paradigm shift: the new novel oral anticoagulation agents

Atrial fibrillation [AF] is the most common arrhythmia and represents one-third of the arrhythmia-related hospital admissions in the developed countries

Embolic strokes associated with AF are more severe and disabling

Thrombo-embolic stroke prevention is a major goal in treatment of AF and Warfarin has successfully served this purpose for many years

Drug-drug interaction and regular monitoring with Warfarin pose a significant challenge where health care system has limited resources; and lack of a well-structured health system, hinders regular International Normalized Ratio [INR] monitoring. Novel oral anticoagulants [NOACs] have opened up a new exciting chapter in the field of anticoagulation in non-valvular atrial fibrillation [NVAF]. This review discussed the landmark trials that led to the development of NOACs and explored the potentials of these new agents with simultaneous comparison of Warfarin

Troponin-I positivity in patients referred to rapid access chest pain clinic

Rapid Access Chest Pain Clinics [RACPCs] are set up to access patients with new onset chest pain [within the preceding three weeks], of possible cardiac origin. These patients are seen in the clinic within two weeks of referral and the attending physician takes a history, performs a routine clinical examination, and if clinically justified, a treadmill exercise test is performed according to Bruce Protocol. Within the group of patients referred to the RACPC with new onset but otherwise stable angina, there is a potential overlap with patients who in fact may have an evolving acute coronary syndrome, i.e., unstable angina. The aim of this study was to assess the prevalence of Troponin-I positivity as an indicator of acute coronary syndrome. This cross-sectional descriptive study included 60 consecutive patients referred to the RACPC with history of recent onset chest pain [within the last three weeks] of possible cardiac origin and positive ETT or confirmed abnormal ischemic ECG at baseline. Troponin-I was measured in these patients. Out of the total 60 patients, 8.33% of the patients referred to RACPC with new onset angina had positive cTnI. Point of care test [POCT] for cTnI can help to identify the high risk patient referred to RACPC

Frequency of severe mitral stenosis in young female patients having pure mitral stenosis secondary to rheumatic heart disease

High morbidity and mortality due to Rheumatic heart disease [RHD] associated with females is mainly because of late diagnosis on one hand and socioeconomic reasons on the other hand. Poor referral to tertiary care centres leads to delayed diagnosis which results in complications. The objectives of this cross-sectional descriptive study was to assess the frequency of severe mitral stenosis in woman of child bearing age, having pure mitral stenosis [MS] secondary to rheumatic heart disease. Two hundred and fifty women of child bearing age with RHD were enrolled in the study using consecutive non-probability sampling technique. Out of these 250 patients, cases of pure MS were selected. Patients with associated mitral regurgitation and aortic valve disease were excluded. After admission, assessment of mitral valve stenosis was done with 2D colour Doppler echocardiography. Out of 250 consecutive patients of rheumatic carditis, 110 [44%] patients had pure mitral valve stenosis, 85 [34%] had stenosis with mitral regurgitation and 55 [22%] patients had both mitral and aortic valve problem of varying severity. Among 110 patients with pure mitral valve stenosis, 48 [43.6%] had severe mitral valve stenosis. Severe mitral valve gradient [MVG] and high pulmonary artery pressure [PAP] was observed in 66 [60%] and 49 [44.5%] of the patients respectively. This high frequency can be linked to lack of early detection of the disease at primary level, poor management of throat infections and poor rheumatic fever prophylaxis at community level

Neonatal sepsis: causative bacteria and their resistance to antibiotics

Neonatal sepsis is one of the major causes of neonatal morbidity and mortality, particularly in developing countries. The objective of this study was to determine the causative bacteria and level of their resistance to commonly used antibiotics. This descriptive study was carried out at Ayub Teaching Hospital, Abbottabad from April 2009 to January 2010. All neonates of either gender admitted in neonatology unit with clinical sepsis and positive blood culture were included in the study. Neonatal period was defined as 28 days of life at term and up to 44 weeks of gestational age in preterm babies. One hundred and thirty neonates of either gender were studied during the period. Blood sample for culture was taken from a peripheral vein or an artery ensuring standard anti-septic measures. BACTEC technique was used for obtaining bacterial growth and drug sensitivity after incubation of 24-48 hours. Second blood culture was also performed in few cases which were not showing improvement after initial treatment. Male to female ratio was 1.3:1. Early and late onset sepsis was found in 29.2% and 70.8% respectively. Gram-negative bacteria were more frequent than grampositive bacteria with a frequency of 54.6% and 45.4% respectively. Gram-positive and gram-negative bacteria showed high resistance against commonly used antibiotics such as ampicillin, amoxicillin, cefotaxime, ceftriazone and gentamicin. Staph. aureus is the most common gram-positive bacterium and E. coli is the most common gram-negative bacterium causing neonatal sepsis. Grampositive and gram-negative bacteria are highly resistant against commonly used antibiotics such as ampicillin, amoxicillin, cefotaxime, ceftriazone and gentamicin, and are relatively more sensitive to less commonly used drugs like amikacin and ceftazidime