Compliance to discharge treatment among acute coronary syndrome patients in a tertiary care hospital

Background: Medicine compliance is a matter of concern for clinicians and policy makers

Objective: To assess the compliance to drug treatment after discharge from hospital among acute coronary syndrome patients in a tertiary care hospital

Methodology: This was a cross sectional study conducted over a period of six months from 1st January to 30th June 2015 at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Out of 126 patients of acute coronary syndrome, discharged from CCU of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, we were able to contact 80 patients on phone, 47 were alive and have given information regarding medicine use, 3 were reported died during study period while 30 has given inadequate information so were excluded from study. The patients also having other diseases like; Diabetes Mellitus, Renal failure, Hepatitis, Endocrinal diseases were excluded. Informed verbal consent was taken from each patient before inclusion in study. Baseline data regarding medicines prescribed was noted in a questionnaire including demographic variables, number and types of medicines prescribed on discharge. Patients were contacted on phone, after six months of discharge from hospital, with the purpose to get information on compliance of drug intake. Variables included were number of medicines prescribed; grouped as three drugs, four drugs, five drugs and six drugs. Compliance was noted from; no drug to five drugs. The data was entered and analyzed by using SPSS version 20

Results: The mean age of patients was 54 +/- 12 years with 37[78.7%] males. Our study showed that 24[51%] were prescribed three drugs at time of discharge. 18[38%] were prescribed 4 drugs, 4[8.5%] were prescribed 5 drugs and 1 [2%] was prescribed 6 drugs on discharge. This study showed that 11[23%] of patients did not use a single drug after six months of discharge from hospital, 6 [12.7%] only two drugs compliance, 18[38%] showed three drugs compliance and 10[21%] showed compliance to four drugs where as 2[4%] showed compliance to five drugs after 6 months of discharged from CCU. Our results showed that 3[6%] patient died after discharge from CCU

Conclusion: Our study showed that compliance to the recommended treatment for acute coronary syndrome patients at discharge was poor within six months after discharge from hospital and resulting even in death to many of the patients. We suggest that appropriate interventions for secondary care may be planned to improve compliance among acute coronary syndrome patients

Knowledge and practices of rural mothers about diarrhea among infants

Background: Diarrhea is one of the most common cause of morbidity and mortality in children

Objective: To assess knowledge and practices of rural mothers about diarrhea among infants

Methodology: Study design Cross-sectional sutdy. Place and Duration: This study was conducted at EPI center of OPD and diarrheal unit of children ward Sheikh Zayed Hospital Rahim Yar Khan, from 15th March to 15 May 2016. A total of 224 rural mothers of infants were included in the study by non probability consecutive sampling technique. Before commencing with the data collection, informed consent was taken. The performa was designed and pretested and it contained variables like age, mother's education, mothers occupation, family income per month, knowledge about definition of diarrhea, causes of diarrhea, signs of dehydration, consequences of diarrhea, prepration of market available ORS sachet, continuation of breast feeding during diarrhea, consultation with doctor during diarrhea, time of consultation with the doctor, diet preferences during diarrhea and preventive measures applied by mothers during diarrhea. All the data collected was recorded on the performa, entered and analyzed by using SPSS version 16

Results: Mean age of mothers was 27 +/- 5 years. In our study [49.10%] months were illiterate. Regarding mothers occupation 74.11% were housewives. Regarding Knowledge of the mothers on definition of diarrhea 46.43% told loose watery stool, 3.57% told increased frequency and 36.61% told both loose watery stool and increased frequency. As regards causes of diarrhea, [24.11%] pointed out contaminated water, [9.82%] eating mud and [26.78%] told both contaminated water and eating mud. Regarding signs of dehydration [9.82%] sunken eyes, [6.25%] dry skin and [25%] considered both Sunken eyes and Dry skin. Regarding practices during diarrhea, 68.76% continued breast feeding during diarrhea, 92.86% consulted doctor but before consulting the doctor, 21.88% did self medication and 65.62% consulted the doctor when condition of child was not improving. 33%] gave diet preferences to both ORS and khichree, 26.79% ORS and 6.69% khichree only. 40.89% applied boiling the water, covering the food and keeping child and environment clean as preventive measure during diarrhea whereas 22.32% did boiling the water and covering the food only, whereas, 3.57% boiling the water only and 2.67% covering the foods only

Conclusion: Majority of the mothers has good knowledge and practices about diarrhea but still many of them do not have clear idea about prevention and ideal practices to be adopted during diarrhea and they should be focused. There is a need of health education program to be started in the rural areas of Rahim Yar Khan

In hospital outcome of patients with acute ST-elevation myocardial infarction requiring temporary transvenous pacing

Background: Acute myocardial infarction continues to be a major public health problem worldwide. Temporary pacing is needed in various situations of myocardial infarction

Objective: To determine in hospital outcome [electrical and mechanical complications] of acute myocardial infarction [MI] patients requiring temporary transvenous pacing

Patients and Methods: This descriptive case series was conducted at the Cardiology Department of the Punjab Institute of Cardiology, Lahore from October 2007 to April 2008.One hundred patients presenting with acute chest pain consistent with acute myocardial infarction, typical ECG changes and raised serum markers of myocardial infarction and requiring temporary pacing during their hospital stay were included

Results: A total of 100 patients were included in study. The mean age of the study population was 49.9+/-7.5 years. There were 85% males and 15% females. Majority of patients 66% were smokers. Diabetes mellitus and hypertension was observed in 45% patients. Mean duration of onset of symptoms till arrival at the hospital was 8.2+/-4.6 hours. Majority of patients 65% had inferior wall myocardial infarction [IWMI], 3% patients had IWMI with right ventricular MI. Extensive anterior wall myocardial infarction [AWMI] was observed in 25%. Anteroseptal wall MI occurred in 7% of patients. Streptokinase was used for thrombolysis in 76% patients. First degree heart block was noted in 2% patients at arrival. Second degree Mobitz type 1 occurred in 1% and Mobitz type 2 in 4%. Third degree or complete heart block was noted in 31% patients. Right bundle branch block with left anterior fascicular block occurred in 3% and trifascicular block in 4%. During hospital stay, complete heart block occurred on 1[st] post MI day in 55% patients, and on 2[nd] post MI day in 3% patients. Temporary pacemaker was implanted in 40% of patients at presentation, in 57% of patients on 1[st] post MI day and in 3% on 2[nd] post MI day. In-hospital mortality occurred in 8%, ventricular tachycardia in 29%, ventricular fibrillation in 2% and asystole in 2% patients

Conclusion: Complete heart block in patients with ST-Elevation myocardial infarction requiring temporary pacing is accompanied by a worse early prognosis. A more aggressive therapeutic approach aimed to reduce early mortality seems warranted in these patients

Dobutamine and exercise echocardiography in the evaluation of known or suspected coronary artery disease: an observational study from single centre

Stress echocardiography has emerged as an important tool for non-invasive assessment of coronary artery disease [CAD]. Exercise and dobutamine stress echocardiography [DSE] are frequently used modalities with distinct clinical indications and procedural variations. We report our findings on these two tests comparing various aspects and outcomes. Four hundred seventy one consecutive patients underwent SE at Sheikh Zayed Hospital Rahim Yar Khan. Exercise Echo [Ex.E] was performed on treadmill using Bruce's protocol. DSE performed in standard method. SE was considered as positive with the appearance of new or worsening wall motion abnormality. Ex.E performed by 300 patients and DSE 171 with mean age of 48.09 and 54.92 respectively. Males were dominant in both groups. The risk factors were almost same in both groups. Ex.E was more performed for diagnosis of CAD than DSE [59% vs 25%]. Viability testing was exclusively done by DSE. Post revascularization status was assessed in 10% and pre-operative assessment for non cardiac surgery in only 2%. Incidence of side effects was 26% in DSE and none in Ex.E. The double product was greater in Ex.E. Positive tests were reported in 43% and 33% in DSE and Ex.E respectively. Stress induced LV dysfunction was more common in DSE. Comparing available coronary angiograms, single vessel disease was better detected by DSE [60% vs 46%]. Double vessel disease was relatively higher in Ex.E [35% vs 28%]. Ex.E is safer and better non invasive diagnostic imaging modality in patients who can perform physical exercise, however DSE is more useful for viability, pre-operative evaluation and patients physically disabled for treadmill or ergometer exercise test