TIMI risk scores; frequency of double vessel coronary artery disease in different TIMI scores in patients presenting with non ST-elevation acute coronary syndrome at Gulab Devi Chest Hospital

Background: thrombolysis In Myocardial Infarction [TIMI] risk score predicts adverse clinical outcomes in patients with non-ST-elevation acute coronary syndromes [NSTEACS]. Whether this score correlates with the coronary anatomy is unknown

Objective: to determine the frequency of low, moderate and high TIMI risk score in patients of NSTEACS and to compare the frequency of two vessel coronary artery disease on angiography with low, moderate and high TIMI risk scores in patients of NSTE-ACS

Study design: this was a cross sectional study

Setting: department of Cardiology, Gulab Devi Chest Hospital, Lahore

Duration: six months

Patients and Methods: total 170 patients were included in the study. Patients' selection was done with the help of a pre-defined inclusion and exclusion criteria. TIMI risk score was calculated for each patient and patients were categorized into low, moderate and high risk groups [as per operational definition]. Patients were further evaluated with coronary angiograms to assess the double vessel CAD. All angiographies were performed by a single physician. Data analysis was done on SPSS version 17

Results: mean age of our patients was 54.81 +/- 10.55 years. Gender distribution shows that there were 106[62%] male and 64[38%] female patients. TIMI score risk classification showed that among 50[29.4%] patients TIMI risk score was low, among 107[62.9%] patients it was moderate and in 13[7.6%] patients it was high. There were 105[62%] patients who had two vessel coronary artery disease. Among 105 patients who had two vessel coronary artery disease, 25[23.8%] had low TIMI score, 69[65.7%] had moderate and 11[10.5%] of the patients had high TIMI score

Conclusion: in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score is significantly associated with two vessel coronary artery disease. So it should be recommended that a routine invasive strategy be carried in patients with moderate or higher TIMI risk score

Ewing's sarcoma chest

The aim of this review article was to highlight clinical presentations, diagnosis and treatment approaches of thoracic cavity Ewing's sarcoma. This was a prospective study. Ewing's sarcoma is the second most frequent bone tumour among children and young adults. It comprises 10-15% of all bone tumours. Ewing's sarcoma arises intramedullary. The frequency of rib involvement follows that of the femur, the pelvic bones, the fibula, the humerus and the tibia. Between January 1999 and December 2005, 5 patients of Ewing's sarcoma chest were dealt with. The age range was 6-12 years

All the 5 patients had huge masses compressing the lung and other vital structures in the chest. One patient was on ventilatory support preoperatively. Thoracotomy was done in 3 patients prior to chemotherapy and later on after chemotherapy in 2 patients. Post-operative stay range was 7- 15 days. No hospital mortality occurred

This article demonstrates the most effective and immediate treatment in case of Ewing's sarcoma chest. The three cases that had to be operated urgently before the chemotherapy survived and received chemo-radiation later on thus signifying the importance of timely and proper surgery. Referral to proper hospital is mandatory who cater these kinds of cases

Serum B[12] and folate levels in patients with megaloblastic change in the bone marrow

Vitamin B12 and folic acid are essential components of DNA synthesis in red cell precursors. Folic acid is directly involved and Vitamin B12 [methyl cobalamine] participates as a cofactor. A deficiency of Vitamin B12 causes the same symptoms as folic acid deficiency. The study was carried out to find the cause of megaloblastic anemia. In this descriptive study, we evaluated clinical and morphological features of 80 consecutive patients with a megaloblastic change in bone marrow from 2008-2010. The study was carried out in the Hematology Laboratory, Services Institute of Medical Sciences, Lahore. Eighty patients with a megaloblastic change in bone marrow were studied. There were 32 males [40%] and 48 females [60%]. The most common clinical presentation was pallor and fatigue [67 patients, 84%]. Out of the 80 patients, 50 [62.5%] were deficient in folic acid and 24 patients [30%] were Vitamin B12 deficient. 6 patients [7.5%] were Coomb's positive, indicating Immunemediated Hemolytic Anemia as the cause of megaloblastic anemia. Folic acid deficiency was the most common cause of megaloblastic anemia [62.5%] in the given population. Vitamin B12 deficiency was the next most common cause [30%]. 6 patients [7.5%] had normal levels of Vitamin B12 and Folic acid and were Coomb's positive showing that Immune - mediated hemolytic anemia can also be a cause of megaloblastic change in the bone marrow

Comparison of diagnostic efficacy of rapid diagnostic devices for Dengue virus infection-a pilot study

To compare the diagnostic efficacy of commercially available rapid diagnostic test devices for Dengue serology. To find out the sensitivity and specificity of rapid diagnostic devices with Elisa results as the Gold standard. During the dengue virus epidemic in Lahore a pilot study was conducted in order to evaluate the diagnostic efficacy of two most frequently used immunochromatographic rapid test devices in public sector hospitals. The results of both the kits were compared to each other. Sensitivity and specificity was calculated against results of ELISA as the reference gold standard. Results of kit-A revealed a very high false negative rate when compared to ELISA where actual prevalence rate shown by ELISA was 96.0% compared to prevalence rate of 44.0% with rapid diagnostic test device kit-A. Similarly the results of rapid test device Kit-B showed high false negative results for dengue virus prevalence. Actual prevalence rate of dengue fever shown by ELISA was 96.0% where as it turned out to be 50% with the kit-B rapid test device. Comparison of Results of two kits revealed no significant difference of test positivity rates. Rapid test devices based on immunochromatographic method supplied in the public sector hospitals are not reliable diagnostic tools for screening for dengue virus infection Health authorities need to review their strategy for supply of more reliable tools during epidemics in order to avoid false negative results

Role of decortication in cases of empyema thoracis in childhood - a case series

The aim was to analyze role of decortication in managing progressive empyema thoracis in children at our hospitals. The study included cases of empyema thoracis admitted at CH and ICH Lahore from May 1999 to November 2000. Total No. of patients included was fifty eight. There were 36 males and 22 females with a mean age of 4 years. Common presentation was fever, chest pain and cough. Mean duration of symptoms was 3 weeks Out of 58 patients 24 underwent decortication because fever and drainage of pus were not settling down. All the patients in decortication group were cured .34 patients responded well to medical treatment and tube thoracostomy commonest cause of empyema was pneumonia and tuberculosis. If the empyema is not setting down, early surgical intervention e.g. decortication should be instituted. Early referral of all empyema patients to thoracic units for definitive therapy is strongly recommended

Compensatory renal hypertrophy following unilateral nephrectomy in albino rats

This study was carried out on 72 albino rats [36 experimental and 36 control] following UNX and so we know the rate and extent of compensatory renal hypertrophy [CRH] of the remaining kidney. The mean absolute change in mass due to hypertrophy in the experimental kidney KW [compensatory] following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 0.384 +/- 0.003, 0.674 +/- 0.005, 0.768 +/- 0.004, 0.926 +/- 0.006, 0.940 +/- 0.005 and 0.932 +/- 0.007 gm respectively. The mean relative change in mass due to hypertrophy in the experimental kidney,%KW[compensatory following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 46.36 +/- 0.84, 77.66 +/- 1.16, 91.43 +/- 0.96, 105.71 +/- 0.77, 110.15 +/- 0.77 and 112.08 +/- 1.89 respectively. It was concluded that there was rapid compensatory increase in the renal mass of the experimental kidney within first 10 days, the mean relative compensatory increase in the renal mass of the experimental kidney was 46.36 +/- 0.84% than the control. From the 11th day to the 40th day there was a steady compensatory increase at a slower rate [59.35% in 30 days] until the mean relative compensatory increase in the renal mass of the experimental kidney had reached 105.71 +/- 0.77% of the control value

FNAC and core needle biopsy - A comparison in space occupying lesions of liver

A prospective analysis was conducted on 110 FNAC and results were compared with histologicul reports of patients with intrahepatic focal defects. Cytology permitted a diagnosis of the lesion in 98% cases. When aspirates with insufficient material were excluded [4], the diagnostic accuracy of FNA was 94%. Among the 106 patients who underwent both procedures, FNAC and CNB had the some diagnostic accuracy 94% i.e., sensitivity 96% and specificity 93% of FNAC. There were no complications during the execution of FNAC and CNB. FNAC is an effective and safe method in the diagnosis of focal hepatic lesions, with diagnostic accuracy almost similar to that of CNB. When the two techniques are combined, the accuracy of the diagnosis of malignancy of focal liver lesions increases