Validation of arrhythmogenic right ventricular cardiomyopathy risk calculator for sudden cardiac death: a systematic review

In the context of ARVC, a systematic review of the validation of the ARVC risk score can provide insights into the accuracy and reliability of this score in identifying patients at high risk of ARVC. Digital databases were searched to identify the relevant studies using Medical Subject Headings (MeSH). A total of 8 studies were included in this systematic review. A total of 8 studies were included in this review. The review found that the sensitivity of the ARVC risk scores ranged from 80 to 95%, and the specificity ranged from 31 to 79%. The PPV was 55%, and the NPV was 88%. The ARVC score provided a C-index for a 5-year VA risk prediction of 0.84 [95% CI (0.74–0.93)] and a Harrell C-index of 0.70 (95% CI 0.65–0.75). The calibration slope was 1.01 (95% CI 0.99–1.03). ARVC score demonstrated a significant event 5-year threshold between 15 and 20% and the classical ARVC 5-years/freedom-from-VA rate was 0.76(0.66–0.89) and the non-classical form 5-years/freedom-from-VA rate was 0.58 (0.43–0.78). In conclusion, the validation of ARVC risk scores is an essential step toward improving the accuracy of ARVC diagnosis and risk stratification. Further studies are needed to establish the accuracy and reliability of ARVC risk scores and to address the limitations of the current evidence.

New perspectives in the management of hypertension: role of herbal medicines

To compare the efficacy of coded herbal medicine [Hyprol] and losartan in hypertensive type II diabetic patients. Case control study. This study was carried out at the Out-patient Department of JPMC, Karachi and Herbal Clinics of Karachi from January 2014 to June 2014. This study is a case control prospective study to compare the effects of Losartan with herbal medicine [Hyprol] in type 2 diabetic hypertensive patients. 200 patients were enrolled and divided in two groups [A] [Control group] and [B] [Test group] treated with Losartan and Hyprol respectively. With ARB [Losartan] baseline to final change for SBP as well as DBP was significantly reduced i.e. 22.45% [p<0.001] and 16.84% [p<0.001] respectively and FBS was reduced by 21.85% [p<0.001] while Hyprol shows comparable results i.e. difference in SBP, DBP and FBS was 14% [p<0.001], 15.31% [p<0.001], 34.57% [p<0.001] respectively. ARBs are the first line drug of choice for hypertension since long time. Use of herbal medicine is an alternative mean of therapy to treat these patients and limit its cardiovascular and renal complications

Clinical evaluation of coded herbal medicine [hypoess] and angiotensin receptor blocker [candesartan] in essential hypertensive patients

The basic aim of this research study was to determine the comparative effect of herbal treatment in comparison with standard allopathic medicine in control and treatment of essential hypertensive patients. Prospective and comparative study. This study was carried out in Department of Pharmacology, HCM and D, FH and MS, Hamdard University, Karachi, from January 2014 to July 2014. A total of 200 patients were enrolled in study and were given Hypoess in one hundred patients while remaining one hundred patients received allopathic medicine Candesartan. In test group one hundred patients were treated with herbal drug [Hypoess] and it decreased mean systolic blood pressure of study patients with a decrease of 15.17% whereas, a reduction of 20.56% was found with allopathic medicine Candesartan Cilexetil. Similarly a decrease of 18.07% was found in mean diastolic blood pressure with herbal medicine in test group patients and a decrease of 21.65% was observed in case of allopathic drug in mean diastolic blood pressure of control group patients. The effects of herbal medicine were found statistically significant in controlling blood pressure and it has been found as an alternative option to treat essential hypertensive patients with its cost-effectiveness

Vacuum assisted closure [VAC] therapy for difficult wound management

To show the usefulness of vacuum assisted closure [VAC] therapy for management of difficult wounds. Descriptive type of study. The study was conducted in the surgical dept of Combined Military Hospital Rawalpindi from September 2002 to February 2003. Fifty two patients were selected through non-probability convenient sampling. Age ranged from 12 years to 61 years. Out of 52 patients 22% were females while 78% were males. The commonest wound type was traumatic in 68%, diabetic ulcer in 15%, pressure ulcer in 8%, venous ulcer in 7% and radiation ulcers in 2%. The commonest location of wound was lower limb in 42%, foot in 30%, hand in 12%, abdomen in 9% and chest in 7%. Muscle and soft tissues comprised the largest group of wound bed 71%, tendon in 16%, bone in 7% and orthopedic implant in 6%. Out of 52 patients in the study 18% were smokers while 21% had diabetes mellitus. The reduction in wound size at the end of VAC therapy was 68.1%. Granulation tissue formed in 88% of wounds. Duration of VAC therapy ranged from 2 weeks to 5 weeks. The dressing changes ranged from 2 to 12 and mean was 5 dressing changes. Foam odour, pain in-growth of granulation tissue in foam and infection. Vacuum-assisted closure therapy promotes healing and the formation of healthy granulation tissue

Circumcision - a comparative study

This quasi-experimental study was conducted in department of surgery in Military Hospital Rawalpindi from September 2003 to January 2004 with the aim to compare the results of one of the most commonly performed surgical procedure, circumcision, by open and bone-cutter method in terms of complications such as trauma to glans, bleeding and infection alongwith cosmetic outcome. Total 200 patients were selected from Out Patients Department on the basis of non-probability convenient sampling. After careful history taking and physical examination, patients fulfilling the criteria were identified into two equal groups, one underwent open method circumcision and the other bone cutter circumcision. Parents were instructed to follow up in the surgical OPD after seven days for assessment and earlier in case of any complication. There was insignificant different in terms of bleeding, superficial infection, cosmetic appearance and trauma to glans [P-value > 0.05]. Both methods proved to be safe and effective techniques with reproducible results but it is important to emphasize that trauma to glans; a well known and catastrophic complication is more common with bone cutter circumcision especially in the hands of an inexperienced operator

Morbidity of laparoscopic cholecystectomy

The aim of this study was to assess the morbidity of laparoscopic cholecystectomy in terms of pain after laparoscopic cholecystectomy, hospital stay after laparoscopic cholecystectomy and complications of laparoscopic cholecystectomy. Descriptive study Combined Military Hospital Rawalpindi, from April 2001 to March 2002. This study was conducted at Combined Military Hospital Rawalpindi surgical III unit. Over a period of one year 75 patients were included in the study. Patients were sampled through non-probability convenient type of sampling, through out patients department. All the patients were assessed for fitness for General anaesthesia and informed consent were obtained. Standard four port Laparoscopic Cholecystectomy was performed in all patients. Routinely all the patients were given post operative analgesia in the form of intraperitoneal infusion of ketorolac and bupivacaine. All the operated patients were assessed for the morbidity of laparoscopic cholecystectomy in terms of postoperative pain using the visual analogue scale [VAS], hospital stay [number of days] and postoperative complications. Mean age was 45 years [25-60]. Female to male ratio was 7.3:1. Pain of mild nature was noted in majority of patients [93.3%]. Hospital stay was short as one day in the majority of patients [84%]. Major complications were seen in [2.7%] of patients. Laparoscopic cholecystectomy is a safe treatment option and should be available to all patients requiring elective or semi elective cholecystectomy

Mortality review of diabetic ketoacidosis in mayo hospital, Lahore - Pakistan

Diabetic ketoacidosis is a known complication of diabetes mellitus. The annual incidence of diabetic ketoacidosis [DKA] among subjects with type 1 diabetes is between 1% and 5% in European and American series respectively. This incidence appears to have remained relatively constant over the last decade in western countries whereas 20-30% of cases occur in newly diagnosed patients. Mortality rate is reported less than 5% in experienced centres whereas internationally overall mortality is 1-10 percent. The objective of this study was to find out mortality rate in patients of diabetic ketoacidosis admitted to east medical ward of Mayo Hospital, Lahore. A descriptive retrospective study was conducted on patients admitted to East medical ward with the diagnosis of DKA. There were 44 patients included in this study. Regarding outcome of patients 84.1% of patients were discharged. The mortality was found to be 15.9% that is much higher as compared to other studies where it was around 5%

comparative study of complications in patients of myocardial infarction managed with and without streptokinase

Background - Numerous meta-analysis have been published and on the basis of the results of the some or all of the more than 33 trials evaluating intravenous streptokinase for acute myocardial infarction. All of these reviews demonstrated a consistent, statistically significant reduction in mortality for patients with acute myocardial infarction who were treated with intravenous streptokinase. Objectives - Intravenous streptokinase clearly confers a protective effect against early mortality in patients with acute myocardial infarction, with this initial hope that the administration of thrombolytics to patients with evolving acute myocardial infarction will prevent infarct complications. We conducted prospective study to observe the rate of complications as a whole in patients who could not get the thrombolytic therapy. Setting - This study was conducted in the coronary care unit and out patient Department of Cardiology Bahawal Victoria hospital Bahawalpur affiliated with Quaid-e-Azam Medical College Bahawalpur. Methods - This observational study was carried out in 960 patients fulfilling the diagnostic criteria for acute myocardial infarction. These patients were prospectively followed for clinical end points during the hospitalization and 90 days follow up period. Streptokinase 1.5 million units was used as a thrombolytic agent in the patients fulfilling the eligibility criteria. Results - A total of 960[21.22%] patients with acute myocardial infarction were assessed for the complications of myocardial infarction with or without thrombolytic therapy. Male and female patients were 664 [69.16%] and 296[30.83%] respectively. Mean age of patients with myocardial infarction was 57.30 years. Anterior myocardial infarction was diagnosed in 680[70.83%] patients and inferior wall myocardial infarction was diagnosed in 280[29.16%] patients. Streptokinase was given in 500[52.08%] patients while 460[47.9%] did not get it. There was statistical significant difference of complications as a whole with p value of < 0.001. Conclusion - Thrombolysis is the first line between life and death and now it has become the established fact beyond doubt in the treatment of acute myocardial infarction. The advent of streptokinase has led to substantial changes in clinical practice of managing acute myocardial infarction especially evolving one. The magnitude of the treatment effect lowers the risk of mortality and hospital stay

Stroke in hypertensive patients

To find the incidence of hypertension in stroke patients comparing it with other common risk factors and to determine the frequency of occurrence of reactive rise in blood pressure in the acute stage of stroke in normotensive patients. A prospective study. The study was conducted in Medical Unit III B V Hospital Bahawalpur from Feb 2001 to May 2002. One hundred consecutive CT Scan confirmed patients of stroke from emergency department were evaluated for various risk factors by using a proforma to record the bio-data, history of hypertension, diabetes mellitus, ischemic heart disease, transient ischemic attacks, smoking and past history of stroke. After segregating the hypertensive stroke patients, the reactive rise in blood pressure due to acute stage of stroke was also studied in the normotensive patients. Out of the 1334 admitted patients 7.49% [100 patients] accounted for acute stroke. There were 64 [64%] males and 36 [36%] Female patient. 78 patients [78%] had cerebral infarction while 22 [22%] were having hemorrhagic stroke. 49 patients [49%] were hypertensive. Out of these 30 [61.22%] were males and 19 [38.77%] were females. 35 patients [7l.42%] had cerebral infarction while 14 [28.57%] patients had hemorrhagic stroke. Hypertension was a risk factor in 35 out of 78 patients [44.87%] with cerebral infarction, while it was present in 14 out of 22 patients [63.63%] with hemorrhagic stroke. Comparing hypertension 49% to the other commonly encountered risk factors in the study, smoking was found in 30%, diabetes mellitus in 19%, ischemic heart disease in 18%, atrial fibrillation in 6% and other cardiac diseases in 4% of all the cases of stroke. Reactive rise in blood pressure in normotensive patients with acute stroke was found in 51% [26 out of 51] cases. Hypertension is the most common risk factor for all types of strokes and a significantly high proportion of normotensive patients show a reactive rise in blood pressure in the acute stage of stroke, which usually becomes normal within a week, without any anti-hypertensive therapy.