Impact of Tibial Tubercle Osteotomy on Final Outcome in Revision Total Knee Arthroplasty:Our Experience and Technique in Pakistan

Background@#Due to extensive fibrosis during revision surgery, adequate exposure is essential and it can be achieved with several extensile approach options, such as tibial tubercle osteotomy. Information regarding surgical exposure during revision arthroplasty is limited in developing countries, such as Pakistan, due to the lack of adequate data collection and follow-up. Therefore, the purpose of this study was to evaluate the impact of tibial tubercle osteotomy on final outcome of revision total knee arthroplasty (TKA). @*Methods@#A total of 231 revision TKAs were performed between January 2008 and December 2017. Twenty-nine patients underwent tibial tubercle osteotomy for adequate exposure during revision surgery. Of these, 27 patients with complete follow-up were included in our study. Factors examined include age at the time of revision surgery, gender, comorbidities, arthroplasty site (right or left), body mass index (BMI), and primary indications for the tibial tubercle osteotomy during revision TKA. Functional outcome was measured by using Knee Society score (KSS) at 3 months and the final follow-up. All statistical analysis was done using SPSS version 20.0 with a p-value < 0.05 considered significant. @*Results@#Out of 27 patients, 6 patients (22.2%) were men and 21 patients (77.7%) were women. Right knee revision arthroplasty was performed in 15 patients (55.5%), left knee revision arthroplasty was performed in 12 patients (44.4%), and bilateral revision surgery was performed in only 1 patient (3.7%). The mean BMI was 29.2 kg/m 2 . We used a constrained condylar knee in 20 patients (74%), a rotating hinge knee in 5 patients (18.5%), and mobile bearing tray plus metaphyseal sleeves in 2 patients (7.4%).The KSS was 52.21 ± 4.05 preoperatively, and 79.42 ± 2.2 and 80.12 ± 1.33 at 3 months and 12 months, respectively. Radiological union was achieved in all patients at 3 months. Of 27 patients, only 1 patient (3.7%) had proximal migration of the osteotomy site at 6 months: the patient was asymptomatic and union was also achieved and, therefore, no surgical intervention was performed. @*Conclusions@#Tibial tubercle osteotomy during revision TKA can be a safe and reliable technique with superior outcomes and minimal complication rates.

Enzyme Functional Screening, Discovery and Engineering; Automation, Metagenomics and High-throughput Approaches

Concerned with the construction and design of novel biocatalysts, the enzyme engineering served to overcome the limitations of native enzymes, in order to create biocatalysts with tailored functions, to facilitate industrial applications. The enzymes, being recognized by screening and discovery workflows and further tailored by engineering platforms, are of immense potential as improved biocatalysts. Functional metagenomics is a powerful tool to identify novel enzymes followed by the construction of metagenome-based enzyme libraries. And the subsequent screening of these enzyme libraries is in turn facilitated by ultra-high-throughput-based, for example FACS or microfluidics, enzyme engineering technologies. Relies on the compartmentalization of reaction components, in order to detect and measure assay signal within the reaction compartments, the enzyme engineering platforms are designed which include cell-as-compartment platforms, droplet-based platforms andmicro-chamber-based platforms. The metagenomics approach and high-throughput screening by these three prime enzyme engineer platforms are the focus of this review.

Economic Burden of Periprosthetic Joint Infection Following Primary Total Knee Replacement in a Developing Country

Background@#Periprosthetic joint infection is one of the devastating complications after primary total knee arthroplasty, which increases the financial burden on patients and affects their quality of life as well. The financial burden of periprosthetic joint infection after joint replacement in developed countries is well known. There is a need to evaluate the economic burden in developing countries such as Pakistan. @*Methods@#This is a single-center, retrospective, case-control study conducted at the Department of Orthopedic Surgery, Liaquat National Hospital Karachi. Cases of primary total knee arthroplasty performed during this study were divided into 2 groups: uneventful primary total knee arthroplasty and periprosthetic joint infection treated with 2-stage revision. To calculate the final cost, we divided the total hospital cost into the hospital stay cost and operating room cost. @*Results@#During study period, 32 patients were diagnosed with periprosthetic joint infection. The total cost of revision surgery for periprosthetic joint infection considering 2 hospitalizations was 1,780,222 ± 313,686 Pakistani rupee (PKR). The total cost of uneventful arthroplasty was 390,172 ± 51,460 PKR. We observed significant difference with respect to economic details between the 2 groups. @*Conclusions@#Management of periprosthetic joint infection was 4.5 times more expensive than uneventful primary total knee arthroplasty. Measures should be undertaken to reduce the prevalence of periprosthetic joint infection, thereby reducing patients’ economic burden.

