to the old pocket through a 3cm fresh incision. The old pocket was approached from below and pacemaker and lead were mobilized. The pacemaker was then transported to the new pocket without exposure. The wound of newly formed pocket was stitched. The exposed area of old pocket was left open with separate dressing. Trans-esophageal echocardiography was done to exclude lead infection and endocarditis. All patients had culture sensitivity of blood and material obtained from wound. Study included 26 patients, 12 females [46%] and 14 males [54%] with mean age 64 years +/- 12 years. The mean duration of PPM implant was 36 months +/- 18 months. The procedure was successful in all patients. All were followed for minimum two years with no recurrence of infection. The procedure was complicated in one patient who had transient asystole due to disconnection of lead. Local redness, tenderness and ooze at old PPM site subsided rapidly. This technique is clinically safe and effective and may be considered as an alternative to complete removal of PPM system in selected patients

Coronary artery disease, is it more frequently effecting younger age group and women?

Objective: clinical audit for looking at the trend of coronary artery disease pattern in patients admitted to Cardiology unit, Lady Reading Hospital, Peshawar over a decade duration

Material and methods: ten years data from1995 to 2004 was retrieved from the computerized database of department of Cardiology, Lady Reading Hospital Peshawar. The data was analyzed yearly for total admissions, deaths and, discharges due to coronary artery disease

Results: total admissions in Cardiology unit, Lady Reading Hospital Peshawar in1995 were 5865, which increased to 8245 in 2004. Coronary artery disease patients in 1995 were 2053, which were 35% of the total admission that increased to 3025 making 37% of the total admission in 2004. Women were 27% of the total CAD burden in 1995 that increased to 39% in 2004. There is 50% increase of CAD in the female population. Mean age of patients with CAD was 49.70 years in 1995 that decreased to 47.38 years in 2004. In 1995 AMI occurred in 948 [16.16%] while in 2004 AMI were 1499[18.18%] of the total admission. The proportion of female in AMI was 25% in 1995 that increased to 34% in 2004. Mortality from AMI in 1995 was 10.65% while that in 2004 was 11.8%. In 1995 patients with unstable angina were 479[8.16%] compared to 883 [10.46%] in 2004. The mortality from CAD is almost static with 8.4% in 1995 and 8.7% in 2004

Conclusion: there is significant increase in the frequency of CAD in the local population more so in the female population with a similar mortality over a decade

Should we say good bye to exercise ECG testing?

This study was aimed to find out the accuracy of exercise test in patients with suspected coronary artery disease [CAD] presenting to Cardiology department, Lady Reading Hospital, Peshawar. In this retrospective study, records of all those patients with suspected CAD, who presented to Cardiology department, Lady Reading Hospital, Peshawar from July 2000 to July 2003, were analyzed. Only those patients who underwent both exercise tolerance test [ETT] and coronary angiography were included in the study. Exercise test was performed using standard Bruce protocol. Study population comprised of 664 patients, including 559 [84%] men and 105 [16%] women, with mean age of 50+9.7 [range 20-85] years. Coronary angiography showed 601/664 patients had stenosis of >70% in at least one coronary artery. Of these 601 patients 351[58.47%] had abnormal ETT, 105[17.47%] had negative ETT and 145[24.12%] had non-diagnostic ETT. After excluding the non-diagnostic results, the sensitivity was 76.97%. Among the 63/664 individuals with minimal or no coronary stenosis, 18[28.57%] had no ischemic ST changes during ETT, 21[33.33%] had positive ETT and 24[38.09%] had non-diagnostic ETT. Thus the specificity was 46.15%. Positive predictive value of ETT was 95% and negative predictive value was 15%. Overall accuracy of ETT was 55.50%. Exercise ECG testing has an important role in diagnosing suspected coronary artery disease. Patients with positive ETT should further be evaluated by coronary angiography. A negative ETT does not exclude CAD

Effect of metal ions on the antimicrobial activity of aminoglycoside class of antibiotics

A number of cobalt [II], nickel [II], copper [II] and zinc [II] complexes of aminoglycoside class of antibiotics such as, gentamycine and streptomycine have been synthesised: The antimicrobial studies of these metal-antibiotic complexes against bacterial species staphylococcus aureus, staphylococcus proteus, pseudomonas aeruginosa, klebsiella pnemonae and escherchia coli have shown to be more active and antimicrobial than the pure uncomplexed antibiotics