Frequency of diabetes in non St elevation myocardial infarction

Objective: To determine the frequency of diabetes mellitus in non ST segment elevation myocardial infarction

Study Design: Cross-sectional

Place and Duration of Study: The study was carried out at the Armed Forces Institute of Cardiology [AFIC] Rawalpindi, from Apr 2010 to Oct 2010

Material and Methods: In this study three hundred fifty two patients with non ST elevation myocardial infarction [NSTEMI] who fulfilled the inclusion criteria were studied while they were admitted to the hospital. They were divided into diabetic and non diabetic groups. Frequency of age, gender, rising levels of cardiac biochemical markers, plasma glucose and HbA1c were seen in both diabetic and non diabetic patients. Results were obtained by using chi-square method and independent t-test

Results: Out of 352 patients of NSTEMI 193 were diabetics. The study population was categorized in three groups according to age as; 30-45, 46-60, and 61-75 years respectively. It was found that 46-60 years group was most frequently affected with frequency of 46.1%, p<0.001 with male predominance as 67.9% and females as 32.1%. Cardiac biochemical markers were raised with mean for CK 528.51 U/L SD +/- 275.82 and CK MB 79.39 U/L SD +/- 32.5, p<0.001 respectively. Raised fasting plasma glucose was found in 189 patients mean 8.74 mmol/L SD +/- 1.52, p<0.001 and elevated HbA1c seen in 187 patients mean 7.94% SD +/- 0.83, p<0.001

Conclusion: Despite modern therapies for unstable angina [UA]/NSTEMI diabetes is an independent cardiovascular risk factor, therefore we need aggressive strategies to manage the high risk group of patients

Synthesis, characterization and antinociceptive activities of Novel 2-[2,4-dichlorophenyl]-4H-chromen-4-one

A novel flavone derivative has been synthesized in good yield from ketone and aldehyde. The structure has been established by different spectroscopic techniques like H NMR, C NMR, IR and elemental analysis. The compound was then screened for its acute toxicity and antinociceptive activity studies on animal model. The novel compound was safe upto a maximum dose of 500mg/kg body weight oral dose in mice and showed 65.92 and 82.18% pheriperal analgesic activity at 15 and 30mg/kg body weight doses. Central antinociceptive activity of the compound was 53.13 and 64.44% at 15 and 30mg/kg body weight respectively

Micromechanical intervention in sandwich restoration

Objective: To evaluate the sealing ability of two different types of Glass Ionomer Cements [GICs] used for sandwich restorations and assess the effect of acid etching of GIC on microleakage at GIC-resin composite interface

Study Design: Experimental study

Place and Duration of Study: Department of Operative, DIEKIOHS [DUHS] and NED University, Karachi, from February to June 2011

Methodology: Eighty cavities were prepared on the proximal surfaces of 40 permanent human premolars [2 cavities per tooth], assigned to 4 groups [n=20] and restored as follows: Group CIE - Conventional GIC [CI] was applied onto the axial and cervical cavity walls, allowed setting for 5 minutes and acid etched [E] along the cavity margins with 37% phosphoric acid for 15 seconds, washed for 30 seconds and dried; the adhesive system was applied and light cured for 10 seconds, completing the restoration with composite resin light cured for 40 seconds; Group CIN - same as Group CIE, except for acid etching of the CI surface; Group RME - same as CIE, but using a resin modified GIC [RMGIC]; Group RMN - same as Group RME, except for acid etching of the RMGIC surface. Specimens were soaked in 1% methylene blue dye solution at 37[degree]C for 24 hours, rinsed under running water for 15 minutes, bisected mesiodistally and dye penetration was measured following the ISO/TS 11405-2003 standard. Kruskal Wallis and post Hoc tests significant differences in the microleakage among all the four groups

Results: There was a significant difference between the two groups of GICs [RMGIC and CI, p=0.001]. There was no significant difference in between the two sub-groups that is between CIN and CIE [p=0.656], and between Groups RME and RMN [p=0.995]

