A comparative study of vision-related quality of life (VRQoL) among glaucoma and nonglaucoma patients at a tertiary care center of North India

Purpose: Glaucoma influences vision?related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL. Methods: An institution?based, cross?sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life?15 (GQL?15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire. Results: Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL?15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment. Conclusion: Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.

Dilemmas and Perceptions regarding Medical Education in Hindi medium among Medical Community of Northern India: A Cross Sectional study

Introduction: The medical curriculum, the medium of instruction and evaluation in India, is primarily English. While it has the advantage of preparing Indian medical graduates to represent and interact globally, it also translates into learning difficulties for a substantial population of Indian medical students. Hindi is the common language of communication among majority of the population in Uttar Pradesh.Madhya Pradesh Government in India has already started the option of pursuing the allopathic graduate medical course in Hindi. There is paucity of data regarding opinion of medical professionals about implementation of Medical Education in Hindi in Uttar Pradesh and nearby states. Objective: To assess the attitude and opinion of medical students and medical professionals towards using Hindi in Medical Education. Method: A cross-st stsectional web-based online survey was conducted between 1 December 2022 and 31 January 2023. Undergraduate medical students, interns, residents and faculty from medical colleges, hospitals of Uttar Pradesh and neighbouring states (Uttarakhand and Bihar) were contacted to participate in this survey using pretested structured questionnaire. Results: A total of 1606 participants responded and answered the questionnaire and 1575 responses were found complete and used in analysis.Most participants (52.8%) believed that Medical Education in Hindi would attract more students from Hindi backgrounds to join the medical field. Similarly, 58.9% of participants were of the opinion that Medical Education in Hindi would improve communication with patients. However, about half of the participants (49.5%) perceived teaching in Hindi as a hurdle in acquiring higher education. Conclusion: More than half of the participants thought that medical education in Hindi will attract more students from Hindi backgrounds to join the medical field. Similarly, Medical Education in Hindi was perceived to improve communication skills with patients, at least where Hindi is a vernacular language by majority of the participants.

Study of thrombotic complications in COVID-19

Background:In December of 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)began to infect humans in the city of Wuhan and has rapidly become pandemic. Recent clinical trials suggested that COVID-19 related thromboembolic complications are the major cause for increased incidence of morbidity and mortality. We conducted a prospective observational study to evaluate the prevalence of vascular complications due to COVID-19 and to analyse the difference in the inflammatory markers before and after the events.Methods:Prospective observational study, conducted at department of general medicine, Bangalore Medical College, Bangalore Karnataka from 3 months, 01 August2021 to 30 October2020. The incidence of thrombotic events was 70.7% (53/75). The incidence of arterial thromboembolic events was 48%, involving 36 patients of the overall study population. Of these 36 patients, majority of them were suffering from cerebrovascular accident (CVA)accounting for about 12 (16%) of the patients followed by 11 (14.7%) with ischemic heart disease(IHD). About 22.66% (17/75) of patients had developed venous thromboembolic events. Of which, 13 (17.3%) patients had developed deep-vein thrombosis(DVT).Results:We observed that all the inflammatory markers had significantly increased after the onset of thrombotic events. Serum ferritin, lactate dehydrogenase (LDH), interleukin-6 (IL-6)and fibrinogen were almost raised by 50% of the pre-event values. We could not calculate the sensitivity, specificity, positive predictive value and negative predictive value for each parameter as the severity of the disease was widely distributed. Majority of these thrombotic events were observed among the patients aged >60 years and those with comorbid conditions. But there no statistically significant difference observed.Conclusions:We concluded that COVID-19 causes significantly increased surge of inflammatory markers and thereby the significantly increased prevalence of arterial and venous thrombotic events.

Understanding and Targeting the Colon Cancer Pathogenesis: A Molecular Perspective

Abstract Colorectal cancer (CRC) one of the leading cause of cancer-related deaths worldwide. With the presently available knowledge on CRC, it is understood that the underlying is a complex process. The complexity of CRC lies in aberrant activation of several cellular signaling pathways that lead to activation and progression of CRC. In this context, recent studies have pointed towards the role of developmental pathways like; hedgehog (HH), wingless-related integration site (WNT/ß-catenin) and Notch pathways that play a crucial role in maintenance and homeostasis of colon epithelium. Moreover, the deregulation of these signaling pathways has also been associated with the pathogenesis of CRC. Therefore, in the search for better therapeutic options, these pathways have emerged as potential targets. The present review attempts to highlight the role of HH, WNT/ß-catenin and Notch pathways in colon carcinogenesis

Management of iatrogenic displacement of maxillary third molar into pterygomandibular space: case report

Third molar surgery is the most common minor oral surgical procedure performed in dental clinics. Displacement of maxillary third molar tooth into adjacent spaces such as infratemporal fossa, maxillary sinus has been reported earlier. We present an unusual case of iatrogenic displacement of maxillary third molar into pterygomandibular space.A 24 year old dental undergraduate reported to Department of Oral surgery with complaints of trismus and swelling in the check region after unsuccessful attempt at extraction of maxillary right third molar tooth. Computed tomography scan localized the tooth in the pterygomandibular space. A surgical removal of the displaced tooth was performed under general anesthesia.Displaced tooth was approached by an intraoral vertical incision along the anterior border of ramus of mandible. Correlating with computed tomography scan, tooth was located and removed followed bysuturing of the surgical site. A good knowledge of the operating area and adjoining spaces is essential to avoid iatrogenic damage to tissues during minor oral surgery procedures. Adequate exposure and appropriate instrumentation during surgery can prevent undue complications and ensure quality patient care

Stump appendicitis single centre experience: a retrospective study

Background: Appendicectomy is the most common surgical procedure done for acute appendicitis worldwide. However, one among 50000 appendicectomy patients may present with recurrent abdominal pain, requiring hospitalization as stump appendicitis and may need completion appendicectomy. There are a few reports addressing management of stump appendicitis in the literature. Here we present our experience of laparoscopic completion appendicectomy over ten-year duration.Methods: A retrospective evaluation of records of appendicectomy from January 2008 to December 2018. All patients who had stump appendicitis as diagnosis and those who underwent completion appendicectomy were included. There were no exclusions. Details pertaining to presentation, duration of symptoms, records of previous surgery, perioperative and postoperative data was recorded, including follow-up of at least six months.Results: All 15 patients were managed by laparoscopic completion appendicectomy. Patients age range from 12 to 58 years, 12 were males and 3 female, duration of symptoms was from two to ten days, previous appendicectomy was done 4 to 84 months before, nine were diagnosed by ultrasonography of abdomen and six by CT scan, stump size ranged from 1 to 3.6 cm, mean operating time was 86.4 mins (range, 60-120 minutes). Duration of hospital stay was 3 to 5 days. There were no perioperative morbidity or mortality.Conclusions: Laparoscopic approach of completion appendicectomy is safe for management of stump appendicitis.

Accidental aspiration of endodontic file: a dreaded but a preventable complication

Accidental ingestion of dental objects has been reported previously in literature. Accidental aspiration of a dental object is however uncommon. The affected patient may exhibit varying range of symptoms depending on location, type, shape and size of the foreign body swallowed/aspirated. We report a case about successful retrieval of an aspirated endodontic file with special focus on risk factors, prevention and management of these iatrogenic complications.

Study the association between platelets count and grades of oesophageal varies in patients of cirrhosis of liver with portal hypertension

Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.

To Study the Association between Splenic Size and Grades of Oesophageal Varices in Patients of Cirrhosis of Liver with Portal Hypertension.

Chronic liver disease develops when the functional capacity of the liver is deranged, and it is not able to maintain normal physiological conditions. This study was carried to find out the association of portal vein size with gastro-oesophageal varices in diagnosed cases of cirrhosis of liver, so that this parameters can be used in predicting propensity to oesophageal varices non-invasively, and thus help in starting prophylactic therapy earlier to prevent bleeding and other complications of varices.METHODS100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were included for the study. Ultrasonography was done in all cases to find out the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was performed to see the presence of oesophageal varices of different grades. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient. p Value of <0.05 was considered for significant.RESULTSAmong 100 patients studied, 90% patients were found to have oesophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 oesophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of splenic diameter with grades of oesophageal varices, it was found that patients with splenic diameter >13 cm had higher grades of oesophageal varices i.e. 32 patients were grade 2 and 18 patients were grade 3, with p<0.001 and was found highly significant.CONCLUSIONSIn this study, we found that with increasing spleen size there are chances of formation of higher grades of oesophageal varices and both are also having positive association.

A prospective hospital based study of relation between carotid artery intimal medial thickness in patients with type 1 diabetes

Background: The aim of this study was to found association between Type 1 Diabetes Mellitus and Carotid Arterial Intimal Thickness (CIMT).Methods: Study design: It was a prospective case control hospital-based study. One hundred type 1 diabetes patient between the age group 3-36 years were taken. The association between type 1 diabetes with CIMT was studied. All the measurements were standardized. 50 age and sex matched controls were taken for comparison.Results: There is positive correlation between type 1 diabetes and CIMT (p<0.0001). The correlation further extends between duration of diabetes, glycemic control, age of onset, frequency and severity of diabetic related complication with CIMT.Conclusions: Carotid atherosclerosis as measured by CIMT has definite association with type 1 diabetes.

Does Cereal crops asymmetrically affect Agriculture gross domestic product in Pakistan? Using NARDL model approach / As colheitas de cereais afetam assimetricamente o produto interno bruto da agricultura no Paquistão? Usando a abordagem do modelo NARDL

ABSTRACT: This study contributes to the extant literature on the nexus among rice, maize and wheat production with agriculture gross domestic product (AGDP) of Pakistan. We use time series data from 1970 to 2017 and employ the Non-linear Autoregressive Distributed Lag (NARDL) model. Short run and long run shocks between the selected variables and result's is checked through the co-integration and nonlinear error correction model.Autoregressive distributed lag bound testing approach for co-integration and to find the relationship between variables Granger causality test is applied.Our results confirm co-integration, positive shocks results show that rice, maize and wheat production have significantly influence on AGDP. The asymmetrically positive shocks of three crops have neutral effect on AGDP. While in symmetric results show the unidirectional effect between rice, maize production with AGDP and wheat production do not have ganger causality with AGDP. Finally, results depict that wheat, maize and rice production significantly contributes to agricultural GDP in the case of Pakistan.

RESUMO: Este estudo contribui para a literatura existente sobre o nexo entre a produção de arroz, milho e trigo com produto interno bruto agrícola (AGDP) do Paquistão. Utilizamos dados de séries temporais de 1970 a 2017 e empregamos o modelo NARDL (Non-linear Autoregressive Distributed Lag). Choques de curto e longo prazo entre as variáveis selecionadas e os resultados são verificados por meio do modelo de co-integração e correção não linear de erros. É aplicada uma abordagem de teste de atraso retardado distribuído autorregressivo para co-integração e para encontrar a relação entre variáveis. Nossos resultados confirmam a co-integração; os resultados de choques positivos mostram que a produção de arroz, milho e trigo influencia significativamente na AGDP. Os choques assimétricos positivos de três culturas têm efeito neutro no AGDP. Enquanto nos resultados simétricos mostram o efeito unidirecional entre o arroz, a produção de milho com AGDP e a produção de trigo não têm causalidade de ganger com AGDP. Finalmente, os resultados mostram que a produção de trigo, milho e arroz contribui significativamente para o PIB agrícola no caso do Paquistão.

The impact of agriculture trade and exchange rate on economic growth of Pakistan: an NARDL and asymmetric analysis approach / O impacto do comércio agrícola e da taxa decâmbio no crescimento econômico do Paquistão: uma abordagem de análise NARDL e assimétrica

ABSTRACT: This study contributes to the extant literature on the nexus among agriculture export, import exchange rate and economic growth in Pakistan. We used annual time series data for 1980-2017 and employ the Non-linear Autoregressive Distributed Lag (NARDL) model. The NARDL testing results affirms asymmetric co-integration among the variables. The study main results show: (i) Co-integration test for long run the positive shocks in export and import have positive significant while exchange rate has positive effect the economic growth. (ii) Co-integration test for short run the positive shocks in import has positive significant and while Export and exchange rate have negative significant effect on economic growth. The symmetrical results show: (i) Export has unidirectional granger causality (ii) Exchange rate has bidirectional granger causality (iii) Import has not ganger causality with economic growth. In addition, the results demonstrated that causality relationship can help out policy maker to design such policies which are useful to economic growth of Pakistan, which could further promote foreign trade to gain the maximum level of economic growth.

RESUMO: Este estudo contribui para a literatura existente sobre o nexo entre exportação agrícola, taxa de câmbio de importação e crescimento econômico no Paquistão. Utilizamos dados de séries temporais anuais para 1980-2017 e empregamos o modelo Não-linear Autoregressive Distributed Lag (NARDL). Os resultados dos testes NARDL afirmam a co-integração assimétrica entre as variáveis. Os principais resultados do estudo mostram: (i) no teste de co-integração de longo prazo, os choques positivos nas exportações e importações têm uma significância positiva, enquanto a taxa de câmbio afeta positivamente o crescimento econômico; (ii) Teste de co-integração para curto prazo, os choques positivos nas importações são positivos significativos e, enquanto a exportação e a taxa de câmbio têm um efeito negativo significativo no crescimento econômico. Os resultados simétricos mostram: (i) a exportação tem causalidade unidirecional sobre o crescimento ; (ii) a taxa de câmbio tem causalidade bidirecional sobre o crescimento ; (iii) a importação não tem causalidade sobre o crescimento econômico. Além disso, os resultados demonstraram que a relação de causalidade pode ajudar o formulador de políticas a elaborar políticas úteis ao crescimento econômico do Paquistão, o que poderia promover ainda mais o comércio exterior para obter o nível máximo de crescimento econômico.

Comparative study of safety and efficacy of pregabalin and gabapentin in management of neuropathic pain associated with chronic lumbar radiculopathy

Background: Chronic lumbar radiculopathy a clinical condition in which there is back and leg pain associated with sensory, reflex, or motor deficits in the area of nerve root distribution lasting for more than 12 weeks. The prevalence of lumbar radiculopathy has been reported to be 5.3% in men and 3.7% in women. Pregabalin and gabapentin, which fit in to a new category of drugs called as alpha-2-delta (?2?) modulators, have been discovered to be effective in the treatment of neuropathic pain related with multiple conditions. So this study was done to compare safety and efficacy of pregabalin and gabapentin in management of pain associated with chronic lumbar radiculopathy.Methods: This was a randomized two arm comparative prospective study. Total 160 patients were enrolled and randomized equally into 2 groups. Group A patients were given capsule pregabalin 75 mg two times a day orally, Group B patients were given tablet gabapentin 300 mg two times a day. Pain intensity was assessed at the start of study i.e. at baseline (0 week), at 6 weeks and at 12 weeks of starting the treatment using numeric pain rating scale.Results: There was significant reduction in pain at the end of 12 weeks in both the groups (p<0.0001), but there was no significant difference between these two groups. The incidence of adverse effects was also more in group A.Conclusions: Both the drugs are having comparable efficacy but gabapentin is more tolerable in such cases.

Secondary cleft deformities: case report and review of literature

The aim of this paper is to highlight the iatrogenic aspect of secondary cleft deformity, methodologies to treat them and the importance of reporting such cases. Secondary deformities are common in cleft lip and palate patients. Primary aim of treatment incleft patients is to enhance their normal growth and development and minimize morbidity and number of operative procedures. Meticulous diagnosis, treatment planning and execution of primary surgery are of utmost importance in such cases to prevent majority of secondary deformities. Treatment of secondary deformity depends on the degree of deformity and the severity of impact on normal functions and growth. Following is a case of 16-year-old female patient who incurred secondary cleft deformities after undergoing multiple surgical interventions for congenital bilateral cleft lip alveolus and palate, last of which was conducted at the age of 6 years. Lip revision and tongue flap surgeries to close the palatal fistula were performed to address the patient‘s complaint and improve quality of life. Performing a tongue flap for anterior palatal fistula was more successful than Bardach‘s palatoplasty technique.It is important that each case encountered at various congenital defect care facilities is reported in literature to make the masses aware of probably outcomes and also help maintain a database to have more accurate data of such cases.

Intravitreal dexamethasone as an adjunct for the treatment of dengue virus related maculopathy: a case report

Dengue infection related ocular pathology whether as a direct manifestation of coagulopathy or as a sequale of immunological reaction is being increasingly recognized in endemic regions and has expanded out into a spectrum with pan ocular presentation. Authors present a case of a young female from an endemic region who developed visual field abnormality and loss of vision several days after onset of fever. She was diagnosed with dengue virus infection and subsequently went on to develop thrombocytopenia requiring transfusion. Detailed ophthalmological evaluation revealed maculae edema, and changes consistent with neuroretinitis and posterior segment vasculitis. She was treated with a combination of pulse steroid therapy and intravitreal dexamethasone injection. Patient went on to have excellent visual recovery on follow up with no persisting visual field deficit.

A comparative study of efficacy and tolerability of doxofylline over other methylxanthenes in mild to moderate persistent bronchial asthma patients in a tertiary care hospital

Background: Studies have shown that doxofylline is endowed with a remarkable bronchodilator activity with less extra respiratory effects than other methylxanthines. To compare the efficacy and tolerability of doxofylline over other methylxanthines in mild to moderate persistent bronchial Asthma patients.Methods: It is a comparative study conducted in patients of mild to moderate persistent bronchial Asthma in the outpatient department of regional chest hospital. The subjects were randomly assigned into 2 groups, one group treated with oral doxofylline and the other with theophylline oral or Deriphylline. Efficacy was measured objectively using spirometric parameters like FEV1 (Forced Expiratory Volume at the end of 1 second), FVC (Forced Vital Capacity), FEV1/FVC and PEFR (Peak Expiratory flow Rate), Subjectively by the Asthma control test questionnaire, subjective rating of Asthma control and the need for use of rescue medications like β2 agonists in the previous four weeks. Tolerability were done at base line and at the end of study.Results: Doxofylline compared to other methylxanthines groups was statistically better with respect to subjective parameters like Asthma control tests questionnaire, subjective rating of Asthma control. Doxofylline had equal efficacy with spirometric parameters compared to other methylxanthines. Doxofylline was significantly better tolerated with adverse drug reactions noted in 10% compared to 28% in other methylxanthins group.Conclusions: Doxofylline with better tolerability profile and equivalent efficacy seemed to be a good alternative to other methylxanthines in the treatment of bronchial Asthma.

Lipohypertrophy due to HAART: a case series

A subset of HIV-1 infected patients undergoing Highly Active Antiretroviral Therapy (HAART) develops a lipodystrophy syndrome. It is characterised by loss of subcutaneous adipose tissue (face, limbs and buttocks) visceral fat accumulation and lipomatosis especially in dorsocervical area. In addition these patients show metabolic alteration implicative of metabolic syndrome particularly dyslipidaemia and insulin resistance. These alterations lead to enhanced cardiovascular risk and favour the development of diabetes in such patients. A complex combination of HIV infection, drug treatment related events and lipotoxicity appears to contribute to the development of lipodystrophy syndrome. Active lipolysis in subcutaneous fat combined with impaired storage capacity in subcutaneous depot leads to ectopic deposition of lipids either in visceral or in non-adipose sites. Lipotoxicity, a pathogenic factor in the lipodystrophy syndrome should be considered in the strategies for treating and /or preventing the morphological alterations and systemic metabolic disturbances associated with lipodystrophy.

A case series of cefixime induced Steven抯 Johnson Syndrome

Drug induced adverse reactions are a major health problem. Drug hyper sensitivity reactions manifest themselves in many diseases, of which some are very severe. The most common allergic reactions occur in the skin. Stevens-Johnson syndrome is mainly caused by drugs (antimicrobials e.g.: penicillin抯, sulphonamides and cephalosporin抯 e.g.: cefixime, antiepileptic抯, NSAIDS), infections and also by other risk factors not yet identified. The most common allergic reactions occur in the skin. These reactions ranging from simple pruritic eruptions to potentially life threatening events are a significant cause of iatrogenic morbidity and mortality. Identification of the cause, withdrawal of the trigger and supportive management is crucial to improve the patient state. Despite of all therapeutic efforts, mortality is high and increases with disease severity, patient抯 age and underlying medical conditions. Survivors may suffer from long-term squeal such as strictures of mucous membranes including severe eye problems.

Drug utilization study in OPD of a tertiary care hospital in a rural area of Jalna, Maharashtra, India by using WHO prescribing indicators

Background: Drug utilization studies (DUS) are used as potential tool in the evaluation of healthcare system. DUS are conducted to facilitate the rational use of drugs in populations. The indicators of prescription in practice measure the performance of health care provider in several key dimensions related to appropriate use of drug. Therefore, the present study was undertaken to analyze the prescription written by doctors in a Tertiary Care Hospital in rural area.Methods: Present study is a cross sectional, prospective and observational study. The study was conducted in a rural tertiary, teaching hospital at JIIU’s Indian Institute of Medical Science and Research, Warudi, Taluka Badnapur from January 2017 to September 2017 for duration of 9 months. Data was obtained from 300 prescriptions. Data was analysed as per WHO prescribing indicators.Results: Average number of drugs in the present study was found to be 2.85. Percentage of drugs prescribed by generic name is 13.48%. Percentage of encounters with an antibiotic prescribed 60%. Percentage of encounters with an injection prescribed 4.33%. Percentage of drugs prescribed from essential drugs list 72.91%.Conclusions: These types of studies help to design policy for rational use of drugs and motivation of physician for rational use of drugs.

Surgery for tetralogy of fallot in adults: early outcomes

Abstract Objective: To study the in-hospital outcome of adult patients who had undergone surgical repair for Tetralogy of Fallot. Methods: A retrospective descriptive study was conducted at the Punjab Institute of Cardiology searching the hospital records. All those adult patients who had undergone repair for Tetralogy of Fallot from January 2012 to December 2014 were included in the study. All the patients were operated by the same surgical team. Patients who underwent primary repair as well as those with previous palliative procedures were included in the study. Thirty days outcome was studied by recording variables from the database. Data was analysed using Statistical Package for Social Sciences version 16. Results: A total of 80 patients was included in the study, in which there were 48 (60%) male patients and 32 (40%) female patients. Mean age was 21±0.21 years. Those with previous palliation were 15 (18.75%). The associated problems observed were: atrial septal defect 27 (33.75%), right aortic arch 30 (37.5%), patent ductus arteriosus 6 (7.5%) and double outlet right ventricle 3 (3.75%). In-hospital mortality recorded was 7 (8%). Postoperative complications encountered were low cardiac output syndrome 9 (11.25%), pleural effusion requiring tapping 3 (3.75%), reoperation for bleeding 3 (3.8%), pulmonary regurgitation (moderate to severe) 20 (25%) which occurred in the transannular patch group only and atrial arrhythmia 4 (5%). Conclusion: A large number of adult patients are still operated for tetralogy of Fallot in Pakistan. With increasing experience in the technique the mortality and morbidity is comparable to international literature.