The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI

Treat-to-target approach in daily clinical practice in Pakistani patients with early rheumatoid arthritis

To determine the frequency of patients with early Rheumatoid Arthritis [RA] achieving disease remission and/or low disease activity after 6 months of treatment with conventional Disease Modifying Anti-Rheumatic Drugs [DMARDs] by using treat-to-target approach in routine clinical practice. Descriptive study. Division of Rheumatology, Fatima Memorial Hospital [FMH], College of Medicine and Dentistry, Lahore, from March 2011 to February 2012. Patients with early RA defined as disease duration

Snap, crackle and pop: a normal variant of increased insertional activity: may be misleading for electromyographer

To describe the findings of Snap Crackle and Pop in different patients referred for electromyographic evaluation. From August 2007 to December 2010 total of 2098 patients were referred to neurophysiology laboratory for evaluation in three different hospitals namely The Aga Khan University Hospital, Karachi, Pakistan, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan and Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia. Electromyography [EMG] needle examination was done by single electromyographer in the above mentioned hospitals. EMG findings were then confirmed by qualified consultant Clinical Neurophysiologist. Clinical information and EMG data were collected in text form. Out of 2098 patients only 4 patients showed characteristic EMG findings of Snap Crackle and Pop. All 4 patients were male and they are giving history of vigorous exercise. All four patient exhibit abnormal insertional activity with diffuse positive sharp waves in different muscles. In one patient occasional fibrillation potentials were noted. Snap Cracle and Pop is rare disorder in male gender. Having characteristic EMG findings and can be misinterpreted easily

Minimal invasive plate osteosynthesis of close fractures of distal tibia

Background: The limited soft tissue, subcutaneous location and poor vascularity render the tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive plate osteosynthesis [MIPO] technique may minimise damage to soft tissues and the vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. This descriptive study was conducted to assess the outcome of patients treated with MIPO technique for distal tibial fractures. Methods: Seventy three cases of multifragmentary fractures of the distal tibia admitted in Bahawal Victoria Hospitals, Bahawalpur between April 2009 and October 2010 were included in this study. Patient's outcome in terms of period of radiologic union of the fractured segments and period of full weight bearing capacity were accessed. Results: There were 66 males and 7 females of mean age 43 years. The mean follow-up period was 13 weeks. [Ranging from 9–16 weeks]. All patients were fully weight bearing at 16 weeks [ranging 9–16 weeks] showing radiological union. There were two superficial infections treated successfully using oral antibiotics and no failures of fixation. There were no cases of rotational malalignment. Conclusion: MIPO is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incisions is technically demanding but decreases surgical trauma to soft tissues. Keywords: Distal tibial fractures, Minimally invasive plate osteosynthesis, MIPO

Skin closure in laparotomy; delayed versus primary closure performed for generalized peritonitis

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Quasi experimental study from September, 2006 to March, 2007. Surgical floor of Allied Hospital, [Punjab Medical College] Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients [group A] were left open and closed on 4th day while that of next thirty patients [group B] closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence [16.66%]. Four belonged to group A [13.33%] and six belonged to group B[20%] [p<0.05]. In advancing age the infection rate was significantly high in the same group [p<0.01]. Regarding hospital stay of patients of two groups the difference was statistically significant. Group A [mean=7.77, std. dev=2.029 and std. error of mean=0.370]. Group B [mean=10.30, std. dev=4.822 and std. error of mean=0.880]. Regarding age the difference was not statistically significant between two groups. Group A [mean 30.47, std. dev=10.099 and std error of mean=1.844]. The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care

Upper gastrointestinal endoscopic assessment of patients presenting with dyspepsia

To evaluate common causes of dyspepsia and to correlate endoscopic findings with histological examination of biopsy specimens. Material and This observational descriptive study was conducted at department of medicine Khyber Teaching hospital Peshawar, from 1st June 2006 to 31st December 2006. Detailed history, thorough physical examination and relevant investigations were done in each patient. All patients underwent upper gastrointestinal [GI] endoscopy. Biopsies were taken in every patient from oesophagus, stomach and duodenum. Histological examination was done from single pathologist. The endoscopic findings of 50 patients with dyspepsia were studied. Out of 50 patients, 35[70%] were males while 15[30%] were females. Eighty two percent [41/50] were in the age group of 30-50 years. The most common presentations were epigastric pain in 45 [90%] cases, heartburn in 36 [72%] and flatulence in 35 [70%] cases. The endoscopic findings were normal in 25 [50%] patients. The abnormal findings included esophagitis in 6 [12%] patients, gastric ulcer in 5 [10%] patients, duodenal ulcer in 4 [8%] patients, gastritis in 4 [8%] patients and duodenitis in 2 [4%] patients; while esophagogastritis, gastroduodenitis, esophagogastroduodenitis and carcinoma stomach were present in 1 [2%] patient each. All the endoscopically abnormal as well as normal findings were confirmed by histopathology. The endoscopic findings were normal in majority of patients with dyspepsia. The common abnormal endoscopic findings included esophagitis, gastric ulcer, duodenal ulcer and gastritis. The endoscopic findings were, matching with histological diagnosis

Hypoglycemia in newborns [a clinical study in 100 newborns at Nishtar hospital Multan]

This was a prospective open, clinical study, conducted in the Neonatal Unit, Department of Pediatric Medicine, Nishtar Hospital, Multan from 2001 to 2002. 100 consecutive newborns admitted were selected to detect hypoglycemia early and prevent the detrimental neurologic outcomes, in newborns. It was also aimed at identifying the common risk factors, relative incidence and clinical symptoms of hypoglycemia. 49% of these sick newborns were hypoglycemic with a male to female ratio of 1.5:1. Majority of newborns admitted on day 1 [67 out of 100] were hypoglycemic 50.7%. Major clinical symptoms, were lethargy, jitteriness, reluctance to feed, seizures hypothermia, hypotonia and cyanosis etc, whereas, major risk factors identified were, sepsis, preterm, IDM, birth asphyxia, jaundice, post tem and SGA. Hence it can be concluded that hypoglycemia is a common problem amongst the sick neonates. Babies of all gestational age are prone and the most common risk factors are, sepsis, low birth weight, post-maturity, IDM etc. and even the normal healthy infants who are asymptomatic can have hypoglycemia

Significance and production technology of some important spices of medicinal value

Pakistan is rich in plants of significant medicinal value whereas masses are unaware of theit significance and production technology. Therefore a brief account of significance and production technology of some important spices is described in this paper to.encourage progressive growers to cultivate these on commercial basis and get better returns per unit land along with saving valuable foreign exchange