Conclusion: Phosphoric acid etching of GIC, prior to the placement of composite resin, does not improve the sealing ability of sandwich restorations. RMGIC was more effective in preventing dye penetration at the GIC-resin composite dentine interfaces than CI

Pictorial review of intrathoracic manifestations of progressive systemic sclerosis

Intra-thoracic manifestations of progressive systemic sclerosis [PSS] are not well known particularly the imaging features, which forms the basis of accurate and timely diagnosis. The aim of this study is to familiarize the physicians and radiologists with these features. The diagnosis can remain elusive because of the non-specific nature of symptoms which mimic many common conditions. Thus, the diagnosis of PSS can be missed leading to continuous morbidity if the correct imaging is not pursued. The authors examined the records of rheumatology patient referrals of over a 5 year period. A hundred and seventy patients with systemic sclerosis and mixed connective tissue disorders were chosen for detailed study of the imaging available, which form the basis of this review. The images included conventional chest radiographs, digital radiographs computed radiography [CT] and high resolution computed tomography [HRCT]. Where applicable computed pulmonary angiography [CTPA] and radionuclide scans were also interrogated

Atypical radiological manifestations of thoracic sarcoidosis: a review and pictorial essay

Thoracic sarcoidosis is a common disease, with well-described and recognizable radiographic features. Nevertheless, most physicians are not familiar with the rare atypical often-confusing manifestations of thoracic sarcoid. Although these findings have been previously reviewed, but more recent advances in imaging and laboratory science, need to be incorporated. We present a review of literature and illustrate the review with unpublished data, intended to provide a more recent single comprehensive reference to assist with the diagnosis when atypical radiographic findings of thoracic sarcoidosis are encountered. Thoracic involvement accounts for most of morbidity and mortality associated with sarcoidosis. An accurate timely identification is required to minimize morbidity and mortality. It is essential to recognize atypical imaging findings and relate these to clinical manifestations and histology

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

Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture

To determine the outcome of intramedullary interlocking surgical implant generation network [SIGN] nail in diaphyseal tibial fractures in terms of union and failure of implant [breakage of nail or interlocking screws]. Case series. Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Forty one [88%] patients had united fracture within 6 months, 5 [10%] patients had delayed union while 4 [8%] patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function

3-[[2-chloroquinolin-3-yl]methyl]quinazolin-4[3H]-ones as potential larvicidal agents

The larvicidal effect of series of 3-[[2-chloroquinolin-3-yl]methyl]quinazolin-4[3H]-ones, 5a-e, against Chironomus tentans Fabricius has been investigated. The results showed that tested compounds demonstrated strong larvicidal activity, and caused high percentage of mortality after 24 h at the doses of 40-100 microg/ml, especially in the case of 3-[[2-chloro-8-methyquinolin-3-yl]methyl]quinazolin-4[3H]-one, 5b, that act as a promising larvicidal agent

Seasonal variations of vivax and falciparum malaria: an observation at a tertiary care hospital

Malaria is a major public health problem in the malaria endemic zones of the world. Various factors influence the prevalence of malaria. This study was conducted to determine the variation in frequency of Plasmodium vivax and Plasmodium falciparum malaria in different seasons of the year in Khyber Teaching Hospital, Peshawar. A total of 411 patients were included in the study. All these febrile patients were reported to have trophozoites of either Plasmodium vivax or Plasmodium falciparum malaria on Giemsa stained thick and thin smears. The frequency of vivax and falciparum malaria was worked out and statistically analysed for different season of the year. The study was carried out from 2[nd] Jan 2004 till 31[st] December 2008. Out of total 411 diagnosed malaria cases, total 134 [32.60%] presented in the autumn season [vivax=33.58%, and falciparum=66.42%], 37 [9%] in winter season [vivax=32.4%, and falciparum=67.6%], 76 [18.49%] in spring season [vivax=93.4% and falciparum 6.6%] and 164 [39.90%] in summer season [vivax=89.6, and falciparum=10.4%]. The malaria showed a highly significant pattern in different seasons of the year [p=0.00] in a way that Plasmodium falciparum malaria reached its highest frequency in autumn and winter seasons while Plasmodium vivax malaria reached its peak frequency in spring and summer seasons. There was highly significant seasonal variation of vivax and falciparum malaria. There is arrival of Plasmodium falciparum in autumn which peaks in winter followed by arrival of Plasmodium vivax in spring till the end of summer.

