Frequency of modifiable risk factors about coronary artery disease in an urban female

Objective: To determine frequency of modifiable risk factors about coronary artery disease in an urban female population of Sargodha city of Punjab province of Pakistan

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the urban female population of Sargodha city of Punjab province of Pakistan from March, 1[st] to 30[th] 2016

Materials and Methods: This study was carried out to identify frequency of modifiable risk factors about coronary artery disease in an urban female population of Sargodha city. All 100 married female apparently healthy participants; 25-60 years of age were included

Results: The mean age of subjects was 36.02 +/- 10.02 years. The frequency of smoking [27%] was expressively advanced in study population, sedentary lifestyle [19%] obesity [25%], use of salt [16%] and use of fat [13%] respectively

Conclusion: The current research concludes a reduced information related to modifiable threat aspects regarding coronary artery disease in the urban feminine populace. Consequently, there is a speedy prerequisite to initiate actions to educate peoples of this group in relation of changeable risk features so that those at high risk for upcoming patients of controllable coronary artery disease can be coped

Knowledge regarding modifiable risk factors about coronary artery disease in an urban male population

Objective: To ascertain knowledge of modifiable risk factors about coronary artery disease in an urban male population of Sargodha city; Pakistan

Study Design: Observational / cross sectional study

Place and Duration of Study: This study was carried in urban male population of Sargodha city, Pakistan from November, 1[st] to 30[th] 2015

Materials and Methods: This study was carried out to recognize knowledge of modifiable risk factors about coronary artery disease in an urban male population of Sargodha city. All 100 married male apparently healthy participants; 25-60 years of age were included

Results: The mean age of subjects was 40.12 +/- 10.22 years. The frequency of smoking [28%] was significantly higher in study population, sedentary lifestyle [5%] obesity [22%], use of salt [17%] and use of fat [8%] respectively

Conclusion: The present study determines a poor knowledge of modifiable risk factors regarding Coronary artery disease in the urban male population. Therefore, there is an immediate need to initiate measures to raise awareness of these modifiable risk factors so that individuals at high risk for future Coronary artery disease can be managed

Culprit artery characteristics and severity of angiographic thrombus burden in primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction

The purpose of study was to characterize culprit artery characteristics in terms of presence of thrombus burden in patients with acute myocardial infarction using prevalent parameters of thrombus estimation. Descriptive study. Adult cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] October 2011 to 31[st] September 2012. We studied 119 patients treated with primary percutaneous coronary intervention for ST- segment myocardial infarction. Bare metal stents were used in all patients as per hospital protocol. Thrombus burden [TB] was graded [G] as GO = no thrombus, G1= possible thrombus, G2 = small [greatest dimension <, 1/2 vessel diameter [VD]], G3 = moderate [>1/2 but <2 VD], G4 large [>2 VD], G5 = unable to assess TB due to vessel occlusion. Patients with G5 were reassessed after passage of guide wire or small balloon for thrombus burden. Frequency of major adverse cardiac events [MACE]-defined as death, myocardial infarction and infarct- related artery revascularization was recorded for the pen-procedural period which was defined in our study up to 72 hours. Overall, in hospital MACE was 8.4%. Large thrombus burden is a significant predictor for mortality and MACE

Frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty

To determine the frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty. Descriptive study. Armed forces Institute of Cardiology / National institute of Heart Disease Rawalpindi from June 2012 to Nov 2013. Hundred patients undergoing elective single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before, after 8 hours and 24 hours following coronary angioplasty. The detailed performa was filled from each patient covering the necessary variables. Out of 100 patients 22% had raised creatinine kinase at 8 hours and 43% had raised creatinirie kinase after 24 hours following coronary angioplasty. Whereas 19% patients and 38% patients had raised creatinine kinase MB levels at 8 hours and 24 hours following the procedure respectively. No patient had rise of creatinine kinase or creatinine kinase MB more than 3 times of normal limits in the study. Among patients with raised CK-MB highest frequency was of diabetes mellitus, raised LDL levels, smoking and hypertension. Patients with raised CK-MB levels after 1[st] day of coronary angiography had diabetes mellitus [84%], raised LDL levels [79%], smoking [68%] and hypertension [58%]

Procedural outcome of primary PCI inst-segment elevation myocardial infarction at Afic and Nihd Rawalpindi - Pakistan

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results

Diacetylmorphine [heroin] body packer presenting with respiratory arrest

Intracorporeal concealment of illicit drugs known as 'body packing' is uncommonly reported. A body packer with swallowed capsules containing Diacetylmorphine [heroin] for smuggling purposes presented with respiratory arrest and recovered after ventilatory support and nalaxone infusion

