ABSTRACT
To evaluate the clinical characteristics and predictors of in-hospital mortality in patients with infective endocarditis at a tertiary care centre in Pakistan. The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January 1, 2002, to December 31, 2006, and comprised 84 consecutive patients hospitalised with infective endocarditis. All patients underwent verification of the diagnosis according to the Modified Duke criterion. Data was collected through a questionnaire and analysed using Student's t test, Chi square and Fisher's exact test. Univariate and multivariate logistic regression analysis was performed to assess predictors of mortality. Of the total, 53[63%] patients were male and 31[37%] female. The mean age of the patients was 42 +/- 17 years. Overall, 34[41%] patients had rheumatic valve disease as a predisposing condition. The most commonly affected valve was mitral in 43[51%] patients, and the most commonly isolated organism was methicillin-resistant staphylococcus aureus in 12[14.3%]. Overall in-hospital mortality was 27[32.1%], while 18[21%] patients developed congestive cardiac failure, 15[18%] developed arrhythmias, 16[19%] developed peripheral embolism and renal failure was present in 38[54%]. Besides, 17[20%] patients underwent surgical intervention. The final multivariate model that can be used to predict mortality in this study consisted of the presence of neurological complications [p <0.001] Odds Ratio 7.26, Confidence Interval [2.27-23.18], congestive cardiac heart failure [p <0.023] Odds Ratio 5.39, Confidence Interval [1.26-23.04], and arrhythmias [p <0.034] Odds Ratio 4.21, Confidence Interval [1.11-15.88]. Significant predictors of mortality in hospitalised patients with infective endocarditis in our study were the presence of neurological complications, congestive cardiac heart failure, and the presence of arrhythmias
Subject(s)
Humans , Male , Female , Tertiary Care Centers , Hospitalization , Cross-Sectional StudiesABSTRACT
To compare hemodynamic stability, efficacy and extubation time by using fentanyl / isoflurane versus nalbuphine / Isoflurane for coronary artery bypass surgery. Intervention experimental study. The Department of Anesthesiology and Surgical Intensive Care Unit, Dow Medical College and Civil Hospital, Karachi from April 2003 to April 2004. Sixty patients, both sexes, with ejection fraction not less than 40%, elective coronary artery bypass surgery were randomly allocated to receive either fentanyl / isoflurane or albuphine. Hemodynamic stability, drugs supplemented and extubation time were recorded. During intubation, skin incision and sternotomy systolic blood pressure was 126, 47 +/- 7.45, 127.97 +/- 7.58 and 127.03 +/- 7. 10 in group A fentanyl/isoflurane] and 167.60 +/- 14.41, 169.50 +/- 12.99 and 165.83 +/- 11.79 in group B nalbuphine/isoflurane] respectively with [p < 0.05] which is significant. To maintain hemodynamic stability in group B, supplementation with propofol and glyceryltrinitrate infusion was required. Extubation time in group A was 8.2113.87, and in group B was 6.15 +/- 3.41 with [p<0.05] which is significant. Fentanyl/isoflurane provides better hemodynamic stability than nalbuphine / isoflurane, but nalbuphme / isoflurane leads to earlier tracheal extubation than fentanyl / isoflurane group