Guidelines for the role of FDG-PET/CT in lung cancer management

Fluoro-2-deoxy-D-glucose [FDG]-positron emission tomography [PET] and PET/computed tomography [FDG-PET/CT] is regarded as a standard of care in the management of non-small-cell lung carcinoma [NSCLC] and is a useful adjunct in the characterization of indeterminate solitary lung nodules [SLN], and pre-treatment staging of NSCLC, notably mediastinal nodal staging and detection of remote metastases. FDG-PET/CT has the ability to assess locoregional lymph node spread more precisely than CT, to detect metastatic lesions that would have been missed on conventional imaging or are located in difficult areas, and to help in the differentiation of lesions that are equivocal after conventional imaging. Increasingly FDG-PET/CT is employed in radiotherapy planning, prediction of prognosis in terms of tumor response to neo-adjuvant, radiation and chemotherapy treatment. Evidence is accumulating of usefulness of PET/CT in small cell lung cancer.

Initial experience of fractional flow reserve in 30 patients with moderate coronary artery lesions at armed forces institute of cardiology

To evaluate our initial experience of Fractional Flow Reserve [FFR] for decision making in coronary revascularization in moderate lesions. A descriptive study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases from August 2009 to August 2010. A total of 30 consecutive patients who underwent FFR at AFIC/NIHD from August 2009 to August 2010. These were the cases in which decision regarding PCI was difficult on visual assessment alone as experienced operators differed in their opinion. A 0.014" FFR wire was used and pressure gradients across the lesions were noted A total of 30 patients with 44 moderate lesions on coronary angiography were evaluated in our initial experience. Amongst these, 27 [61.4%] LAD lesions were studied [20 lesions had an FFR > 0.80 while 7 [15.9%] had an FFR 0.80 or less]. Seven [15.9%] lesions of LCX were evaluated [5 had an FFR > 0.80 and 2 had 0.80 or less]. Seven [15.9%] lesions were of RCA [4 had an FFR >0.80, 3 had 0.80 or less]. One case of LMS lesion was found to be non-critical. Two [4.5%] vein graft lesions were included of which one was found to be angiographically critical, [FFR 0.72]. Out of the total 44 lesions studied 14 [31.82%] lesions were critical with an FFR 0.80 or less, which were stented. Thus 30 stents were saved. This reduced the cost, as well as the un-necessary hazards and risks associated with PCI and the issue of difference in opinion was put to rest. We thus conclude that FFR is a very important tool in guiding the interventionist for planning PCI in moderate lesions

Accelerated 2 hour regimen of streptokinase for pulmonary embolism

To assess the safety and efficacy of accelerated 2 hour regimen of streptokinase [SK] in acute massive pulmonary embolism. The primary end point of study was immediate hemodynamic improvement and safe discharge from the hospital. Quasi-experimental study. Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD], March 2010 to Sept 2010. Twenty five patients referred to AFIC-NIHD Rawalpindi with recent symptoms [<5 days] suggestive of acute massive pulmonary embolism were considered for entry into the study. On confirmation of acute massive pulmonary embolism, they were thrombolysed with 1.5 million units of streptokinase over two hours followed by unfractionated heparin infusion intravenously at a dose of 1,000 IU/h. They were observed for immediate hemodynamic and clinical improvement and followed up till discharge from the hospital. Safety of Streptokinase was assessed by observing for major bleed [requiring blood transfusion]/fatal bleeding/intracranial haemorrhage confirmed on CT scan or anaphylaxis secondary to accelerated regimen. Mean age of the patients was 55 years [range 24 to 85 years] and 60% [15] were males and 40% [10] were females. CT pulmonary angiogram in all 25 cases confirmed massive pulmonary embolism. Streptokinase 1.5 million units were given to all 25 patients in infusion form over a period of 2 hours followed by unfractionated heparin infusion at 1000 IU/hour. No bleeding complication was observed in any of these cases. Eighteen [72%] patients showed immediate hemodynamic and clinical improvement but 28% [7] expired on the same day. Average hospital stay of the patients was 6 days. Mortality of patients with massive pulmonary embolism is high even after thrombolysis. Accelerated 2 hour regimen of streptokinase can be routinely used in patients with massive pulmonary embolism without obviously compromising efficacy or safety but further randomized controlled trials to compare the two SK regimens are required to better predict the efficacy and outcome of the two regimens