Myocardial damage in successful single vessel coronary angioplasty as assessed by creatinine kinase and its myocardium band lsoenzyme levels

To determine the frequency of myocardial damage in elective, successful, single vessel percutaneous coronary angioplasty by assessing myocardial band [MB], creatinine kinase levels and to find out the association of common modifiable risk factors with myocardial damage in patients undergoing single vessel coronary angioplasty. Descriptive. Armed Forces Institute of Cardiology / National Institute of Heart Disease, Rawalpindi, from September 2006 to September 2007. Fifty patients undergoing elective and successful single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before and after 8 hours and 1[st] day following coronary angioplasty. Studied variables included the length of stent deployed, maximum deployment pressure and total balloon inflation time, apart from hypertension, cholesterol level, smoking and diabetes mellitus. Out of 50 patients, 9 had raised creatinine kinase at 8 hours [18%] and 10 had raised creatinine kinase [20%] on 1[st] day following coronary angioplasty, 7 [14%] patients and 8 [16%] patients had raised creatinine kinase MB levels at 8 hours and 1st day following coronary angioplasty respectively. The rise of either was equal to or more than 3 times the normal limits. Modifiable risk factors, significantly associated with myocardial damage, were diabetes mellitus [p=0.006] and LDL levels [p=0.009] in patients undergoing single vessel coronary angioplasty. Successful elective, uncomplicated, single vessel coronary angioplasty resulted in some myocardial damage evident by mild rise in cardiac enzymes but rise of creatinine kinase MB above 3 times of normal, which signifies percutaneous coronary angioplasty-related myocardial infarction, was not seen. There was a significant association between diabetes mellitus, LDL levels and myocardial damage in patients undergoing coronary angioplasty but no significant association was found between hypertension, smoking and myocardial damage

Coronary artery anomalies; An AFIC/NIHD experience

Introduction: Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population1. The incidence of various coronary anomalies and associated clinical, angiographic and hemodynamic findings have been cited in several internationally published clinical series4-8. To compare our experience with previously reported studies, we have reviewed clinical and angiographic findings for 50 adult patients with coronary artery anomalies. We surveyed the records of 5050 consecutive adult patients who had undergone coronary angiography. Armed Forces Institute of Cardiology and National Institute of Heart Disease [AFIC/NIHD] Rawalpindi. 1[st] Jan 2004 and 30th April 2005, and identified 50 adults with various coronary artery anomalies. 5050 reports were reviewed and 50 [0.9%] coronary artery anomalies were identified in 50 patients. Different anomalies identified are; both coronary arteries from right sinus of Valsalva [RSV]-[n = 1], both coronary arteries arising from the left coronary sinus [n = 4], single coronary arteries [n = 2], LCx from RSV/RCA [n=6], anterior descending artery arising from the right coronary sinus [n = 1], coronary artery fistulae [n = 4], separated origin of anterior descending and left circumflex coronary arteries [n = 25], and separate origin of conus/ RV branch [n = 7]. The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, and anterior in the anterior descending arteries. We conclude that adult congenital anomalies of the coronary arteries are not uncommon finding in a tertiary care cardiac center. Separate origin of LAD and LCx from LSV and left circumflex coronary artery arising from RSV/RCA are the most frequently diagnosed anomalies

Diagnostic role of endoscopy; an experience at Faisalabad

To see the usefulness of Endoscopy in patients with various gastrointestinal manifestations. Prospective study. Department of medicine and gastroenterology Allied Hospital Faisalabad January 2005 to July 2005, This study was conducted on 500 patients presented to us with various gastrointestinal manifestations of either sex and between 13-70 years. 260 patients were Males and 237 were Females. Most common indication was epigastric pain. 60.4% of the patients had organic lesion. Endoscopy was maximally positive in inpatients [91.86%]. Most common lesion was in stomach i.e. gastritis. Collectively ulcerative lesions came out to be 27.30%. Diagnostic yield of Endoscopy is undoubtedly very high if the patient selection is done in a meticulous way

Lipid-lowering effect of atorvstatin in patients with type-2 diabetes mellitus

Dyslipidemia is an important factor in the causation of macrovascular disease in type 2 diabetics. The role of atorvatatin in the management of dyslipidemia in patients with type 2 diabetes mellitus is not very well elucidated. The Acerican College of Cardiology and American Diabetes Association suggest the aggressive therapy of diabetic dyslipidemia will reduce the risk of coronary heart disease in diabetics and that optmal levels are serum low-density lipoprotein cholesterol <2.60 mmol/L [<100mg/dl], high density lipoprotein cholesterol >1.15 mmol/L [>45 mg/dl] and triglycerdes <2.30 mmol/L [<200mg/dl]. This study was planned to compare the effect of atorvastatin together with behavioral modification and behavioral modification alone, In age, sex and body mass index matched patients with type 2 diabetes mellitus with dyslipidemia, In reaching the target levels of various lipids as suggested by the American Diabetes Association criteria 2001. An open label, prospective study was conducted on 80 patients with type 2 diabetes mellitus, who had fair to moderate glycemic control with a total glycated hemoglobin <10%. The patients in the control group [n=40] were treated with only behavioral modifications like calorie control and daily walking for 30-45 minutes, and no lipid- lowering agent was given. The lipid profile was re-evaluated after 6 and 12 weeks. The patients in the test group [n=40] were advised behavioral modification and given atorvastatin. The starting dose was 10 mg at bed time. After 6 weeks of atorvastatin therapy, a lipid profile was done. If the goal of low-density lipoprotein cholesterol <100 mg/dl and /or triglycerides <200mg/dl and /or high-density lipoprotein cholesterol >45 mg/dl was not achieved, the dose of atorvastatin was increased to 20 mg at bedtime for another 6 weeks. It was observed that low-density lipoprotein dyslipidemia was most prevalent. In the control group, a favourable alteration in lipid levels was brought about but none was statistically significant and the American Diabetes Association goals were not lipid moieties, and the target levels were achieved in 80% of patients after 12 weeks. There was no significant alteration in glycemic control and liver functions. Myopathy was not seen in any patient. In our study, behavioral modification alone did not achieve the larget levels of various lipids in diabetic dyslipidemia as per the American Diabetes Association guidelines. Hence, pharmacological therapy with statins should be resorted to in patients with type 2 diabetes mellitus who carry a high risk of coronary hearts disease. Atorvastatin is a safe and effective lipid-lowering drug

Risk factors for coronory artery disease in Pakistan

The objective of this study was to look for the presence of risk factors in patients with ischemic heart disease [IHD] in the Pakistani population. The study was undertaken in collaboration with the World Health Organization [WHO] and the Ministry of Health, Government of Pakistan. One thousand patients, 25 to 64 years of age, of both genders and with diagnosed coronary artery disease, were questioned and investigated regarding the known risk factors for coronary artery disease. World Health Organization [WHO] MONICA [Monitoring of Trends and Determinants in Cardiovascular Disease] project protocol was followed in diagnosis, questioning and investigations as far as possible. Coronary heart disease [CHD] was much more common in men compared to women in all age groups [78.2% vs. 21.8%]. Relative difference in CHD prevalence between sexes was largest among the youngest subjects [86.5% vs. 13.5%], and smallest among the oldest subjects [73.8% vs. 26.2%]. There were more men aged 50-59 who had CHD [43.2%] compared to other age groups [16.4% and 40.4%]; whereas over half the women [51.4%] with IHD were between 60 and 64. Smoking was much more common in men [57.8% vs. 1.37%]. Total cholesterol was higher [230 vs. 221] and LDL cholesterol was lower [122.66 vs. 130.33] in women, whereas HDL cholesterol was higher in women [43.0 vs. 41.3] compared to men so as to result in the same HDL/total cholesterol ratio in the two genders. With age, total and LDL cholesterol rose whereas HDL cholesterol reduced in both sexes. In all age groups and both sexes, HDL cholesterol was lower than the desirable levels [41.3 in men and 43.0 in women]. Both systolic blood pressure [SBP] and diastolic blood pressure [DBP] were higher than desirable in both men and women and increased further with increasing age [151.2/86.1 to 167.1/102.8 in men and 132.6/79.6 to 165.6/99.7 in women]. Both SBP and DBP were higher in men compared to women although this difference became less marked in the older age groups. BMI was higher among women in all age groups and was more marked in the older age groups [28.4 to 30.1 vs. 28.4 to 33.2]. The prevalence of diabetes mellitus was higher in women with IHD compared to men, in all age groups and increased in both men and women with increasing age but more so in women [5.0% to 16.9% vs. 3.1% to 10.1%]

Takayasu's arteritis

Two patients with takayasu's arteritis are described in whom the diagnosis was proven only on arteriography. The first patient was a young male who presented with fever of unknown origin. The only abnormal physical finding was feeble pulses in the upper limbs, which disappeared completely in the next few days. The second patient, a young female, had a history of fever, arthralgia and pain in the arms on using them. In both cases laboratory tests were not particularly helpful but arteriography showed typical appearance of Takayasu's arteritis. Both cases showed immediate improvement on treatment with prednisolone