Left atrium volume as a surrogate marker of left ventricular diastolic dysfunction

Objective: To determine correlation between left atrial volume and left ventricular diastolic dysfunction

Methodology: This was a single center observational study conducted at Lady Reading Hospital, Peshawar. Patients above 18 years of both genders, who were in sinus rhythm and having no significant systolic dysfunction or significant mitral insufficiency on echocardiography, were included in the study, using purposive non-probability sampling technique. A total 339 patients underwent transthoracic echocardiography from July 2013 to June 2014. Detailed cardiac echocardiography was performed to determine left atrial volume, ejection fraction, E and A velocities, deceleration time and e've-locity, E/e

Results: A total of 339 patients were studied. Male were 61.9%. Mean age of study population was 58.42 +/- 10.48 years. Baseline characteristics of patients having some degree of diastolic dysfunction were; mean age 65.5 +/- 12.3, mean body mass index 25.2 +/- 2.5 kg/m2, mean ejection fraction 55.1 +/- 7.5%, hypertension 48.6%, diabetes mellitus 10.1% and left ventricular hypertrophy 38.6%. Echocardiographic findings in diastolic dysfunction patients were as follow: mean left atrial volume was 65.3 +/-10.1 ml, E/A 1.4 +/- 0.6, TDI e' was 6.7 +/-1.3 m/sec and TDI E/e' was 12.7 +/- 2.1. Increasing left atrial volume was well correlated with increasing severity of left ventricular diastolic dysfunction [y = +0.8, Spearman rank correlation]

Conclusion: Increase in left atrial volume is directly correlated with severity of diastolic dysfunction. Severity of diastolic dysfunction increases with increased left atrial volume

Clinical profile of patients with normal coronary angiogram

To observe the clinical and bio-chemical profile of patients having normal coronary angiogram following an abnormal stress test. This was a single center retrospective, descriptive study. Coronary angiograms done from July 2009 to December 2011 were retrieved and reviewed for normal coronary arteries. Clinical and bio-chemical profile of the patients having normal coronary angiogram was retrieved from hospital record. Patients, whose computerized data could not be retrieved from department database, were excluded from the study. Out of 8425 angiograms reviewed, 816[9.7%] were having normal coronary arteries. Mean age was 4 +/- 27.4 years. Females were 66.7%. Clinical and biochemical profile for normal coronary angiograms was as follows: smokers 59%, family history of premature coronary artery disease 41%, hyperlipidemia18.5% and hypertension 14%. Diabetes was present only in 2.1%. Among females: 11% were current users of oral contraceptives pills, 3.4% were post menopausal and 0.87% pregnant. Mean BMI was 25.4 +/- 5.2 and total cholesterol and triglyceride were 278 +/- 31mg/dl and 180 +/- 28mg/dl respectively. Normal coronary angiogram is infrequently observed in catheterization laboratories and mostly found in younger to middle aged females. Smoking is very common in such patients. Hyperlipidemia, hypertension, diabetes mellitus are not frequently present in these patients.

Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following st elevation myocardial infarction

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A [successful thrombolysis] and group B [unsuccessful thrombolysis] using ECG criteria. Total number of patients were 200. Group A included 136 [68%] patients and group B included 64 [32%] patients. There were total 88 [44%] patients of anterior MI with 47 patients in group A and 41 patients in group B [34.6% vs 64.0%, p<0.001]. There were total 110 [55.0%] patients of inferior MI with 88 patients in group A and 22 patients in group B [64.7% vs 34.4%, p<0.001]. Lateral myocardial infarction was diagnosed in 2 [1%] patients with 1 patient each in group A and group B [0.7% vs 1.6%, p=0.583]. Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Knowledge, attitude, perception [KAP] of coal mine workers of Shangla district regarding occupational safety

Coal- miners are at risk of developing several diseases related to their exposure to coal dust and are prone to many accidents. We conducted this study to document Knowledge, Attitude, and Perception [KAP] of 101 randomly selected coalmine workers were assessed. The means of the study sample were; Age 37.56 yrs., BMI of 20.3, duration of work 13 yrs. and work per day of 9.57 hrs. The average family size was 10, 90 were married and 44 were able to read and write. The absence of scientific method of working was evident as 75 participants reported digging and drilling, 14 reported blasting, 9 reported both as methods used for coal extraction. Despite primitive methods used, 751101 were not using any protective gear during work and only 8 out of 101 were aware of coal mine related health hazards. Only 29 participants reported inspection of the one or the other nature during their work period. 19 participants had to avail health related leave of absence for more than 3 month and 76 were currently disabled and retired because of respiratory symptoms. 60 out of 101 were able to recall accidents happening at the coal mines resulting into serious injuries and deaths. Despite being victims of mine, 21 out of 101 were still willing to send their children to work in coalmines. The majority of the miners are unaware of the occupational safety at coalmines and they are underestimating the usefulness of the protective gears and other safety measures

Antituberculous treatment; outcome at outpatient TB clinic in Khyber teaching hospital Peshawar

To determine the clinical profile and treatment outcome of patients with tuberculosis. Descriptive study. Outpatient TB clinic, Khyber Teaching Hospital Peshawar. From 1[st] January 2002 to 31[st] December 2002. Diagnosed case of tuberculosis were registered according to WHO guidelines and treated under the conventional strategy of monthly visits. Patients were assessed for treatment outcome. 134 patients were registered and treated as per WHO guidelines. Out of 134 patients, 72[53.7%] patients were males and 62[46.2%] were females. Ninety-nine [73.6%] patients were in age range of 10 - 40 years. The mean age at the time of diagnosis was 22 years. In category-I, there were 64 patients [47.7%], 4[3%] were in category -II and 66[49.3%] in category -III. Fever and cough were the most common presenting symptom. In this study, pulmonary TB was seen more commonly [n=76] than extra pulmonary TB [n=58]. Out of 76 patients with pulmonary TB, 31 have sputum smear positive. After initial intensive treatment, 30 patients became sputum smear negative. 26 out of 31 were cured and 91 out of 108 had completed the treatment, one patient died, 11 were declared as defaulter, 5 were transferred out. The cure rate is satisfactory but the default rate is worrying