Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery [CABGS]. An observational study. The National Institute of Cardiovascular Diseases [NICVD], Karachi, from December 2008 to December 2009. Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction [MI] within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 [84.3%] males and 21 [15.7%] females, with mean age of 53.7 +/- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time

High total leukocyte count and heart failure after myocardial infarction

Background: Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI

Methods: A cross sectional study carried out from June-August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure

Results: Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [

Conclusion: This study shows that high TLC count appears to be associated with development of CHF and mortality after acute STEMI

High total leukocyte count and heart failure after myocardial infarction

Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI. A cross sectional study carried out from June -August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure. Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [