Gender disparity in patients undergoing percutaneous coronary intervention for acute coronary syndromes - does it still exist in contemporary practice?

<p><b>INTRODUCTION</b>Prior studies have demonstrated evidence of a disparity in the treatment and outcome of male compared to female patients undergoing percutaneous coronary intervention (PCI).</p><p><b>MATERIALS AND METHODS</b>From a dedicated database, we retrospectively analysed all consecutive patients with acute coronary syndrome (ACS) admitted to our institution for PCI in 2008. Baseline and procedural characteristics as well as complications were then evaluated for male patients (n = 331) as compared with female patients (n = 137).</p><p><b>RESULTS</b>Women were noted to be older at the time of presentation (66.1 +/- 10.0 vs 60.7 +/- 11.6 years, P <0.00001), the groups were otherwise well matched in terms of baseline characteristics. Female patients were treated with significantly smaller diameter stents (2.86 +/- 0.44 vs 2.96 +/- 0.50 mm, P = 0.04), though the proportion of drug-eluting stents was similar (53.7% vs 50.5%, P = 0.5). Female patients were significantly less likely to receive optimal medical therapy with lesser use of glycoprotein IIb/IIIa inhibitor (26.3% vs 55.3%, P <0.0000001), and beta-blockers (83.9% vs 90.9%, P = 0.04). At 30 days, there were no differences in the rate of major adverse cerebrovascular or cardiac events (2.9% vs 3.9%, P = 0.8), though females had a significantly higher rate of femoral access site pseudoaneurysm (4.4% vs 0.9%, P = 0.02).</p><p><b>CONCLUSIONS</b>There remains evidence for continued gender disparity in contemporary practice; despite evidence for efficacy in ACS patients, females received a notably lower use of glycoprotein IIb/IIIa inhibitors and beta-blockers. Women are also significantly more likely to develop femoral access site complications with pseudoaneurysm development; it is important therefore to optimise procedures for sheath removal in female patients or give strong consideration to the use of radial access site.</p>

Demographics of bronchogenic carcinoma patients and frequency of cell types

Bronchogenic carcinoma can present in many ways. The diagnosis of its different types is important because of its effect on prognosis and management. Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style have been noted to influence the occurrence of this disease. We conducted this study to document the frequency of various histological types of bronchogenic carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out in the Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan. Thirty consecutive histopathologically and /or cytologically confirmed cases of bronchogenic carcinoma were included in the study. These patients were admitted from January 2001 to May 2002. History was taken in detail with emphases on personal particulars, past and present occupation and living conditions. Specimens for histopathological study were collected by trans-thoracic needle aspiration or bronchoscopy. Four types of bronchogenic carcinoma were found; squamous cell carcinoma 60%, small cell carcinoma 20%, adenocarcinoma 13.33% and large cell carcinoma 6.66%. Among these, seventeen males and one female patient proved to have squamous cell carcinoma were in the age group between 46-89 years and the majority was from the urban areas. While cases with small cell carcinoma belonged to the age group between 56-74 years, being six in total and all were males; four from urban and two from rural areas. On the other hand patients with adenocarcinoma belonged to the age group 50-89 years, being four in total with three females and one male, with only one female from rural area. In addition we found two city dweller males with large cell carcinoma belonging to the age group of 50-79 years. Bronchogenic carcinoma in our setup is more frequent beyond the middle age. It is more common in males and urban dwellers. On histological examination, squamous cell carcinoma is the commonest variety followed by small cell carcinoma. Adenocarcinoma is more common in females

analysis of organophosphates poisoning cases treated at Bahawal Victoria Hospital, Bahawalpur in 2000-2003

To study the socio demographic pattern and mode of presentation of organophosphorous intoxication in Southern Punjab, Pakistan. The study was conducted in the department of Medicine, Bahawal Victoria Hospital, Bahawalpur from April 2000 to March 2003. Descriptive study. One hundred and forty three cases of organophosphorous compound poisoning, admitted through the emergency department, were evaluated in the study. In all the cases a previously established clinical and therapeutic protocol was applied and the outcome was recorded. Seventy-eight [54.54%] patients were male, Sixty five [45.45%] were female with the mean age of 25.04 years. One hundred and eleven [77.62%] cases were attempted suicides and 32 cases [22.37%] were due to accidental events. Mean age was 22.1 years in the 111 suicidal cases [77.62%] and 78 [70.27%] of them were less than 24 years. Among the suicide attempts, 63 [56.75%] were female patients. The attempted suicide proportion was 61.53% in men and 96.92% in women. Sixty six per cent of cases were illiterate and 47.55% of the patients were in the lower middle socioeconomic status. The patients' mean arrival time to the hospital after poisoning was 2.1 +/- 6.01 hours. Exposure routes were gastrointestinal in 111 patients [77.62%], respiratory in 8 patients [5.59%], dermal in 10 patients [6.99%] and both dermal and respiratory in 14 [9.79%]. Death of 10[6.99%] patients was related to either the ingestion of higher doses or delay in approaching the hospital for emergency management. Causes of poisoning [suicide vs non-suicide] and time interval between poisoning to arrival at hospital were major determinants of lethality. These findings call for a shift in emphasis in educating the masses towards first-aid care for intoxication

Safety and efficay of repaglinide compared with glibenclamide in the management of type 2 diabetic Pakistani patients

To evaluate the safety and efficacy [glycemic control] provided by repaglinide compared with glibenclamide in newly diagnosed type 2 [non-insulin dependant] diabetic patients. Diabetic clinic in medical outdoor of Mayo Hospital, Lahore. Randomized prospective study. This single center study of one year duration was carried out in 100 patients between 30-70 years, all diagnosed to have type 2 diabetes mellitus recently and were not on any treatment. They were randomly categorized into two groups, repaglinide [test] and glibenclamide [control] groups. The study consisted of an initial induction day followed by follow-up visits after every fortnight. Repaglinide was given pre-prandial up to three times a day and glibenclamide was administered once or twice daily. Dosage was adjusted after every visit according to blood glucose level. Fasting blood glucose level, two hours postprandial blood glucose, weight and blood pressure were recorded on every visit, while glycosylated hemoglobin [HbA1c] was estimated thrice during the study [at the beginning, at six months and at the end of one year]. Of the hundred randomized patients [50 in each groups], all showed a decrease in fasting blood glucose level, two hours postprandial blood glucose and HbA1c. Mean reduction in fasting blood glucose in repaglinide group was 64+53 mg/dl and those by glibenclamide group was 34.7+53 [P=0.007]. The mean reduction in two hours postprandial blood glucose was 119+66 in repaglinide group, while 87.6+74 was observed in glibenclamide group [P=0.02].HbA1c mean reduction in both repaglinide and glibenclamide groups was 1.1+0.3 and 0.7+0.5 respectively [P=0.00]. No statistically significant weight change was observed and no hypoglycemic events were recorded in both the groups. The results suggest that repaglinide and glibenclamide both were effective in lowering fasting glucose level, two hours postparandial blood glucose level and HbA1c if used regularly for one year. The effect of repaglinide in lowering HbA1c was impressive as compared to glibenclamide. Both the drugs were well tolerated and weight change was minimal in both the groups