Association of interleukin-4 and IgE levels with LDL oxidation in atherosclerosis

Atherosclerosis is an inflammatory and multifactorial disease, with a high prevalence rate in Pakistan. To find a relation between serum IL-4 and IgE levels with oxidized LDL in atherosclerosis. In this observational, cross sectional study 99 male patients, between forty and sixty years of age, with a history of ischemic heart disease [IHD] and established atherosclerotic plaques and angiography were recruited. The study was completed within three years [Jan 2007 to Jan 2009]. One hundred and on age and gender matched healthy subjects with no known history of IHD were also recruited. All the study participants were non-diabetics. Serum IL-4, IgE and oxidized LDL [ox-LDL] levels were measured by quantitative ELISA technique. Serum IL-4 levels were generally undetectable or very low, but were higher in the patient group compared to the control subjects. Similarly, oxidized LDL and serum IgE levels were also increased in the patient group compared to the control, but the differences were not statistically significant. Our study could not detect any relationship between IL-4 and IgE levels with LDL oxidation in atherosclerosis

Cardiac mortality trends in the emergency department of a tertiary care cardiac centre

Limited information is available on trends in mortality from cardiovascular diseases in Pakistan. The objective of this study was to examine the various cardiac causes of early deaths and asses the treatment strategies in emergency department of a tertiary care cardiac centre. We conducted a prospective observational study of early deaths over an eight months period. Data of emergency admissions from June 2006 to January 2007 was analyzed. There were 357 early deaths; median age 60 years, and median survival time 1.55 hours. There were 6221 emergency admissions, with 4.6% of men and 9.4% of women having early mortality in emergency department. Only 14 were non-cardiac deaths and 314 [88%] were cardiac related deaths. Valvular heart disease comprised 6% of cardiac deaths. There were 373 cases received dead in emergency and assumed to be sudden cardiac deaths. Cardiogenic shock [CS] was the leading cause [265, 74%] of cardiac deaths and ST elevation myocardial infarction [STEMI] comprised nearly half of those deaths [130, 49%]. Only 39% [51/130] of STEMI patients were thrombolysed and there was only marginal difference in the survival time of patients with or without lytic therapy. ST depression was seen in 17% of CS patients. Ventricular fibrillation and ventricular tachycardia constituted only 20% of cardiac deaths. Complete heart block [CHB] was seen in a quarter of CS patients and emergency transvenous pacing was successful in 67% [42/63]. The survival time was shorter in patients with failure to pace acutely; men [0.50 vs. 1.30 hrs], women [1.00 vs. 2.15 hrs]. A very large number of early deaths were cardiac and cardiogenic shock was the major cause. Only half of cardiogenic shock patients had diagnostic ECG changes of ST segment elevation and less than half of these were thrombolysed