Double stick approach for chronic total occlusion of coronary arteries

To describe experience of double stick access to arterial system with contralateral injection of the opposite artery to visualize the distal cross filling vessel when a totally occluded vessel has no antegrade flow. A Quasi-experimental study. Armed Forces Institute of Cardiology / National Institute of Heart Disease Rawalpindi from Jan 2009 to Aug 2010. Retrospective analysis of 20 coronary angiograms performed for CTO at the cardiac catheterization laboratory of AFIC/NIHD were included in the study. Double stick access was gained through femoral artery in the groin 1cm apart. Twenty patients with chronic total occlusions underwent PCI with contralateral injection technique. Out of them 70% were male and 30% were female. The mean age was 53.65 years. Multivessel coronary artery disease was seen in 45% of patients. Left anterior descending artery lesion was present in 60%, while right coronary artery lesion in 40%. There was no LCX lesion. Single wire was used in 55% of cases while 40% required a second wire which was stiffer and heavier than the previous one. Pilot 50 was successful in 70% and 10% required cross it 200. Predilation was done in all cases using multiple balloons. DES was used in 93.75% cases of CTO. The procedure was successful in 80% while in 20% it was unsuccessful. There was no death during the procedure, nor any other periprocedural or access site complications. We conclude that double stick approach with contralateral injection is a safe and effective way to cross total occlusion

Pulmonary vascular complications of chronic liver disease: pathophysiology, imaging, and treatment

To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease

calcified lung nodule: what does it mean?

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules [PN] to aid diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, harmartome, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging

Imaging lung manifestations of HIV/AIDS

Advances in our understanding of human immunodeficiency virus [HIV] infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome [AIDS] remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis

Angina pectoris; role of trimetazidine

To assess the clinical efficacy, cost effectiveness and side effect profile of trimetazidine in the management of stable angina pectoris. An open label, uncontrolled study was conducted in 200 patients with stable angina in armed forces institute of cardiology, Rawalpindi Pakistan. Patients were treated for 4 weeks with modified release trimetazidine tablet [35 mg] twice daily in addition to their conventional therapy. As compared to base line trimetazidine significantly reduced the number of angina episodes per week from 10 to 3 [p<0.005], improved exercise duration time on standard exercise tolerance test [ETT] [410 vs. 370 sec; p<0.01], time to onset of typical angina [380 vs. 290 sec; p<0.05], time to 1mm or more ST segment depression [340 vs. 290 sec; p<0.01]. There was no drop out of patients due to side effects or non compliance. These results indicate that trimetazidine is effective and well tolerated when used in combination with existing antianginal therapy in patients with angina pectoris

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1[st] June 2007 to 31[st] May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumo'peritonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique

Carcinoma of prostate in clinically benign enlarged gland

Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate [TURP] and enucleated prostatic tissues were sent to histopathology. Eighty-five percent patients had PSA level up to 10 [eta]g/ml. PSA level of 15 [15%] patients were above 10n gm/ml out of which 13 [13%] patients were having PSA in range of 11-12 [eta]g/ml and two [2%] had PSA level between 20-25 [eta]g/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically