Efficacy of nitrates and calcium channel blocker in prevention of radial artery spasm during coronary angiographies

Background: radial artery vasospasm is the most frequent complication of transradial cardiac catheterization. It causes discomfort and pain to the patient, prolongs the procedure and even makes it impossible for the interventionist to continue the procedure

Objective: to evaluate the efficacy of combined use of nitrate and calcium channel blocker [Verapamil] in prevention of radial artery spasm during coronary angiographies

Study design, settings and duration: it was a case control study conducted among 100 cardiac patients undergoing coronary angiography in Rehman Medical Institute [RMI] Peshawar from the duration of January 2016 to December 2016

Subjects and Methods: sample selection was done through convenient non probability sampling technique. Written informed consent was taken from the patients included in the study. Patients were divided into two group's control [50] and experimental [50]. One group was treated with heparin/nitrate as control group while other group was treated with heparin/nitrates/verapamil [Calcium channel blocker] as experimental group. Both groups were checked for radial spasm, pain and catheter resistance during angiography procedure. All other demography and history were collected through using a predesigned questionnaire. Data was collected, analyzed using SPSS version 16

Results: it was found that 63% patients were male, 37% were female and 68% cardiac patients were above the age 50 years. The study provided that using Verapamil as calcium channel blockers with nitrate does not put a significant effect on radial spasm with p value 0.806. The study provided that in comparison of cases and control for different variable, no significant difference was observed for radial spasm, pain, outcome, catheter resistance and time taken by the procedure. However the outcome of procedure was 100% successful among test group than control [98%]

Conclusion: calcium channel blocker [Verapamil] use with nitrate provided no significant difference in lowering radial spasm during coronary angiography. The assumption of using calcium channel blocker against radial artery spasm during angiography nullified

Policy message: economic burden due to use of calcium channel blockers along with nitrate during coronary angiograph

Knowledge, attitude and practices of Pakistani women regarding Breast Cancer

Objective: To assess the knowledge, attitude and practices of Pakistani women about breast cancer

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Sep 2012 to Feb 2013

Material and Methods: Two hundred adult female patients and their accompanying attendants were randomly selected [Those with breast complaints were excluded] in outpatient department of military hospitals and were interviewed. In order to gather data patients were asked to reply through a questionnaire along with their demographic profile structure questionnaire, comprising of 28 questions [included both open and closed ended], was used to collect data which was analyzed in the end with the help of SPSS version 15

Results: Mean age of participants was 37.5 +/- 7.5 years. Majority were married [87 percent], housewives [89 percent] with average family income of Rupees 15000 [53 percent]. Majority 94 percent [n=188] had heard about breast cancer. Questions regarding knowledge showed that participants awareness about relationship of breast cancer with obesity, smoking and increasing age was more than 50 percent. Up to 70 percent women had knowledge of breast lump as main symptom of breast cancer. Knowledge regarding diagnostic modalities was very poor. Only 16 percent knew about FNAC/Biopsy and 7.5 percent about mammography. A large majority [90 percent] showed positive attitude and were ready to see a doctor immediately in case they felt a lump in breast but practices of breast self-examination were poor [39 percent]

Conclusion: It was concluded that knowledge of most respondents was limited, practices were poor, but attitude towards breast cancer was positive. Lack of education, socio-cultural taboos and getting information from wrong sources surfaced as leading reasons of unawareness

Factors affecting serum ferritin level in school going children of district Bannu

To investigate the factors affecting serum ferritin level in school going healthy children in Distt Bannu, Khyber Pakhtunkhwa and to know the potential risk in children associated with hypoferritinemia, leading to microcytic hypochromic anemia in our population. This cross sectional study was carried out at Institute of Kidney Diseases [IKD] Hayatabad Medical Complex Peshawar in one year time from March 2010- March 2011. A total of 113 healthy children of both genders were selected with no history of bleeding, blood transfusion, any extensive surgery or infections. 05cc blood sample was taken from each child. Out of which, 03cc were used for ferritin estimation by using the Roche Elecsys 2010 Immunoassay Analyzer, while 02cc were used for basic hematological examination, using Sysmex k-1000. There was no significant relationship between serum ferritin of boys and girls [p>0.05].However boys had high ferritin level as compared to girls. While comparing serum ferritin in rural and urban areas it has been observed that serum ferritin was high in rural areas. Moreover serum ferritin was positively correlated with hygienic conditions [p=0.01] and dietary intake [p=0.00]. The finding of our study reveals that serum ferritin level is quite low in female population in both urban and rural areas, hence anemia and low iron status are more prevalent in female population. Environmental conditions, socioeconomic factors and diet habits are the main factors, which affect ferritin level in children

Lipoprotein abnormalities and body mass index differences in type 2 diabetic postmenopausal women in tertiary care hospitals of Peshawar

Objective: to detect serum lipoprotein abnormalities and body mass index differences in type 2 diabetic post menopausal women compared to controls

Material and Methods: this case control studywas conducted at tertiary care hospitals of Peshawar, that is Hayatabad Medical Complex, Khyber Teaching Hospital, and Lady Reading Hospital over a period of two years i.e., from July 2005 to July 2008. One hundred and fifty diagnosed diabetes type 2 post menopausal females compared with fifty non diabetic post menopausal healthy controls were included. Determination of glucose, total cholesterol, high density lipoprotein cholesterol were assessed by enzymatic lab technique [Elitech] using micro lab 200 [Merck], and low density lipoprotein cholesterol was determined by Friedewald formula

Results: the results indicated highly significant difference between the biochemical indices of cases and controls which included elevated levels of LDL-C [p=0.001], reduced levels of HDL-C [p=0.001] and triglycerides [TG] above the target levels [p=.000]. Body Mass Index showed significant change in diabetic postmenopausal females as compared to controls. [p<0.015]

Conclusion: dyslipidemias in post menopausal diabetic females are more prevalent. Lipoprotein abnormalities are a risk factor for cardiovascular diseases which becomes more prevalent with the loss of estrogens and the decrease in High density lipoprotein [HDL] cholesterol levels that occurs concurrently with menopause

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

Hypertensive left ventricular hypertrophy [LVH] is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 [31.2%] men and 344 [69%] women >30 years of age in the study. Among them 177 [35.4%] were diabetic, 224 [45%] were dyslipidemia, 188 [37.6%] were smokers, and 14 [3%] had homocysteinemia. Duration of hypertension [HTN] was >/= 2 years]. Mean systolic BP [SBP] was 180 +/- 20 mm Hg and diastolic BP [DBP] was 95 +/- 12 in male and female patients. Left ventricular mass index [LVMI] was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 [25%] male and 299 [59.8%] female patients. Atrial fibrillation was noted in 108 [21.6%] male and 125 [25%] female patients, 30 [6%] male and 82 [16.4%] female patients had atrial flutter. Ventricular tachycardia was noted in 37 [7.4%] male and 59 [11.8%] female patients. Holter monitoring showed significant premature ventricular contractions [PVC'S] in 109 [21.8%] male and 128 [25.69%] female patients while Holter showed atrial arrhythmias [APC'S] in 89 [17.8%] males and 119 [23.8%] females. Angiography findings diagnosed coronary artery disease in 119 [23.8%] with CAD male and 225 [45%] without CAD while 47 [9.4%] females presented with CAD and 109 [21.8%] without CAD. A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH

Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases

Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction [STEMI]. Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction [AMI]. The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase [SK] were enrolled in the study. Of the total 1023, 689 [67.3%] patients were males and 334 [32.6%] were females. Six hundred and twenty-nine [61.5%] were successfully resolved after thrombolytic therapy while in 395 [38.5%] patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve [30%] and 444 [43.4%] with complete resolution, 344 [33.62%] and 325 [31.76%] with partial resolution, 367 [35.8%] and 491 [19.29%] were with no resolution at 60 and 90 minutes respectively. Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution

Percutaneous coronary intervention of osteal lesions in newly established tertiary care cardiac hospital

To assess the outcome of percutanious Angioplasty in patients with osteal lesions in Coronary artery Diseases. This is a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases [KIHD], a tertiary referral center in Karachi, Pakistan, between the periods August 2006 to August 2008. Fifty patients were enrolled which included thirty-five men and fifteen women and all were >40 years of age. Each patient had a single target osteal lesion: twenty nine patients underwent PCI for ostial LAD lesion [among them twenty males and nine females], six had ostial LCX [five males and one female], and fifteen patients had osteal RCA stenosis [10-male patients and 5- female patients]. After high-pressure balloon dilatation residual stenosis was reduced. Twelve patients were treated with bare metal stents [BMS] while thirty eight with drug eluting stents [DES]. In all cases the procedure was successful without any pre and post procedural complications. A key issue in the treatment of an osteal lesion is to assure that the stent is inserted proximal enough to fully cover the osteal junction. Improvements in technique, equipment, adjunctive drug therapy and better understanding of the procedure have remarkably changed the practice of interventional cardiology

frequency of HBV, HCV and HIV in patients undergoing percutaneous mitral valvuloplasty

Objective: Determine the frequency of Hepatitis B, C and HIV in patients undergoing mitral valvuloplasty with multitrack balloon catheters

Methods: This was a cross sectional study in which 100 consecutive patients of both sexes underwent percutaneous Mitral Valvuloplasty with multi track balloons catheters at the National Institute of Cardiovascular Diseases Karachi from January 2003 to December, 2004. The Viral markers of Hepatitis B Surface Antigen and Antibodies against Hepatitis C and HIV was done in all patients undergoing PTMC prior to procedure

Results: Out of 100 patients undergoing PTMC with multi track balloon catheters, 78 patients were females while 22 of them were males. Screening of these patients showed that 14% of them were Sero positive for HBV while 8% positive for HCV. None of screened patients were HIV positive

Conclusion: 1] The frequency of hepatitis B, C and HIV in patients undergoing PTMC [14% and 8%], as compared to normal population [2.56% for HBsAg] and [5.31% for anti-HCV] respectively. 2] In our country most of patients are non-affording and we have to reuse balloon catheters, so it should be mandatory to screen hepatitis B, C and HIV before undergoing invasive procedures. Balloon used in seropositive patients should be discarded. 3] National guidelines regarding reuse of various hardwire and other preventive measures are mandatory for patient's safety