Non-invasive investigations in heroin users and non-users - a case control study

Objective: To compare heroin users with their age and gender matched relatives as regards non-invasive investigations like chest x-ray, electrocardiography [ECG] and 2D-echocardiography

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases, Rawalpindi, from Feb 2010 to Jul 2010

Material and Methods: Sixty one heroin users [cases] and their 100 non-substance abuser age and gender matched relatives [controls] were included through non-probability consecutive sampling. Chest x-ray [CXR], 12-lead electrocardiography [ECG] and two-dimensional echocardiography [2D-ECHO] were done of each one and the result was interpreted by respected consultants. The data were analyzed on SPSS version 15. Descriptive statistics of mean and standard deviation [SD] were described for quantitative variables while frequency and percentages for qualitative variables. Independent samples t-test compared quantitative variables while for qualitative variables chi-square test was used. Ninety five percent confidence intervals were calculated for all variables

Results: Statistically significant differences were noted between cases and controls as regards chest X-ray. A total of 10% cases had findings consistent with tuberculosis [TB] as compared to 3% controls [p=0.045]. There was however no cardiac abnormality in any study subject. Significant 12-lead ECG findings other than normal were noticed in 12 [19.7%] heroin users as compared to 10 [10%] controls [p=0.083]. In 12 lead ECG, the predominant finding was t wave inversion in leads AVF and III. According to 2D-echocardiography [2D-echo] reports, 15 [24.6%] heroin users [cases] and 17 [17%] controls had abnormal findings [p=0.242]. We report no vegetations on any cardiac valve

Conclusion: On radiological and cardiac parameters, heroin users are a different population as compared to the non-heroin users. The knowledge about variations on non-invasive investigations not only helps the healthcare workers to optimize treatment regarding rehabilitation but also facilitate diagnosis and treatment

Staff surgeon utilization pattern at combined military hospital Lahore

Objective: The study was conducted to highlight the sickness absenteeism pattern among the doctors and nurses of Combined Military Hospital, Lahore in the year 2014

Study Design: Cross sectional descriptive study

Place and Duration of Study: Combined Military Hospital [CMH] Lahore, 1 year from Jan 2014 to Dec 2014

Patients and Methods: Sick-in-Quarter [SIQ] reports of doctors and nurses were collected from the SIQ register of Combined Military Hospital, Lahore for the duration of 1 year. This data was categorized based on gender, rank, causes and duration of illness. Frequencies of Sickness absenteeism of the health care providers based on these categories were noted and analyzed through SPSS 20

Results: A total of 670 SIQ's were issued to health care professionals at CMH Lahore in 2014. Of these, 164 [24.5%] were issued to males and 506 [75.5%] were issued to females. Out of these 316 [47.2%] were doctors and 354 [52.8%] were nurses [p<0.001]. Maximum absenteeism was caused by respiratory diseases 176 [26.28%]. Monday showed the highest predominance of sick reports with 166 [24.8%]. Most SIQ's were issued in April 90 [13.4%] while a low number of SIQs were issued in February 20 [3%]

Conclusion: Sickness absenteeism was highly prevalent, and was higher among nurses than doctors. Respiratory diseases were the leading cause of sickness absenteeism among the doctors and nurses. Measures are needed to sustain the health of doctors and nurses to improve the overall patient care

Body composition analysis to determine gender specific physical fitness equations in a cohort of Saudi population

To determine an association between body composition analysis and physical fitness in the Saudi population and derive gender specific physical fitness equations. A total of 530 healthy Saudi adults aged 15-72 years [mean 37.16 +/- 14.12 years] were enrolled in this study. Body composition analysis was assessed by bioelectrical impedance analysis [BIA], with a commercially available body analyzer according to standard protocols. Different body composition parameters, such as age, height, BSA [body surface area], obesity degree, body mass index [BMI], body fat mass [BFM] and percent body fat [% BF] contents were significantly different in males and females except weight which was non-significant [p=0.649]. There was significant positive or negative correlation among different body composition parameters except weight with age in males and weight with age, height and BSA in females. In males, all the body composition characteristics contributed to the fitness score except BMI and BFM, while in females, the most significant effect was contributed by weight and BFM. Female body composition characteristics were strongly related to fitness score compared to males [R2 = 93.8% vs R2 = 78.5%]. Different body composition parameters like BFM and%BF played an important role in determining physical fitness of healthy male individuals instead of BMI, weight and BSA, while in females weight was the best predictor of physical fitness

Fresh and aged human lymphocyte metaphase slides are equally usable for GTG banding

The identification of chromosomes for routine cytogenetic analysis is based on quality of metaphases and good banding pattern

Fresh slides of human lymphocytes have been shown to produce good bands for the identification of chromosomes morphology. G-bands by Trypsin using Giemsa [GTG] banding of aged slides is generally considered hard to get desired band pattern of chromosomes persistently. The current study is focused on GTG banding of aged slides. A total of 340 subjects including 290 primary infertile and 50 fertile were selected. The blood samples were drawn aseptically for cytogenetic analysis

Lymphocytes were cultured and GTG banding was done on 1440 glass slides

Giemsa trypsin banding of aged slides were done by adjusting average trypsin time for each month according to the slide age and metaphase concentration

Correlation analyses showed a significant and positive correlation between slide ageing and trypsin pre-treatment time. The results of this study suggest that, the fresh and aged human lymphocyte metaphases are equally usable for GTG banding

Veterinary public health capacitybuilding in India: a grim reflection of the developing world’s underpreparedness to address zoonotic risks.

Veterinary public health (VPH) is ideally suited to promote convergence between human, animal and environmental sectors. Recent zoonotic and emerging infectious disease events have given rise to increasing calls for efforts to build global VPH capacities. However, even with their greater vulnerability to such events, including their economic and livelihood impacts, the response from lowand middle-income countries such as India has been suboptimal, thereby elevating global health risks. Addressing risks effectively at the human–animal interface in these countries will require a clear vision, consistent policies, strategic approach and sustained political commitment to reform and refine the current VPH capacitybuilding efforts. Only then can the discipline serve its goal of disease prevention, poverty alleviation and support for sustainable livelihoods through improvements in human and animal health.

Plasma tissue factor pathway inhibitor levels in angiographically defined coronary artery disease among Saudis

This study was aimed to determine plasma levels of total [TFPI-T] and free [TFPI-F] tissue factor pathway inhibitor, plasminogen activator inhibitor-1 [PAI-1], and tissue plasminogen activator [t-PA] in a cohort of Saudi patients with chronic stable angiographically defined coronary artery disease [CAD] and to determine its correlation with its severity. This cross sectional study was conducted in the department of physiology and department of cardiology, College of Medicine, and King Khalid University Hospital and King Saud University, Riyadh. Sixty known cases of CAD who had undergone angiography [35 males and 25 females] were selected. A control group included 39 [20 males and 19 females] healthy subjects. Fasting venous blood samples were analyzed for total [TFPI-T] and free [TFPI-F] tissue factor pathway inhibitor, plasminogen activator inhibitor-1 [PAI-1], and tissue plasminogen activator [t- PA]. Gensini scores and vessel scores were determined for assessing CAD severity. There were non-significant differences between age, body mass index [BMI] and Blood pressure between the controls and CAD subjects. A comparison of hemostatic markers between control and CAD patients showed significantly higher levels of Fibrinogen, PAI-1, TFPI-T and TFPI-F in CAD patients compared to control subjects. But there was no difference in plasma t-PA levels. TFPI-T had a significant positive correlation with severity of disease determined by Gensini Scores [r=0.344; p=0.006] and vessel scores [r=0.338; p=0.015]. Plasma levels of total tissue factor pathway inhibitor are significantly related with the presence and severity of CAD. Elevated levels of TFPI-T may be considered as useful diagnostic and prognostic markers in patients with CAD

Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease

Inflammation plays a key role in the pathogenesis of atherosclerosis. This study aimed to assess the relationship of serum inflammatory marker high sensitivity C Reactive protein [hsCRP], with the presence and severity of angiographically evaluated coronary artery disease [CAD]. This study was conducted at departments of physiology and cardiology, College of Medicine King Khalid University Hospital, King Saud University, Riyadh from August 2009 to March 2012. Eighty seven patients [57 males and 30 females] with angiographically evaluated CAD were studied. In all these patients CAD severity was assessed by Gensini scoring and vessel scoring. Control group consisted of 29 healthy subjects [17 males and 12 females]. Fasting venous blood samples were analyzed for lipid profile and high sensitivity C-reactive protein [hsCRP]. There were non-significant differences in age, weight and BMI among healthy subjects and CAD patients. Comparison of lipid profile between control and CAD patients showed that CAD patients had significantly higher TG and significantly lower HDL levels compared to control subjects. CAD patients presented with significantly higherhsCRP levels than controls. Linear regression analysis between hsCRP and CAD severity determined by Gensini scores showed a significant positive correlation [r=0.423, p=0.018]. Triple vessel disease patients had significantly higher hsCRP levels than one vessel and two vessel disease, while the difference was non significant between one and two vessel disease groups. These results suggest that patients with angiographically evaluated CAD have significantly higher levels of hsCRP levels compared to healthy individuals and are correlated with the presence and severity of CAD

Gender differences in lipid and glycemic control in Saudi patients with Type 2 diabetes mellitus

To assess and determine gender differences in frequency distribution of lipids and glycemic control in Saudi diabetic patients. This cross sectional study was conducted at Department of Physiology and Medicine, King Khalid University Hospital, King Saud University. A total of 1000 Saudi diabetic patients were randomly selected. Selection criteria included Saudi National of any sex aged more than 25 years. Fasting blood samples were analyzed for total cholesterol [TC], triglycerides [TG], low density lipoprotein [LDL]. high density lipoprotein [HDL], glucose and glycosylated hemoglobin [HbA1c]. Glycemic and lipid control was compared between male and female diabetics. Female diabetics were younger than males [p=0.04]. Female diabetic subjects had higher HbA1c than males [p=0.007]. Moreover, they tended to be more obese than males [p=0.0001]. The systolic blood pressure was also higher in females than males [p=0.045]. Lipid profile showed higher levels of TC, LDL and TG levels in females than males [p=0.0004. p=0.04 and p=0.007, respectively]. Prevalence of poor glycemic and lipid control was significantly more in females compared to male patients [p<0.001 and p<0.0001]. Saudi diabetic women had poor glycemic and lipid control as compared to male diabetics. Moreover, they tend to be more obese. These findings may be attributed to poor lifestyle

Assessment of adipokines relationships with cardiovascular risk markers in relation to body indices in normoglycemic males

To evaluate the phenotypic relationship between obesity indices, resistin, adiponectin and cardiovascular risk markers in normoglycemic healthy individuals. This cross-sectional study was conducted in the Department of Physiology College of Medicine, King Saud University, Riyadh. A total of 120 male subjects were selected for the study. All subjects underwent analysis of body composition, glucose, glycosylated hemoglobin [HbA1c], lipids, adiponectin, resistin, lipoprotein[a] and high sensitivity C reactive protein [hsCRP]. Body mass index [BMI] [r=0.326, p < 0.001], body fat mass [BFM] [r=0.377, p < 0.001], body fat percentage [BF%] [r=0.326, p < 0.001], waist hip ratio [WHR] [r=0.402, p < 0.001] and basal Insulin levels [r=0.217, p=0.018] were positively correlated with hsCRP. However, serum adiponectin levels [r=0.189, p=0.0391] were negatively correlated with hsCRP. Adiponectin levels were significantly lower in obese compared to non obese subjects [p=0.0551]. Keeping hsCRP as dependant variable we observed that WHR, BFM, BF%, BMI and adiponectin were significant predictors in univariate analysis. In multiple regression analysis WHR and adiponectin were independent predictors of hsCRP. Obese individuals have significantly higher levels of hsCRP levels and lower adiponectin levels than non obese subjects. Serum adiponectin levels and WHR are independant predictors of hsCRP levels in normoglycemic subjects

