Acute myocardial infarction: evidence for a sex-age interaction

Women with acute myocardial infarction have higher in-hospital mortality than men mainly due to greater age on presentation. To evaluate the age specific sex difference in in-hospital mortality of acute myocardial infarction. Descriptive study. Coronary Care Unit and cardiology ward of Nishtar Hospital Multan from 15th of September 2002 till 30th of April 2003. Four hundred and fifty patients of acute myocardial infarction who fulfilled our inclusion criteria were studied while they were admitted to the hospital. Patients were divided into four groups according to age and sex i.e. Group I [male <45 years], Group II [male >= 45 years], Group III [female <45 years] and Group IV [female >45 years]. In-hospital mortality was compared between different age groups by Chi-square test. The total in-hospital mortality was 76[16.9%]. In Group III none of the patients expired. In Group I in-hospital mortality was 6[7.1%] patients followed by Group II 50[18.3%] patients and Group IV 20[23.3%] patients p<0.019. In-hospital mortality was greater in Group IV than in any other group. Group IV patients were more frequently diabetic and hypertensive than patients in any other group. Group IV patients presented late to the hospital. There was no significant difference in site of myocardial infarction in different groups. Higher Killip class was observed in Group II and IV p<0.05. Streptokinase injection was given less frequently in Group IV than in any other group p <0.012. Only 34[39.5%] patients in Group IV had no complication during hospital stay while more patients in other groups had uneventful hospital stay. Female sex is associated with higher in-hospital mortality in older age group as compared to the male patients of same age group. p<0.001

In hospital outcome of acute myocardial infarction [ST segment elevation type] in diabetics and non diabetics

To evaluate the in-hospital mortality and complications of acute myocardial infarction in diabetic and nondiabetic patients. Descriptive study. Coronary Care Unit and Cardiology Ward of Nishtar Hospital, Multan from 1st October 2002 till 15th May 2003. Four hundred and forty-eight [448] consecutive patients who fulfilled the inclusion criteria were studied while they were admitted to the hospital. Patients were divided into two groups of diabetics and non-diabetics depending on the presence of diabetes mellitus. In-hospital mortality and complications were compared between the two groups by Chi-square method. Diabetic patients presented in more advanced Killip class as 32[26.7%] patients presented in Killip class II, 13[10.8%] patients presented in Killip class III and 6[5%] patients presented in Killip class IV. In the non-diabetic group, 68[20.7%], 24[7.3%] and 11[3.4%] patients presented in these Killip classes respectively [p<0.042]. The total in-hospital mortality was 17%. Mortality was 28[23.3%] in diabetics and 48[14.6%] in non-diabetics [p<0.03]. In-hospital mortality was almost double in diabetics as compared to non-diabetics. Mechanical complications were observed in 42[35%] patients in diabetic group and 80[24.4%] patients in non-diabetic group. Left ventricular failure was the most commonly observed mechanical complication. Electrical complications were observed in 84[70%] diabetic and 162[49.4%] non-diabetic patients [p<0.205]. In patients with acute myocardial infarction, presence of diabetes mellitus was associated with worse inhospital outcome leading to increased mortality and complications as compared to non-diabetic patients

Comparison of clinical severity of hepatitis B and hepatitis D virus infections

This prospective study was done to assess the clinical severity of acute delta hepatitis as compared to acute HBV infection. A total of 51 HGsAg positive patients of acute viral hepatitis were admitted from October 1991 to July 1992. Among 51 HBsAg positive patients, 38 patients were anti-HD negative and 13 were anti-HD positive. The frequency of complications, particularly hepatic encephalopathy and bleeding diathesis were significantly higher in HDV infection [p< .05]. Mortality was higher in HDV infection [38.4%] as compared to HBV infection [21%]. These results show that HDV infection is more severe than HBV infection

Serum adenosine deaminase [ADA] levels in acute fulminant hepatitis

Adenosine deaminase [ADA] activity is increased in tuberculous effusion, bacterial infections and liver disease particularly viral hepatitis. To observe the clinical significance of serum ADA, levels were studied in 42 HBsAg positive patients of acute fulminant hepatitis. ADA activity was significantly higher in the sera of patients of acute fulminant hepatitis than in control group, 31.32 +/- 18.27 vs 17.47 +/- 5.55 [p< .02]. ADA levels were higher [34.65 +/- 17.71] in grades IV and V encephalopathy than in grades II and III [24.71 +/- 11.07]. These findings suggest that ADA activity may be a new marker to study the severity of viral hepatitis