Short term clinical outcomes of Everolimus-eluting stents in patients with stable angina pectoris

Background and Objective: Everolimus-eluting stents, compared with bare metal stents, reduced the risk of restenosis in clinical trials with strict inclusion and exclusion criteria. The objective of this study was to determine the three months clinical outcomes of Everolimus Eluting Stents in patients with stable angina pectoris in Pakistani population

Methods: It was a descriptive cross-sectional study and the data was collected from Catheterization Laboratory Cardiology Department Lady Readings Hospital Peshawar. Our study included all the patients with stable coronary artery disease who had received Everolimus eluting stents from August, 2013 to April, 2014. Total study duration was 09 months. The primary end points were the rate of target vessel revascularization, myocardial infarction at three months. All those patients who received Everolimus coronary stents were recalled after three months from the index procedure and enquired about target vessel revascularization [TVR], myocardial infarction and hospitalization over the last three months. Data analysis was done using SPSS version 16

Results: Our study included 378 patients with stable ischemic heart disease who underwent revascularization with Everolimus eluting stent.These patients were followed up for a period of 3 months for target vessel revascularization [TVR] and myocardial infarction [MI]. Mean age was 57.04+/-9.307, males were [72%]. Left Anterior Descending [LAD] and Left circumflex [LCx] were the predominant vessels vascularized. Mean length of Everolimus eluting stent was 21.91+/- 4.6 while mean diameter of stent was 2.90+/-0.248. Thirteen [3.4%] patients had TVR and 14 [3.7%] patients had MI during three months follow up after PCI. TVR and MI were prevalent in patients who received longer Everolimus stents as compared to those who received shorter stents at three months, and the difference between the two was statistically significant

Conclusion: Short-term results from this study suggest that real-world outcomes among 378 patients are comparable to those reported in other registries and trials, and safety outcomes as measured by rates of TVR, MI were low. The long-term safety of Everolimus-eluting stents needs to be ascertained in large, randomized trials

Salivary duct carcinoma of the parotid gland: report of two cases in females

Salivary duct carcinoma is a rare tumor, commonly involving parotid gland. It typically affects middle aged to elderly males. The tumor has an aggressive behaviour and is notorious for early metastasis, high rate of local recurrence, and high mortality. Treatment is mainly surgical but other modalities are also used. We are reporting 2 cases in females who had different presentation, course of disease, treatment, and prognosis

Mammary analogue secretory carcinoma of parotid gland in a teenage boy

Mammary analogue secretory carcinoma [MASC] is a rare salivary gland malignancy that exhibits resemblance with secretory carcinoma of the breast [SC] due to the presence of ETV6-NTRK3 gene fusion, formerly classified as acinic cell carcinoma. It is a slowly growing painless tumor that exhibits wide range of clinical behavior. This tumor typically affects middle aged people. Less than 100 such cases have been reported in the literature so far with only 8 case reports of patients less than 19 years of age. Very little is known about the clinical management of such cases. We hereby report a case of 15-year boy who had been managed for MASC of left parotid gland with exision

Anaesthetic management of supratentorial tumor craniotomy using awake-throughout approach

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length of stay in hospital

Accuracy of 12 lead ECG for diagnosis of posterior myocardial infarction

To determine the accuracy of 12 lead ECG for diagnosis of acute Posterior Myocardial Infarction [MI] after its confirmation by 15 leads ECG. This study was conducted in Cardiology Department, Lady Reading Hospital Peshawar from January to July, 2012. Patients presenting to CCU with typical chest pain, pain epigastrium, sweating, nausea or vomiting and with admitting diagnosis of acute coronary syndrome [ACS] were included. The diagnostic criteria for posterior MI on 12 leads ECG was when R:S was more than 1:1 in V2 or there was tall R wave in V1 or V2 [more than Sin the same leads] or more than 2mm ST segment depression in anterior lead. Posterior MI was confirmed on 15 leads ECG taking it as a standard when ST segment elevation of >1mm was present in C7,8,9. Out of 176 randomly selected patients, 90[51.1%] were male and86[48.9%] female; with mean age of 63 years. Out of these, 70 were in the age range of 51 to 60 years and 40 each in 41-50 and 61-70 years. Eighteen patients had changes of posterior MI on 12 leads ECG and amongst them 10patients had true posterior MI on 15 leads ECG. We had 8 false positive cases on 12 leads ECG with no false negative cases after confirmation with 15 leads. The accuracy of 12 leads ECG for detection of posterior MI was55% after confirmation with 15 leads and there was no age and gender difference in its accuracy

Adenocarcinoma of rectum as second primary cancer after treatment of endometrium cancer

Colorectal cancer is the second leading cause of death from cancer in women in the United States. Previous epidemiologic studies have identified a 1.5 - 3 fold increased risk of colorectal cancer in women after ovarian and endometrial cancer. In Pakistan, neither such a study showing relationship of colorectal cancer with gynaecological cancer has been done nor any case has been reported. Here, a case is being reported who developed adenocarcinoma of rectum as the second primary about nine years after completion of treatment for adenocarcinoma of endometrium

Frequency of coronary artery anomalies in adult cardiology practice; an angiographic study

The aim of this paper was to measure the frequency of various coronary artery anomalies in our patient population who underwent coronary angiography for various indications. The data was collected retrospectively by analyzing the angiographic data of 13,615 consecutive patients undergoing coronary angiography between January 2008 and June 2012. Coronary artery anomalies were found in 305 patients [prevalence of 2.2%]. Among these patients, 186 [61.12%] were male and 119[39%] were female. Two hundred and ninety two [95.7%]anomalies were benign and 13[4.2%] were potentially of dangerous nature. Anomalies of the right coronary artery [RCA] in decreasing order of frequency included ectopic RCA from right sinus of valsalva [RSV] 54 [17.7%], coronary ectasia /aneurysm 24[7.8%], fistula 13[4.2%], RCA from left sinus of valsalva[LSV] with anomalous course 11[3.6%] and split RCA 3 [0.98%]. Anomalies of the left coronary artery[LAD] in decreasing order of frequency included myocardial bridge 71[23.3%], separate origin of LAD and circumflex from LSV [absent left main trunck] 58[19.02%], circumflex arising from RSV with anomalous course 28[9.18%], coronary ectasia/ aneurysm 23[7.54%], fistula 14[4.5%], LAD arising from RSV withanomalous course 3[0.98%], LCA arising from RSV with anomalous course[retroaortic] 1[0.32%] and single coronary artery 2[0.66%]. The prevalence and the pattern of coronary artery anomalies in our patient population were almost identical to previous studies. Cardiologists should be aware of the coronary anomalies because of its potential for serious cardiac events and its importance in interventional cardiology and cardiac surgery practice

Effect of cholesterol level on platelet aggregability in normal individuals

The aim of present study was to find the effect of cholesterol level on platelet aggregability in normal individuals. This study was conducted in Cardiology department, Lady Reading Hospital, Peshawar in September-October 2007. Normal individuals aged 18 years or above were randomly included. Patients who were suffering from any cardiovascular or other diseases were excluded. Those who were taking ante-platelets, anti coagulants and lipid lowering drugs were also excluded. Thus a total of 101 individuals were examined, after taking informed written consent. Fasting blood samples were taken from each patient. Total cholesterol was measured in hospital laboratory, while platelet aggregation was measured with chronolog whole-blood platelet aggregometer [WBA]. A total of 101 patients were examined. Their mean age was 51.24 +/- 8.23 years. Male were 60[59.41%] and female were 41[40.59%]. Mean platelet aggregability of these individuals was 7.87 +/- 4.40 ohms. Mean cholesterol was 163.47 +/- 20.75 mg/dl. When age was correlated with aggregability, both had a weak negative correlation. Pearson correlation coefficient was -.018 [p=0.855]. When age was correlated with cholesterol, again both have a weak negative correlation. Pearson correlation coefficient was -.152 [p=0.129]. When aggregability was correlated with cholesterol, both have a significant positive correlation. Pearson correlation coefficient was +0.269 [p=0.006]. Platelet aggregability is increased in patients with high cholesterol. These patients may need higher doses of anti platelets and more aggressive treatment of lipids to avoid vascular events

Frequency of aspirin resistance in patients with cardiovascular diseases

To find out the frequency of aspirin resistance, as measured by the inhibition of platelet aggregation, using Whole Blood Aggregometery, in patients with cardiovascular diseases presenting to out patient department of a tertiary care hospital. This study was conducted in the outpatient department of Cardiology, Lady Reading Hospital Peshawar, from October 2007 to January 2008. A total of 105 normal individuals not taking aspirin and 136 patients taking aspirin for cardiovascular diseases were randomly included. Blood was taken for measuring platelet aggregation using whole blood aggregometer. Result of each individual was noted on a proforma. Patients who were on any other ante-platelet like clopidogrel; or on warfarin and heparin were excluded from the study. Chi -square and independent t-test were used to find significant differences between different groups and variables. Platelet aggregability in 105 normal subjects, not taking aspirin was 9.28 +/- 3.23ohms. So cutoff for aspirin non responsiveness was taken as 9.28-3.23=6.0 ohms. Mean aggregability of 136 cardiovascular patient, taking aspirin was 5.81 +/- 5.47 ohms. Mean age was 52.66 +/- 10 years.Male were 80[58.8%]. Patients having aggregability >/= 6 ohms were 47.1%[n=64]. Mean aggregability of male patients was 5.66 +/- 5.45 ohms. Mean aggregability of female patients was 6.03 +/- 5.54 ohms[p=0.69]. When age was correlated with aggregability, both have a weak negative correlation [Pearson correlation coefficient= - .109 [p=0.205]. Mean age of patients having aggregability /= 6 was 51.46 +/- 10.36 [p=0.19]. Aspirin resistance as defined by inhibition of platelet aggregation measured with Whole Blood Aggregometry, is a common problem. Gender and age has no significant affect on platelet aggregability

Does BMI affect cholesterol, sugar, and blood pressure in general population?

Higher BMI in child hood is also associated with an increase risk for coronary heart disease in adulthood. Impaired glucose tolerance is highly prevalent in children and adolescents with severe obesity. Positive correlations between BMI and glucose, lipids and BP have previously been reported. The objective of this study was to find the correlation of BMI with cholesterol and sugar level in general population. This study was a part of 'Peshawar Heart Study', performed at Cardiology Department, Lady Reading Hospital, Peshawar in 2008-2009. Individuals with different ages, gender, professions, socioeconomic class were randomly selected from general population. Random blood sugar and cholesterol was measured with strip method. Height and weight of each individual was recorded and BMI calculated. All individuals were asked about any current medical illness and whether they were performing any exercise or not. Using SPSS-13, descriptive statistics were used for frequencies. Bivariate correlations were used for measuring correlation between BMI, sugar and cholesterol. Partial correlations were used to factor out the effect of other variables. A total of 2,270 individuals, 1,798 [79.2%] male and 472 [20.8%] female were examined. Mean age was 38.47 +/- 12.66. Mean BMI was 26.38 +/- 4.97. Mean RBS was 113.7 +/- 47.145. Mean cholesterol was 168.47 +/- 28.23. Exercise was performed by 929 [40.90%] individuals. Diabetes was present in 113 [5.0%] and history of high cholesterol in 25 [1.1%] persons. When bivariate correlation analysis were done systolic BP, diastolic BP, RBS and cholesterol had positive correlation with BMI [correlation coefficient of 0.317 [p<0.000], 0.319[p<0.000], 0.125 [p<0.000] and 0.205 [p<0.000] respectively]. These variables also showed a positive correlation among themselves. After factoring out the effects of age, exercise, gender and current medical status on the above correlations, the correlation of RBS and cholesterol with BMI decreased to 0.025 [p=0.232] and 0.135 [p<0.000] respectively and between sugar and cholesterol decreased to 0.018 [p=0.401]. In general population BMI is positively correlated with RBS and cholesterol. With the effect of age, sex, exercise and current medical status, this correlation is reduced

Prevalence of risk factors for cardiovascular diseases among journalists in Peshawar - the Peshawar heart study

To assess the prevalence of risk factors for cardiovascular diseases in journalists working in Peshawar. This was a descriptive study involving journalists working in Peshawar recruited in Peshawar Heart Study [PHS]. All participants were interviewed in detail including family history, past medical history, smoking history and medications history. Dietary habits were explored. All participants' pulse, blood pressure, BMI and waist hip ratio was determined. Their random blood sugar and total cholesterol was checked. Twelve lead ECG was recorded. Data was analyzed for cardiovascular disease risk factors. Total of 150 Journalists were interviewed at press club Peshawar. Mean age was 32 +/- 7.7 years. Current smokers were 36% [n=54]. Naswar was consumed by 6% [n=10]. Family history of cardiovascular disease was present in 30% [n=46]. Only 26% [n=40] took regular exercise. Mean Body Mass Index was 25.68 +/- 4.78. Mean W/H ratio was 0.91 +/- 0.03. Mean systolic blood pressure was 115. 31 +/- 14.63 mmHg while 20% [n=31] had systolic of > 140 mmHg. Mean diastolic blood pressure was 75.30 +/- 9.92 mmHg. Mean cholesterol was 158 .53 +/- 20.31 mg%. Mean random blood sugar was 98. 28 +/- 32.12 mg% with five journalists having more than 180mg%.Risks factors for cardiovascular disease like obesity, smoking, sedentary life style, hypercholesterolemia and hypertension were found prevalent among the journalists working in district Peshawar

Pre and post percutaneous transvenous mitral commissorotomy assessment of ventricular functions in severe rheumatic mitral stenosis by tissue doppler imaging echocardiography

To evaluate the left and right ventricular functions in patients with rheumatic mitral stenosis by Doppler tissue imaging echocardiography technique before and 24 hours after percutaneous transvenous mitral commissurotomy. A total of 60 patients included in the study. Pre and Post Percutaneous Transvenous Mitral Commissurotomy of Left and Right Ventricular functions were assessed by calculating velocities at Mitral and Tricuspid Valve Annulus by using Tissue Doppler Imaging Echocardiography at Echo Wing of Cardiology unit LRH. The peak systolic velocities improved from 0.07 +/- 0.01 Pre to 0.085 +/- 0.01 Post Percutaneous Transvenous Mitral Commissurotomy with statistical significance [p-value=0.001] at Mitral valve annulus. Similarly early diastole and late diastolic velocities also showed statistically significant improvements at mitral annulus. Pre Percutaneous Transvenous Mitral Commissurotomy early diastolic velocity of 0.075 +/- 0.02 improved to 0.1 +/- 0.02 Post Percutaneous Transvenous Mitral Commissurotomy with a highly significant P-value of 0.001. For late diastole, p-value was also significant [Pre=0.11 +/- 0.02, Post=0.15 +/- 0.03, p-value=0.01]. An analysis of various velocities was also made at individual sites of mitral valve annulus i.e., septal, lateral, inferior and anterior sites. At all these sites, Post Percutaneous Transvenous Mitral Commissurotomy velocities were statistically significant with p-value less than 0.05. Tricuspid annular velocities did not show statistically significant improvements after 24 hours of Percutaneous Transvenous Mitral Commissurotomy. Systolic and diastolic velocities significantly improved after Percutaneous Transvenous Mitral Commissurotomy at mitral annulus, but this change was not observed at tricuspid annulus. It showed that Tissue Doppler Imaging Echocardiography aided in assessment of immediate improvement in left ventricular function after Percutaneous Transvenous Mitral Commissurotomy in patients suffering from severe mitral stenosis and in sinus rhythm

Long-term survivor of brain metastases from malignant melanoma

Malignant melanoma is notorious for distant metastases. Median survival for stage IV melanoma is 6-10 months and 5 year survival is less than 5%. Median survival for melanoma with brain metastases is even lower i.e. 2 to 9 months. Here a case is reported who was treated for melanoma of sole of left foot with ipsilateral inguinal adenopathy and brain metastases in 2001 and is still surviving disease-free after a lapse of 8 years

Wound infections and culture sensitivity pattern in pediatric burn patients

To identify common organisms causing burn infection and their antimicrobial sensitivity pattern. A retrospective study of sixty patients with burn wound infection was carried out at burn unit of Khyber Teaching Hospital Peshawar from September 2006 to August 2007. Children who received burn injuries with signs and symptoms of septicemia were included in this study. Age, sex, percentage of burn wound and etiology of burn wounds was recorded. Culture and sensitivity tests were performed from burn wounds of those patients who were having fever and other features of septicemia by tissue culture of all patients[from infective sites] and their results were noted. Out of sixty patients, fourty were male and twenty were female pediatric burn patients. The most frequent organism isolated was staphylococcus aureus [25%], followed by pseudomonas [21.6%]. Other organisms included mix pseudomonas and staphylococcus aureus [23.5%], E-coli [13%], proteus [3%], Klebsiella [3%]. All these organisms were resistant to most routine antibiotics. This study highlights that staphylococcus aureus [25%] and pseudomonas [21.6%] are the most common organisms and cefoperazone/sulbactam and imipenem/cilastatin are the most effective empirical therapy in our setup

Hepatic and skeletal metastases from primary intracranial atypical meningioma

Meningioma constitutes 27% of primary CNS tumours. It rarely metastasizes to distant sites [< 0.1%]. Here, we present a case report of primary atypical intracranial meningioma metastasizing to liver and bone after 4 years of surgery and postoperative radiotherapy presenting with multiple episodes of hypoglycemia

Porocarcinoma: a rare sweat gland malignancy

Eccrine Porocarcinoma [ECP] is a malignant tumour arising from the intraepithelial ductal parts of the sweat gland. It has also been described as malignant hidroacanthoma simplex, sweat gland carcinoma, malignant intra-epidermal eccrine poroma, eccrine poroepithelioma, dysplastic poroma, malignant syringo acanthoma and porocarcinoma. Treatment with wide local excision but metastatic lesions can be treated with chemotherapy. Here, we present a case report of 52 years old male who presented with a fungating growth on left pre-auricular region that came out to be a case of ECP on histopathological examination

Process indicators in clinical outocme of stroke

To evaluate the value of process indicators in outcome assessment of stroke patients. This study was conducted at the Department of Medicine, Lady Reading Hospital, Peshawar from June 2002 to Nov 2002. Sixty patients with acute stroke were included in this study. Detailed history and full clinical examination was carried out. Data were recorded on standard proforma regarding the frequency of pressure sores, multidisciplinary involvement, distribution of Barthel Index of Activities of Daily Living [ADL] and formal swallowing assessment. These indicators were measured during admission and at six seeks follow up. Neurologist and physiotherapist examine all the patients. Speech and Language Therapist [SALT] saw 50% of cases while 12 [20%] were examined each by a neurosurgeon and a psychologist. Four [6.66%] patients developed pressure sores. Formal swallowing assessment identified 17 patients to have dysphagia and those treated by SALT showed low rate of aspiration pneumornia. Distribution of Barthel score showed very low score for those patients whose both sides were involved. Patients with right sided weakness were more dependent with an average score of 14.2 [moderately dependent] as compared to patients with left-sided weakness as they had an average score of 17 [mild dependency] at six weeks. With routine measurement of process indicators can prevent complications like pressure sores and aspiration pneumonia. This can help in selection of patients who will benefit from secondary stroke services and rehabilitation

Pattern of valvular lesions in rheumatic heart disease

To evaluate relative frequency of cardiac lesions in Rheumatic heart disease [RHD] in patients presenting to cardiology department, Lady Reading Hospital, Peshawar. This retrospective study was conducted at Cardiology Department Lady Reading Hospital Peshawar. The data on patients undergoing transthoracic two-dimensional echo and Doppler studies were retrieved from the computerized database from July 2003 to July 2006. The data was analysed with SPSS 11 window. Out of 3060 patients of RHD [1278 male and 1782 female], 1723 [56.3%] had mixed valvular lesions. Mean age was 22 + 6 years. Mitral stenosis [MS] was the predominant valvular lesion affecting 2141 [70%] patients [1040 pure MS and 1101 in combination]. Of those, 525 [24.5%] patients had severe MS, and 811 [37.9%] had moderate MS. Mitral regurgitation [MR] affected 1793 [58.59%] patients [245 pure MR, 1548 mixed] while 404 [22.5%] patients had severe MR and 497 [27.1%] had moderate MR. Aortic regurgitation [AR] was present in 1438 [47%] patients and almost always [98 85%] in combination. One hundred and eight [7.5%] patients had severe AR. Aortic stenosis [AS] was noted in 48 [1.56%] patients, of which 30 [62.5%] were in isolation and 18 [37.5%] in combination. Out of 1723 mixed lesions, MS+MR+AR were found in 826 [47.94%] cases and MR+AR in 428 [24.84%] cases. Most of the patients had mixed Valvular lesions. The predominant lesion was mitral stenosis followed by mitral regurgitation, aortic regurgitation and aortic stenosis respectively

Neoadjuvant chemotherapy in stage IV ovarian malignancy

A 57 years old woman was diagnosed to have stage IV ovarian malignancy on the basis of ascitic fluid cytology, tumor marker and imaging. Neoadjuvant chemotherapy was administered before surgery. Four months after surgery no evidence of malignancy was found on laparotomy and histopathology. She is under surveillance for any signs of recurrence