Body mass index and body fat percentage in assessment of obesity prevalence in saudi adults / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To assess the obesity prevalence in Saudi adults according to the international standards of body mass index (BMI) and body fat percentage (BF%).</p><p><b>METHODS</b>Five hundred and thirty healthy Saudi adults aged 18-72 years (mean 36.91 ± 15.22 years) were enrolled in this study. Their body composition was assessed by bioelectrical impendence analysis with a commercially available body composition analyzer. Standard BMI and BF% values were used to define obesity.</p><p><b>RESULTS</b>The prevalence of underweight, normal underweight, overweight and obesity in Saudi adults according to the BMI criteria (<18.5 kg/m², 18.5-24.4 kg/m², 25-29.9 kg/m², 30 kg/m² and above, respectively) was 2.5%, 30.2%, 33.6%, and 33.8%, respectively, whereas the obesity prevalence was 60% (n=318) in Saudi adults according to the BF% criteria (25% for males and 30% for females), which was significantly higher than that according to BMI criteria. However, it was 50.6% (n=268) when the BMI cutoff point was 27.5 kg/m², proposed by WHO for the Asian population. Kappa analysis showed that the obesity prevalence defined by BMI and BF% was higher in females than in males (k=0.530 vs k=0.418, P<0.0001). The sensitivity and specificity of BMI (30 kg/m² and 27.5 kg/m²) were 54.1% and 96.7% and 76.4% and 88.2%, respectively, for obesity. A lower BMI cutoff point (26.60 kg/m²) was proposed in this study, which gave the maximum sensitivity (84.3%) and specificity (85.4%), with a moderate kappa agreement (k=0.686). Moreover, the obesity prevalence at this cutoff point (56.4%) was significantly higher than that recommended by WHO.</p><p><b>CONCLUSION</b>The specificity of BMI for obesity is high and its sensitivity is low in both sexes. Its sensitivity can be increased by changing BMI cutoff to a lower value. The choice of BF% reference is of great influence for the assessment of obesity prevalence according to the BMI.</p>

Serum alkaline phosphatase screening for vitamin D deficiency states

To determine whether serum vitamin D levels are correlated with serum levels of alkaline phosphatase or not. Cross-sectional, observational study. Multi-centre study, conducted at Liaquat National Hospital and Medical College, National Medical Centre and Medicare Hospital, Karachi, from January to October 2009. Patients attending the Orthopaedic OPDs with complaints of pain in different body regions and serum vitamin D[3] levels of

Effect of drinking Arabian Qahwa on fractional exhaled nitric oxide levels in healthy nonsmoking Saudi adults

Fractional exhaled nitric oxide [FENO] is an emerging marker of inflammation in respiratory diseases. However, it is affected by a number of confounding factors. We aimed to study the effect of drinking Arabian Qahwa on FENO in non-smoking Saudi healthy adults. We recruited 12 nonsmoker healthy male adults aged 36.6 +/- 2.7 [21-50] years. All subjects were free from acute respiratory infections or allergies and had normal ventilatory functions and serum IgE levels. At 8 am in the morning, their baseline values of FENO were recorded. They had not taken tea or coffee in the morning and had taken similar light breakfast. They were given three cups of Arabian Qahwa to drink and then after every 30 minutes, serial levels of FENO were recorded. Average FENO levels at baseline were 28.73 +/- 9.33 [mean +/- SD] parts per billion [ppb]. The mean FENO levels started to decrease significantly after 30 minutes of drinking Arabian Qahwa [P=0.002]. This decrease in FENO level was further observed till two hours after Qahwa drinking and then it started to increase in next 90 minutes but still was significantly lower than the baseline [P=0.002]. The mean FENO level recorded after 4 hours was 27.22 +/- 10.22 [P=0.039]. FENO levels were significantly lowered by intake of Arabian Qahwa and this effect remains for about 4 hours. Therefore, history of recent Qahwa intake and abstinence is essential before performance of FENO and its interpretation

Níveis de PCR são maiores em pacientes com síndrome coronariana aguda e supradesnivelamento do segmento ST do que em pacientes sem supradesnivelamento do segmento ST / CRP levels are higher in patients with ST elevation than non-ST elevation acute coronary syndrome / Niveles de PCR son mayores en pacientes con síndrome coronario agudo y supradesnivel del segmento ST que en pacientes sin supradesnivel del segmento ST

FUNDAMENTO: Há grande interesse no uso de proteína C-reativa de alta sensibilidade (PCR-as) para avaliação de risco. Altos níveis de PCR-as no início da síndrome coronária aguda (SCA), antes da necrose tecidual, pode ser um marcador substituto para comorbidades cardiovasculares. OBJETIVO: Dessa forma, nosso objetivo foi estudar diferentes medidas de seguimento de níveis de PCR-as em pacientes com SCA e comparar as diferenças entre infarto do miocárdio sem elevação do segmento ST (NSTEMI) com pacientes apresentando elevação do segmento ST (STEMI). MÉTODOS: Este é um estudo observacional. Dos 89 pacientes recrutados, 60 apresentavam infarto agudo do miocárdio (IAM). Três níveis seriados de PCR-us, a nível basal na hospitalização antes de 12 horas após inicio dos sintomas, níveis de pico 36-48 horas após hospitalização e níveis de acompanhamento após 4 a 6 semanas foram analisados e comparados entre pacientes com (IAMCSST) e sem supradesnivelamento do segmento ST (IAMSSST). RESULTADOS: Pacientes com IAMCSST tinham IMC significantemente mais alta quando comparados com pacientes IAMSSST. Os níveis de creatino quinase fração MB (CK-MB) e aspartato aminotransferase (AST) eram significantemente mais altos em pacientes com IAMCSST quando comparados com pacientes com IAMSSST (p<0,05). Os níveis de PCR a nível basal e no acompanhamento não diferiram de forma significante entre os dois grupos (p=0,2152 e p=0,4686 respectivamente). Houve uma diferença significante nos níveis de pico de PCR entre os dois grupos. No grupo de pacientes com IAMCSST os níveis foram significantemente mais altos quando comparados aos pacientes com IAMSSST (p=0,0464). CONCLUSÃO: Pacientes com IAMCSST apresentam picos significantemente mais elevados de PCR quando comparados a pacientes IAMSSST. Esses dados sugerem que o processo inflamatório tem um papel independente na patogênese do infarto do miocárdio. Dessa forma, os níveis de PCR podem ajudar na estratificação de risco após o infarto do miocárdio.

BACKGROUND: There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE: Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS: This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS: STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p= 0.2152, p=0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p=0.0464). CONCLUSION: STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

FUNDAMENTO: Hay gran interés en el uso de proteína C-reactiva de alta sensibilidad (PCR-as) para evaluación de riesgo. Altos niveles de PCR-as en el comienzo del síndrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevación del segmento ST (NSTEMI) con pacientes presentando elevación del segmento ST (STEMI). MÉTODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalización antes de 12 horas después del inicio de los síntomas, niveles de pico 36-48 horas después de hospitalización y niveles de control después de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenían IMC significativamente más alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fracción MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente más altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente más altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSIÓN: Pacientes con IAMCSST presentan picos significativamente más elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogénesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificación de riesgo después del infarto de miocardio.

Experience of Fontan surgery at Armed Forces Institute of Cardiology /National Institute of Heart Diseases [AFIC-NIHD]

To assess the overall outcome and success of Fontan surgery at our institute. AFIC-NIHD Rawalpindi. 01 September 2005 to 31 March 2010. For this retrospective study, institute's cardiac surgery database was used. Patients of single ventricle physiology, who had normal Left Ventricular End-diastolic Pressure and pulmonary artery pressures, were included. Data was analyzed using SPSS version 16. A total of 34 Fontan procedures were done. The mean age at operation was 4.83 +/- 1.37 years. There were 22 [64.7%] males and 12 [35.3%] females. Twenty five [73.5%] had a staged Fontan [successful previous Bidirectional Glenn's shunt, BDG]. Nine [26.5%] were primary Fontan procedures [no successful previous Bidirectional Glenn's shunt, BDG]. Thirty two [94.8%] were Extra Cardiac Conduit Fontan [ECCF] and 2[5.8%] were Intra Cardiac Fontan. Mean Bypass time was 132.65 +/- 48.44 minutes. Aorta was cross clamped in intracardiac Fontan and its mean time was 43.31 +/- 5.85minutes. Fenestration was employed in 14 [41.2%] patients. Mean pre-operative oxygen saturations were 77.41 +/- 10.27%, which significantly increased to 93.94 +/- 3.96% post-operatively [p<0.001]. In-hospital mortality was 2 [5.8%]. Fontan surgery has acceptable morbidity and mortality in our set up