Compare wall motion score at 6 weeks in patients with short and normal deceleration time on day 1 after acute MI

Objective: To compare wall motion score at 6weeks in patients with short and normal deceleration time on day 1 after acute MI

Study Design: Cohort study

Setting: Cardiology Department Sheikh Zayed Hospital Lahore

Sample Size: 100 patients

Sample Technique: Non probability convenient sampling

Data Collection Procedure: In my study I evaluated 100 patients with acute MI on day 1 and at six weeks post MI. All patients were treated with streptokinase and heparin. Echocardiography was performed using Vivid I ultrasound machine [GE medical system]. Patients were divided in two equal groups depending on deceleration time, group A [DT <150 ms] and group B [DT >150 ms] on day 1 post MI .Their wall motion score ,left ventricular volumes and ejection fraction were compared at base line and at six weeks

Results: Patients with short DT showed higher wall motion score [29 +/- 3 vs 20 +/- 2.5] higher left ventricular volumes [LVEDV 98 +/- 21 vs 77 +/- 8, LVESV 64 +/- 13 vs 38 +/- 6 ] and lower ejection fraction [37 +/- 5 vs 50 +/- 4] at base line. Also, at 6 weeks, patients with short DT showed less improvement in wall motion score [27 +/- 2 vs 17 +/- 6] and ejection fraction [39 +/- 5 vs 53 +/- 5] compared to patients with normal deceleration time

Conclusion: Patients with short deceleration time have larger infarcts[high WMS], poorer left ventricular systolic function and are at higher risk of ventricular remodeling compared to patients with normal deceleration time. DT measured post MI is a reliable and noninvasive short term predictor of outcome after MI

Effects of coronary artery bypass grafting on QT dispersion

Abnormal dispersion of QT interval [QTd] measured as the interlead variability of QT, reflects an in homogeneity of ventricular action potential. This is increased in coronary artery disease [CAD] due to ischemia of myocardium

Aims and Objectives: To determine / investigate the values of QT dispersion in our population. To investigate whether there is any short term influence of coronary artery bypass grafting [CABG] on QT dispersion, evaluated early [7 days] after surgery

Design of study: Single center observational study

Site of study: Department of Cardiology and Cardiothoracic Surgery, Shaikh Zayed Hospital, Lahore

Patients and Methods: A total of 50 consecutive patients, who underwent CABG in Shaikh Zayed Hospital, were included in the study. All the patients were given the standard therapeutic treatment for the management of ischemic heart disease [IHD]. Biochemical lab data including complete blood count, blood sugar level, serum electrolytes, urea and creatinine was collected and assessed for any abnormality before the operation. A twelve lead electrocardiogram [ECG] was recorded during a resting period in all patients planned for CABG 24 hours before surgery. ECG was repeated 48 hours after operation and at the time of discharge from the hospital. QT interval was calculated from the onset of QRS complex to the point of return of 'T' wave to isoelectric line or to the nadir between 'T' wave and 'U' wave, in cases where a 'U' wave was present. QT dispersion was measured as the difference between maximum and minimum QT from the 12 lead ECG

Results: The mean QTd in healthy individuals was [53.60+/-19.56 ms] [p=0.000]. There was significant reduction in QTd from 24 hours before CABG to 48 hours and seven days after CABG [74.80+/-28.59 ms] [p=0.000] vs. [46.40+/-17.82 ms] [p=0.000] and [33.20+/-15.44 ms] [p=0.000] respectively

Conclusion: There is a significant reduction of QTd early after CABG. It seems that QTd is a simple non-invasive and a reliable mode for detecting coronary ischemia and also for evaluating the effects of revascularization

Thrombolysis in acute thrombosis of metallic mitral valve: case report

Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy is a low-cost, noninvasive imaging technique, with limited radiation exposure that allows the correct evaluation of opening and closing angles and can add diagnostic value to echocardiography. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician's experience are important determinants for the management of prosthetic valve thrombosis

Factors for intimate partner violence [IPV] in urban Pakistani families

The present study was conducted to estimate the prevalence of Intimate Partner Violence [IPV] among women seeking healthcare services and identification of factors associated with Intimate Partner Violence [IPV] in this study sample. Cross-sectional research. Karachi, November 2007 to September 2008. There would be high rates of Intimate Partner Violence [IPV] among women seeking healthcare services. Women would report physical abuse, psychological abuse and sexual abuse. Age level, education, employment status, family income, family system, years of marital relation, number of children, nature of parental marital relations, cigarette smoking, childhood verbal and physical abuse of both husband and wife would be associated with Intimate Partner Violence [IPV]. The Study sample comprised of 500 women who came to seek healthcare from family health clinics and general O.P.D of some large hospitals of Karachi-Pakistan. Karachi Domestic Violence Screening Scale Urdu Version [KDVSS-U], Demographic Street. Descriptive Statistics and Pearson Correlation were applied for statistical analysis. Findings demonstrated high prevalence rates of IPV. Some specific demographic and social factors including low levels of education, poor employment status, childhood physical and verbal abuse, absence of parental support, and violence in family of origin found to be associated with the presence of IPV. Findings illustrated that women were at risk of IPV regardless of their age, employment status, years of marital relationship, number of children, and type of family system. Women's education, however, was found to be a protective factor against family violence. Husband's education, better employment status and family income were also found to be protective factors. Support from parents and in-laws were also a protective factor. Childhood physical and verbal abuse among husbands was associated with wife abuse. Presence of violence and abuse in family of origin of both spouses was also associated with violence in their own marriage. An average Pakistani woman still does not enjoy gender equality and independence, especially in terms of martial relationships

Coronary artery by pass graftingearly morbidity and mortality in patients with tight glycaemic control versus standard control

Several studies have suggested superiority of tight glycaemic control in reducing the incidence of surgical site infection and mortality after cardiac surgery. To compare the frequency of post operative surgical site infections after CABG in patients with tight glycamic control and those with standard glycamic control. Shaikh Zayed Hospital, Lahore. June 2008 to March 2010. Total of 496 patients were included, they were randomized to tight glycaemic control group [TGC, n =248] or standard control group[SC, n=248].In TGC group blood glucose was maintained between 90 - 130 mg/dl, while in SC group blood glucose was maintained between 131- 190mg/dl for 48 hours post surgery. Results were prospectively evaluated. Demographic and surgical data was similar in both groups. Patients in TGC group showed significant reduction in post operative superficial sternal wound infection [4 vs 12, p < 0.05], deep sternal wound infection [1 vs 7, p <0.05] and leg wound infection [2vs 9, p<0.05].There was also non significant reduction in the incidence of post operative mediastinitis [1 vs 3], new myocardial infarction [2 vs 3],and atrial fibrillation [10 vs 12]. Mortality was equal in both groups [1 in each]. Significant reduction in SSI was observed in TGC group and no change was seen in other morbidities and short term mortality in the study

Measuring distance in personal relationships [a preliminary report]

The study is divided into three parts. The first part is aimed at identifying gender differences in the use of relational distancing tactics by university students [38 males and 38 females]. It was seen that women tend to use the strategy of disengagement significantly more than males [p < .01]. The results showed, that disengagement was used more than avoidance [t = -7.221, p < .001] and cognitive dissonance [t = 14.440, p< .001] as distance. strategies. The second study explores the relationship between Relational Distance Index and subjective distance perception on a sample of 36 students. The test-retest reliability of Relational Distance Index [Hess, 2003] as measured in the third study on 100 Pakistani students turned out to be r= .698, p< .001. Means, correlations and t-tests are used for the analysis of the data

Family sense of coherence and quality of relationship: a relational analysis

The purpose of this study is to measure the relationship between family sense of coherence and quality of relationship. Correlational Study. University of Karachi, from March 2007- September 2007. The sample consisted of 100 students [50 males and 50 females] from the University of Karachi, Pakistan. All the participants were taken from the 1[st] and 2[nd] year of graduate programs [B.A/ B.Sc. Honors]. Their ages ranged from 18 to 20 years. The hypotheses are [I] family sense of coherence will be positively related to quality of relationship, and [II] there will be a positive relation between the sub scales of Family sense of coherence and Quality of relationship. Family Sense of Coherence [FSOC]and Quality of Relationship Inventory were the two scales used for measurement. Means, standard deviations and correlations were calculated for statistical analysis. The results indicate a significant relationship among the variables. It appears that family sense of coherence have a strong relation with quality of relationship. The family is a most important source of, and resource for building, maintaining and developing meaning in relationship