Frequency of raised urinary trypsinogen-2 in acute pancreatitis

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis

Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome

Results Mean age of the patients was 38.14 +/-7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 [65.5%] patients. Stratification of age group shows, that 40 [66.7%] patients in age group

Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high

Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Skeletonized versus pedicled internal mammary harvest: relationship of pain towards technique

Objective purpose of this study is to compare skeletonized versus pedicled internal mammary harvest

Introduction one of the commonly used procedures for multi-vessel and left main coronary artery disease is Coronary Artery Bypass Grafting [CABG with fewer and recurrent complication i.e. Post procedure pain that is an outcome of mechanical, thermal or ischemic injury to the inter-costal nerves during Internal Thoracic Artery [ITA] harvesting

Methodology this study is being done to examine whether skeletonized or pedicle harvesting results in lesser occurrence and intensity of post-CABG pain with aim to identify which one is the better of the two techniques that can be used in future for patients planned with CABG. 63 consecutive patients were recruited at Tabba Heart Institute who underwent median sternotomy for CABG with Internal Thoracic Artery harvest was included. Group A went harvesting through skeletonization whereas patients in group B underwent harvesting by Pedicle ITA. This initial screening was done with the help of pre designed questionnaire. The data statistically analyzed by SPSS

Results the results of study concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. It is suggested that that skeletonized ITA is only beneficial when bilateral ITA are used

Conclusion it was concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. We suggest that that skeletonized ITA is only beneficial when bilateral ITA has been used

Surgical closure of ASD's and concomitant procedures needed in adults: a 3 year cardiac centre experience

Objective the study aims to evaluate the surgical closure of Atrial Septal Defect [ASD] and concomitant surgical procedures needed at Cardiac Care Centre

Introduction an ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly [in response to the normal left-to-right atrial pressure gradient] is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection [PAPVC] is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium

Methodology a prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample

Results total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96+/-11.02mm. The relative frequencies of different ASDs were secundum 57 [80.2%], primum 4 [5.6%], and sinus venosus 10 [14.08%]. Major post-operative complications by Age group and by procedure were evaluated and presented

Conclusion it was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results

Hypertensive disorders of pregnancy: frequency, maternal and fetal outcomes

To determine the frequency and distribution of different types of hypertensive disorders of pregnancy and to determine the impact of hypertensive disorders of pregnancy [HDP] on maternal and fetal outcomes. A descriptive retrospective study. The study was conducted in the department of Gynaecology and Obstetric of Isra University Hospital Hyderabad from January to December 2007. All the patients who were diagnosed to have hypertensive disorders of pregnancy during study period were categorized as group I. One hundred nineteen women delivered during the same period without hypertensive disorders of pregnancy were included as group II. The data regarding demographic and obstetrical parameters, associated risk factors, fetal and maternal complications were gathered from available data on medical record files. Total number of deliveries during the same period was obtained. Frequency of hypertensive disorders of pregnancy was calculated. Statistical analysis was performed by SPSS V11. Pearson's chi square and student's t test was used for comparison of variables in between two groups. P value < 0.05 was considered significant. The frequency of Hypertensive disorders of pregnancy was 8.9% in our study. The mean maternal age was 28.57 +/- 5.8 years and 26.56 +/- 5.0 years for group I and II respectively. Forty eight [76.2%] of group I patients were Unbooked for antenatal care, 37[58.7%] belonged to poor socioeconomic status and 82[45.1%] were multipara. Statistically significant difference was found for antenatal booking status [P. 0.04] and socioeconomic status [P. 0.01] and parity [P 0.04] in both groups. Twenty three [36.5%] patients from group I had past history of hypertensive disorders of pregnancy, while it was reported only by 8[6.7%] of group II patients. It was observed that women with HDP have strong family history of hypertension [P. <0.001]. Regarding maternal outcome more patients from group I were shifted to ICU as compared to group II. Maternal mortality was significantly high in group I [P <0.001]. The mean gestational age was 35.29 +/- 2.6 weeks and 38.03 +/- 1.3 weeks in group I and II respectively. The mean birth weight of baby was 2.5 +/- 0.73 kilograms and 2.8 +/- 0.41kilograms in group I and II respectively. Statistically significant difference was observed in both groups for mean gestational age [P<0.001] and mean birth weight of baby [P<0.001]. Statistically significant difference was observed for Preterm birth, Still born, Neonatal death and admission of newborn in neonatal intensive care unit [P <0.001], [P <0.001], [P <0.001], [P<0.001] respectively. The Perinatal mortality was 230/1000 births in group I, while it was 40/1000 in group II. Frequency of HDP is high in our set up. It is associated with high maternal and perinatal morbidity and mortality

Knowledge, attitude and preferences of pregnant women towards modes of delivery

Objective: to determine the knowledge, attitude and preferences of pregnant women towards vaginal and caesarean delivery

Study design: KAP [Knowledge, attitude and preferences] study

Place and duration of study: antenatal clinic of Obstetrics and Gynecology Department at Isra University Hyderabad Sindh, from August 2007 to February 2008

Subjects and methods: four hundred and forty-six women who have attended the antenatal clinic during the study period were interviewed after taking informed consent. The information regarding sociodemographic, obstetric history, knowledge and attitude statements towards vaginal and caesarean delivery, the source of their knowledge, information regarding willingness to accept caesarean delivery as a primary mode of delivery for current pregnancy and the reasons for chosen preferences were recorded on questionnaire. All data were analyzed by using SPSS v.12. Overall scores for knowledge and attitude statements, mean +/- SD were calculated

Results: the mean +/- SD age was 26.54 +/- 5.08 years. Majority [39.7%] of women interviewed have received no formal education. Overall rating for knowledge about modes of delivery was weak in 392 [87.9%] women, while medium and good was rated by 47 [10.5%] and 7 [1.6%] respectively. Mean attitude score was 21.99 +/- 3.12 for vaginal delivery and 8.78 +/- 4.47 for caesarean delivery. It shows that 304 [68.1%] women regarded vaginal delivery as a natural and accepted mode of delivery. Majority of women reported that they obtained the knowledge regarding modes of delivery from their relatives. Three hundred and fifty-seven [80%] women refused to accept caesarean delivery as primary mode of delivery in current pregnancy, common reason given was fear of operation. Only 89 [20%] accepted it and the main reason for acceptance was doctor's advice

Conclusion: women in our setup have low level of knowledge regarding modes of delivery and positive attitude towards vaginal delivery. There is need for a program to increase women's understanding about different modes of delivery