ABSTRACT
Abstract: The resting ankle- brachial index [ABI] is a non-invasive method to assess the patency of lower extremity arterial system and to screen for the presence of peripheral occlusive arterial disease. Diagnostic efficacy of ABI to predict atherosclerosis is well documented and reduction in index [< 0.9] is indicative of generalized atherosclerosis. Present study was planned to evaluate the role of ABI as a possible non- invasive marker for coronary atherosclerosis
Objective: To evaluate the relationship between ABI and the extent of coronary artery disease estimated by angiography. Study design: Cross Sectional Study. Settings: Departments of Medicine and Cardiology, Mayo Hospital, Lahore. Duration: Six months, from July 2006 to January 2007
Subjects: One hundred and fifty patients referred for coronary angiography were selected. ABI was calculated on each patient before undergoing angiography. A single cardiologist using a computer based quantitative coronary angiography made angiography interpretations
Results: The mean age of patients was 51.23+/-10.23 years. There were 147 [98%] patients with normal ABI [>0.9], 2[1.3%] with mild reduction in ABI [0.7- 0.89], and 1[0.7%] with moderate ABI [0.4- 0.69]. In patients with normal ABI 34 [22.7%] patients had normal coronary angiogram, 43 [28.7%] patients had single vessel disease, 33 [22%] patients had two vessels disease, 35 [23.3%] patients had three vessels disease, and 2 [1.3%] patients had four vessel disease. In patients with mild ABI [0.7- 0.89] there was 1[0.7%] patient who had single vessel disease, and 1 [0.7%] patient with four vessel disease. In the moderate ABI category [0.4 - 0.69] there was 1 [0.7%] patient with two vessel disease
Conclusion: Ninety eight percent of the studied population with otherwise symptomatic coronary artery disease had normal ABI. On the other hand 77% of patients with normal ABI had abnormalities on coronary angiogram. ABI lacks the sensitivity to screen atheromatous CAD and cannot be recommended as such
ABSTRACT
Background: Acute myocardial infarction [AMI] is the most common cause of morbidity and mortality. In order to reduce myocardial infarct size, a new technique i.e. ischemic pre-conditioning has evolved. The brief periods of ischemia followed by reperfusion appear to pre-condition the heart and make it more resistant to a subsequent longer period of ischemia. Pre-conditioning is defined as "a rapid, adaptive response to a brief ischemic insult, which slows the rate of cell death during a subsequent, prolonged period of ischemia"
Material and Methods: A comparative study was conducted to identify the patients of AMI with or without pre-infarction angina, to find out the differences in their in-hospital course and to assess the prognostic value of pre-infarction angina in first episode of AMI during hospital stay
Results: Twenty-five patients with [Group A] and 25 patients without [Group B] pre-infarction angina were compared for their in-hospital course. Mean age +/- SD in Group A was 55 +/- 7 years and in Group B 54 +/- 8 years. There were 18 [72%] males and 7 [28%] females in Group A, and 17 [68%] males and 8 [32%] females in Group B. As far as the baseline risk factors in two groups were concerned, 5 vs 7 patients had diabetes mellitus, 7 vs 8 had hypertension, 16 [64%] vs 13 [52%] were smoker, 3 vs 4 had obesity, 4 vs 5 had family history of IHD and 5 vs 6 had hyperlipidemia in Group A and Group B respectively. Regarding the intake of anti-anginal medication like calcium channel blockers, beta-blockers and nitrates in the two groups, there were more patients in Group A as compared to B who were taking them [p<0.05]. Similarly there were also 10 [40%] vs 2 patients in Group A and B respectively who were taking aspirin [p<0.05]. In-hospital complications like cardiogenic shock, CCF, LVF, RVF, recurrent ischemic pain, infarct extension and rhythm abnormalities were more in Group B as compared to Group A [p<0.05]. When echocardiography was performed, the data showed that the ejection fraction percentage [mean +/- SD] in Group A was 55% +/- 7.8 versus 44% +/- 7.9 in Group B [p<0.001]. There were 3 in Group A vs 13 patients in Group B who had developed aneurysm [p<0.05], 2 in Group A vs 1 in Group B who had papillary muscle rupture, 1 in Group A vs 5 in Group B who developed VSD and 4 in Group A vs 10 in Group B who had clot in left ventricle. While in-hospital mortality between two groups was observed, there was only 1 in-hospital death in Group A vs 6 [24%] in Group B [p<0.05]
Conclusion: The presence of pre-infarction angina had a favorable effect on in-hospital course after AMI i.e. a lower incidence of in-hospital mortality, a lower incidence of in-hospital complications, development of significantly smaller infarct size with a higher ejection fraction and a lower incidence of aneurysmal formation
ABSTRACT
Background: Acute myocardial infarction [AMI] is the most common cause of morbidity and mortality and to reduce myocardial infarct size a new technique i.e. ischemic pre-conditioning has evolved. The brief periods of ischemia followed by re-perfusion appear to pre-condition the heart and make it more resistant to a subsequent longer period of ischemia. Pre-conditioning is defined as "a rapid, adaptive response to a brief ischemic insult, which slows the rate of cell death during a subsequent, prolonged period of ischemia"
Material and Methods: A comparative study was conducted to identify the patients of AMI with or without pre-infarction angina, to find out the differences in their in-hospital course and to assess the prognostic value of pre-infarction angina in first episode of AMI during hospital stay
Results: Twenty-five patients with [Group A] and 25 patients without [Group B] pre-infarction angina were compared for their in-hospital course. Mean age+/- SD in Group A was 55 +/- 7 years and in Group B 54 +/- 8 years. There were 18 [72%] males and 7 [28%] females in Group A, and 17 [68%] males and 8 [32%] females in Group B. As far as the baseline risk factors in two groups were concerned, 5 vs 7 patients had diabetes mellitus, 7 vs 8 had hypertension, 16 [64%] vs 13 [52%] were smokers, 3 vs 4 had obesity, 4 vs 5 had family history of IHD and 5 vs 6 had hyperlipidemia in Group A and Group B respectively. Regarding the intake of anti-anginal medication like calcium channel blockers, beta-blockers and nitrates in the two groups, there were more patients in Groups A as compared to B who were taking them [p<0.05]. Similarly there were 10 [40%] vs 2 [8%] patients in Groups A and B respectively who were taking aspirin [p<0.05]. In-hospital complications like cardiogenic shock, CCF, LVF, RVF, recurrent ischemic pain, infarct extension and rhythm abnormalities were more in Group B as compared to Group A [p<0.05]
Conclusion: The presence of pre-infarction angina had a favorable effect on in-hospital course after AMI i.e. a lower incidence of in-hospital mortality, a lower incidence of in-hospital complications, development of significantly smaller infarct size
ABSTRACT
To study the site and culture positivity of extra pulmonary specimens received from year 2000 to 2005. The work was done at the PMRC TB Research center, Mayo hospital Lahore. The centre receives specimens from all the leading hospitals of Lahore. A total of 2476 extra pulmonary specimens subjected for TB culture by standard proportion method and were analyzed. Majority [84.37%] of specimens received were rom pulmonary site while 15.6% were from extra pulmonary site. Overall culture positivity yield was 19.5%. Of the samples received majority [24.3%] were pleural fluid, followed by in descending order of frequency were 16% bronchial washing, 15.5% from genitourinary tract, 14.1% lymph nodes, 2.6% gastric aspirate, 2.5% endometrial,1.5% bone and 1.2% [CSF]. The culture positivity of these specimens were 24.3% for pleural, 16% bronchial, 24.87% genitourinary, 34.18% lymph nodes, 6% gastric aspirate, 4.5% endometrial,13.5% bone and 3.2% CSF. Extra pulmonary tuberculosis remains an important infectious disease, with commonest form being tuberculous lymphadenitis and genital tuberculosis. Physicians and health care providers should keep the diagnosis of tuberculosis high on priority and make efforts in prompt and efficient diagnosis and treatment
ABSTRACT
Accidental, suicidal or homicidal ingestion of various substances is quite common in patients who often present as [Coma of unknown origin]. The pattern of drug used in our society differs from the West. The knowledge of more popular substances in local community can be helpful in early diagnosis and management of these patients. In an ICU setup we studied the etiological distribution of coma resulting from poisoning and its outcome. Poisoning was the most frequently encountered cause [70 cases] comprising 19.18% of all cases of coma. There were a total of 218 patients with metabolic causes of coma, and out of these poisonings contributed the largest chunk [making up 32.11% of metabolic comas]. Taken as a whole, poisoning has a relatively favourable outcome [25.71% mortality]. The leading cause of poisoning encountered in our study was benzodiazepine poisoning i.e. 20 patients [28.57%] and all recovered. The second largest group was wheat preservative poisoning [15 patients, 21.42%], 07 patients died, with a mortality of 46.67%. Seven patients with narcotic overdose were all discharged, while one out of 04 patients of organophosphate poisoning [5.72%] and 05 out of 08 copper sulphate poisoning patients [11.43%] could not survive. In 07 patients, the agent could not be identified. Most poisonings encountered in our study were nonaccidental, and many were [27 patients, 38.57%] those patients who were victims of robbers. The favourite agent of these people was benzodiazepines [15 cases], Dhatura [4 patients], narcotic drugs [1 patient] and an unknown agent in 07 cases. Suicidal poisoning was the largest group with 31 cases [44.28%]. We conclude that poisoning is the single largest cause of coma at our hospital emphasizes the need for poison information centres in our country, on the pattern prevalent in the West
ABSTRACT
A comparative study of 800 sputum cases was carried out to establish the efficiency of direct and concentration method for the detection of AFB. A total of 22.1% sputum specimens were found AFB positive by concentration method and 14.1% by direct method. Positive smears were missed by both methods, but more by direct method. Percentage of agreement between two methods were 89.6% and dis-agreement was 10.4%. It is concluded that positive yield is more by concentration method