Experience with subinguinal cremasteric disruption and venous ligation for varicocele repair

Objective: To evaluate the outcome of subinguinal cremasteric disruption and venous ligation for the treatment of varicocele with regard to improvement in semen parameters, recurrence, hydrocele formation and testicular atrophy. Methods: The clinical study was carried out from December 2011 to June 2019. Fifty-nine patients were included in the study. Varicocele repair was done as a day case surgery under local anesthesia using cremasteric disruption and venous ligation technique. The treatment outcomes studied were improvement in semen parameters and complications like recurrence, hydrocele formation and testicular atrophy. Results: Seventy-four varicocelectomies were done in fifty-nine patients. Semen parameters improved in those nineteen patients who had abnormal semen parameters before surgery and nine out of these nineteen (47.36%) got their semen count normal after varicocele repair. There were five recurrences (6.75%). No hydrocele formation or testicular atrophy occurred during one year of follow up. Conclusion: Day case varicocelectomy by subinguinal cremasteric disruption and venous ligation is a simple, economical choice with minimal morbidity and comparable outcomes.

Prevalence and risk factors for work related musculoskeletal disorders among sonographer of Sindh Province Pakistan

Background: The common work related musculoskeletal disorders [WRMDs] among medical profession are pain in neck, elbow, shoulder wrist and back. Sonographers are more vulnerable to develop WRMDs as their work demands series of awkward repetitive movements

Objective: To determine the prevalence of work related musculoskeletal disorders [WRMDs] and to identify factors that may contribute to musculoskeletal disorders among sonologists of Sindh Province Pakistan

Methodology: This questionnaire based study conducted at the Department of Radiology, Liaquat University of Medical and Health Sciences. The target population chosen for this study was sonologists from the Sind province of Pakistan. SPSS used to analyze the data, results presented as frequency for categorical variables and as mean for continuous variables. To identify predictor variable for WRMDs, multiple bivariate regression analysis was performed, the level of significant was set at P <0.05

Results: Among 145 participants, 53.80% were University employed, while 56.54 were performing ultrasonography up to 10 hours. The prevalence of WRMDs disorder in this series was 75.17%, the mean duration of symptoms was 30.48 months. 45.9% reported it as severe. WRMDs were more prevalent and severe in those doing scanning of both abdomen and Obstetric. The Low back ache is the most common site of WRMDs found in this series [53.21%, n=58], followed by neck ache [24.77%] wrist joint [8.25%], finger [7.33%] and shoulder [6.42%]. The result of bivariate analysis showed that severity of WRMDs correlated statistically significantly with primary area of expertise, duration of WRMDs, working experience and working hours

Conclusion: The prevalence of WRMDs and its severity is significantly high among Sonographers of Sindh province

Aberrant Promoter Methylation at CpG Cytosines Induce the Upregulation of the E2F5 Gene in Breast Cancer / 한국유방암학회지

PURPOSE: The promoter methylation status of cell cycle regulatory genes plays a crucial role in the regulation of the eukaryotic cell cycle. CpG cytosines are actively subjected to methylation during tumorigenesis, resulting in gain/loss of function. E2F5 gene has growth repressive activities; various studies suggest its involvement in tumorigenesis. This study aims to investigate the epigenetic regulation of E2F5 in breast cancer to better understand tumor biology. METHODS: The promoter methylation status of 50 breast tumor tissues and adjacent normal control tissues was analyzed. mRNA expression was determined using SYBR® green quantitative polymerase chain reaction (PCR), and methylation-specific PCR was performed for bisulfite-modified genomic DNA using E2F5-specific primers to assess promoter methylation. Data was statistically analyzed. RESULTS: Significant (p<0.001) upregulation was observed in E2F5 expression among tumor tissues, relative to the control group. These samples were hypo-methylated at the E2F5 promoter region in the tumor tissues, compared to the control. Change in the methylation status (Δmeth) was significantly lower (p=0.022) in the tumor samples, indicating possible involvement in tumorigenesis. Patients at the postmenopausal stage showed higher methylation (75%) than those at the premenopausal stage (23.1%). Interestingly, methylation levels gradually increased from the early to the advanced stages of the disease (p<0.001), which suggests a putative role of E2F5 methylation in disease progression that can significantly modulate tumor biology at more advanced stage and at postmenopausal age (Pearson's r=0.99 and 0.86, respectively). Among tissues with different histological status, methylation frequency was higher in invasive lobular carcinoma (80.0%), followed by invasive ductal carcinoma (46.7%) and ductal carcinoma in situ (20.0%). CONCLUSION: Methylation is an important epigenetic factor that might be involved in the upregulation of E2F5 gene in tumor tissues, which can be used as a prognostic marker for breast cancer.

Outcome of partial nail plate and matrix removal [winograd technique] for ingrown toe nail

INTRODUCTION: Ingrown toe nails are one of the common and painful condition of foot. The most common presentation is distal lateral ingrowing. When the conservative treatment fails, problem is recurrent or if the lesion is more severe, surgical treatment is advised. Surgical treatment consists of partial or complete nail excision in combination or without partial matricectomy

This study highlights the results of surgical intervention with Winograd technique

MATERIAL AND METHODS: The study was conducted at Liaquat university hospital and a private practice setup between January 2010 and July 2011.The inclusion criteria was adult patients of either sex with ingrown toe nail in stage two and three involving big toe. A total of 70 patients were enrolled in the study. Sixty five patients with 65 toes were finally registered for follow up. Winograd surgical technique was used for excising lateral 20% to 25% of the ingrown nail with matrix removal. Primary outcome measures were, well healed wound, pain free toe, and no recurrence. Secondary outcome measures were post operative infection and recurrence within one year after surgery

RESULTS: Thirty [46.15%] patients were male and 35[53.85%] female. Their mean age was 27.30 years [range 20 to 45 years]. The mean follow up period was 9.46 Months. Twenty five patients [38.46%] were in stage II and 40[61.54%] were in stage III. Fifty eight patients [89.23%] recovered uneventfully with no postoperative complications. There mean recovery time was, 13.62 days. Early postoperative complications were seen in seven [ 10.76%] patients. Two had swelling and 5 patients [7.69%] develop postoperative infection. These seven patients with infection and swelling recovered in the mean time of 20.71days, whereas all recovered in the mean time of 14.38 days. Recurrence was seen in 4.61% within a mean period of 5 months. With chi square test only 3 cases had recurrence and 62 behave satisfactory with p value of P<0.0001. All the Ten patients [15.38%] who develop complications belong to Heifetz stage III at the time of surgery

Sixty two out of 65 patients [92.30%] were satisfied with the treatment

CONCLUSION: The Winograd technique of partial nail plate and matrix removal is inexpensive, effective, safe and easy to perform. The procedure has low recurrence rate. The postoperative complications are more common in patients presenting with Heifetz stage III disease

How successful is secondary prevention for coronary artery disease [cad] in the real world?

To document the effects of secondary prevention on different risk factors in the real world situation. It was a cross sectional comparative study carried out at a referral cardiac clinic in Peshawar from January 2010 to December 2010. Study subjects presenting with at least 6 months follow up were included from different parts of Khyber Pukhtunkhawa. All patients with positive history or objective evidence of CAD were enrolled. Study subjects were divided in two groups based on the fact that either taking or had stopped medication for the duration of the study period. Study variables were levels of lipids, glucose, blood pressure [BP], smoking and obesity. A total of 843 patients were included in the study. Males were 70.4% [593]. Mean age was 58.74 +/- 10.6 years. Patients taking regular medicine were 69.03% while 30.97% had stopped their medicine for at least three months. Diabetics, hypertensive and positive family history for CAD were 33.4%, 50.25% and 24% respectively. When compared to patient who had stopped medicine, mean systolic BP [p= 0.014], diastolic BP [p= 0.05], mean Cholesterol [p=0.000], mean LDL [p=0.000], mean HDL [p=0.000] and HbA1c% [p=0.049], was well controlled in patients who were taking medicine regularly. Mean BMI [p=0.786], triglycerides and smoking [p=0.761] had no significant difference between the two groups. Blood pressure, serum cholesterol, LDL, HDL, as well as HbA1c% were reduced with little effect on serum TGs, BMI and smoking in those who were taking medicine regularly compared to those who had stopped

Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus

This study compared the efficacy and safety of streptokinase as thrombolytic agent for ST-elevation myocardial infarction [STEMI] in patients with and without diabetes mellitus. This prospective interventional study was carried out in the department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients admitted to coronary care unit with STEMI and eligible for thrombolytic therapy [no contraindications per AHA/ACC guidelines] were studied from December 2009 to December 2010. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution [reduction] of elevated ST segment was evaluated after 90 min of streptokinase administration. Comlications of streptokinase infusion including hypotension, shock and hemorrhage was noted. Failed reperfusion [<30% ST resolution] was significantly higher in diabetic as compared to non-diabetic patients [21.6% vs. 9.5%; p<0.0003] while successful reperfusion [>/= 70% ST-resolution] was significantly higher in non-diabetic than diabetic patients [66.7% vs. 49.1%; p<0.0001]. Complication rates between the two groups were statistically similar. Hypotension occurred in 45 [20.3%] and 51 [23%]; p=0.458 patients in non-diabetic and diabetic group respectively while shock occurred in 10 [4.5%] and 13 [5.9%]; p= 0.506 and hemorrhagic manifestations in 13 [5.9%] and 10 [4.5%]; p=0.294 patients respectively. The outcome of thrombolytic therapy is adversely affected by Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly the risk of hazards associated with thrombolytic therapy is same in both diabetic and non-diabetic patients

Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia

To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >/= 144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences [SPSS Ver. 15.0]. A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +/- 9.748 [95% CI 57.39 - 55.31]. Male were 58.1% [n=198]. The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation [AF] 15.8%, ventricular tachycardia [VT] 11.7%, ventricular fibrillation [VF] 10.9% and complete heart block [CHB] 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema [CPE] 7.9% and cardiogenic shock [CS] 11.7%. Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively

Correlation of functional class of dyspnea with left ventricular diastolic dysfunction

To correlate functional class of dyspnea with left ventricular diastolic dysfunction assessed by echocardiography. This was a single center descriptive study, conducted in Cardiology department Lady Reading Hospital Peshawar from March 2011 to October 2011. All male and female patients of any age with clinical diagnosis of heart failure with sinus rhythm and no to minimal mitral regurgitation were included in the study, using consecutive non-probability sampling technique. Six minute walk test was performed to place the patients in proper NYHA Class of dyspnea. Detailed echocardiographic study was performed to document left ventricular diastolic dysfunction. The data was analyzed on SPSS version 16. Spearman rank correlation coefficient was used to measure the strength of association between pairs of variables. P-value

Echocardiographic findings in hypertrophic obstructive cardiomyopathy [hocm]

To find out various Echocardiographic findings in patients with HOCM. This was a retrospective cross-sectional study performed in Cardiology department Lady Reading Hospital, Peshawar. Data collected from the database computer section of echocardiography department from February 2009 to November 2011.The data was analyzed using SPSS version 14. Total study population was 28. Male were 14 [50%]. Mean age was 52.5_ 15.9 years. Mean left ventricular end diastolic dimension was 3.84cm; inter-ventricular septal thickness 2cm [1.1-3.1] and posterior wall thickness was 1.17cm [0.6-1.6]. Mean Left atrial [LA] diameter was 3.86cm [0.8-5.6]. Mean peak gradient across LVOT was 48.43 mmHg. Mitral regurgitation [MR] was found in 19 [67.9%] patients. MR was mild in 57.1%, moderate in 7.1% and severe in 3.6% of patients. Aortic regurgitation [AR] was found in 13 [46.4%] patients. AR was mild in 35.7%, moderate in 10.7% of patients. Left atrial size was increased in 14 [50%] patients. Mean LA diameter was 4.6cm, 5cm and 5.6cm in patients with mild, moderate, and severe MR respectively. So there was direct relation between severity of MR and LA diameter. The respective mean gradient across LVOT in patients mild, moderate and severe MR was 31mmHg, 43.5mmHg and 140mmHg. So higher the gradient across LVOT, more will be the MR and hence the LA size and the patient will be more symptomatic. HOCM is significantly associated with both MR and AR and there is direct relation between severity of MR with LA diameter and LVOT gradient

Effect of intervention on the control of risk factors in coronary artery disease patients

To assess the effect of optimal medical therapy on the control of risk factors in coronary artery disease [CAD] patients with or with-out intervention. It was a cross sectional comparative study carried out at Lady Reading Hospital, Peshawar January to December 2010. Subjects were divided into two groups based on percutaneous coronary intervention and optimal medical therapy. Study variables were smoking, physical activity, dyslipidemia, diabetes, hypertension and obesity. Informed written consent was taken from all the study participants. Data was recorded on a preformed Questionnaire and analyzed with SPSS version 16. P-value of 0.05 was taken as significant. A total of 315 patients were studied. Baseline characteristic were similar between groups. Smoking was decreased significantly in [PCI group] as compared to [OMT group] [p=0.027]. Physical activity goal >/= 150 min/ week were achieved more in [PCI group] compared to [OMT group][p=0.019]. Goals set for Serum cholesterol, HbA1c%, serum LDL, Systolic blood pressure and Diastolic blood pressure have significantly achieved in [PCI group] as compared to [OMT group] with p- valves of [0.018,0.027,0.023,0.033 and 0.017] respectively. While goals set for Triglycerides, serum HDL and BMI have no significant difference between the two groups with p-valves of [0.223, 0.089 and 0.164 respectively]. Patients who underwent intervention and remained on optimal medical therapy were more adherent to regular exercise and good compliance which lead to better risk factors control for coronary artery disease as compared to patients who remained on optimal medical therapy alone

Post extraction bleeding associated with long term maintenance dose of aspirin 75-150mg

The objective of this study was to see post extraction bleeding associated with long term maintenance dose of aspirin 75mg-150mg without discontinuation. This study was conducted at Lady Reading Hospital Peshawar from January 2009 to June 2010. Patients for simple single tooth extraction and on aspirin [75-150 mg] were included. Patients with systemic disease like hematologic, renal, or liver disease, bone marrow disorders, alcoholism, or any concurrent medication affecting hemostasis such as anticogulants or anti-inflammatory drugs and patients who needed extractions of deciduous teeth, surgical extractions, extractions in different quadrants, or multiple extractions [>1 tooth] were excluded. Patients were evaluated for immediate and late post extraction bleeding. A total of 254 patients were studied. Patients were categorized into two groups with equal number of patients in each group i.e. 127 each. Group 1 [study] on maintenance dose of Aspirin 75-150mg while group 2 [control] were not taking aspirin. In aspirin group 05 [03.93%] patients had post extraction prolonged immediate bleeding while 03 [02.36%] were in control group. This difference was not statistically significant [p=0.722]. In aspirin group 02 [01.57%] patients had late bleeding at 12 hour post extraction while one [0.78%] patient suffered in control group [p=1.00]. The bleeding was successfully controlled with pressure on gauze and no patient required suturing or re-hospital visit. There was no bleeding in post extraction period at 24 and at 48 hours. It was concluded that simple tooth extraction in patients on long term maintenance dose of 75-150mg aspirin without discontinuation is safe as far as post extraction bleeding is concerned

Frequency of coronary heart disease risk factors among nurses

To find out frequency of various risk factors for coronary heart diseases in nurses. This was a cross-sectional study. Nurses working in three shifts at Lady Reading Hospital, Khyber Teaching Hospital, Nursing school of Lady Reading Hospital Peshawar, were included in the study. All participants were interviewed in detail including their family history, past medical history, smoking and dietary history. Pulse, blood pressure, body mass index [BMI] and waist: hip ratio was determined. Their random blood sugar and total cholesterol was checked. Data was analyzed for cardiovascular risk factors using SPSS version 16. A total of 165 nurses were screened and interviewed. Mean age was 40.75 +/- 8.577 years. Mean BMI was 28.80 +/- 4.77. Mean systolic BP was 124.82 +/- 20.91 mm Hg, while mean diastolic BP was 82.45 +/- 13.07 mm Hg. Mean random blood sugar was 128.39 +/- 52.74 mg /dl. Diabetic nurses were 18[10.9%],hypertensive nurses were 31[18.8%], nurses having high cholesterol were 4[2.4%], nurses having documented CAD were2[1.2%], other than above risk factors or conditions were present in 34[20.6%] of the nurses, not having any of the mentioned risk factors or diseases were present in 76[46.1%]. Nurses not having any regular exercise schedule were 104 [63%]. We noticed that among modifiable risk factors hypercholesterolemia, diabetes and hypertension were less frequent in nurses while obesity, physical inactivity and sedentary life style with more duty hours and smoking were more prevalent

comparative analysis of in-hospital left ventricular function in patients with successful or unsuccessful streptokinase thrombolysis following acute myocardial infarction

To compare in-hospital left ventricular function in patients with unsuccessful and successful thrombolysis presenting with acute myocardial infarction treated with streptokinase. This comparative study was conducted at department of Cardiology, Lady Reading Hospital Peshawar, from October 2006 to October 2007. Two hundred patients with first acute myocardial infarction were divided into two groups: group A [successful thrombolysis] and group B [unsuccessful thrombolysis], using ECG criteria. To determine Left Ventricular Function, 2-D Echo was used. Group A included 136 [68%] patients and group B included 64 [32%] patients. Impaired left ventricular function was found in 41 [30.1%] patients in group A and 41 [64.1%] patients in group B [p< 0.001]. Left ventricular failure was present in 31 [22.8%] patients of group A and 30 [46.9%] patients of group B [p=0.001]. Cardiogenic shock was diagnosed in 2 [1.5%] patients in group A and 6 [9.4%] patients in group B [p-0.008]. Presence of LVF is strongly associated with unsuccessful thrombolytic therapy in this group of patients

Health related quality of life after burns: are we really treating burns?

Background: During the last few decades management of burns has undergone positive revolutionary change. Today, over 50% of all patients with burns involving 80% of their total body-surface area can survive. Although the objective assessment by attending physician can well define a patient's degree of health, the patient's subjective perceptions and expectations that can influence burn survivors' experience of their life is much more important. Methods: Adult burn patients of both sexes admitted to burn unit with major burns either by size or site who required reconstruction for burn injury were the subjects of this study. The health related quality of life was assessed using SF-36v2[R], questionnaire. Results: The mild to moderate pain complaint by 87 [88%] of all burn survivors, badly impact role physical and general health with resultant decrease in physical component summary. What was more difficult to explain was the decreased mental health which is evident soon after the incidence and persisted throughout the period of follow-up, showing statistically insignificant improvement whe compared from basal score [p=0.008]. Longitudinal decline in HRQoL had strong relationship with female sex, involvement of prime area, hospital admissions, hospital stay and sessions of surgery. Sex, occupation, involvement of prime area and hospital admissions, were the important predictors for decrease in physical component summary of burn survivors. Involvement of prime area and hospital admissions were important determinant for decrease in mental component summary. Conclusion: The level and quality of multidisciplinary rehabilitation that these victims needs is very low as compared to developed countries. These patients need long term professional, psychological, and social support. Keywords: Quality of Life, Burn Survivors, Health related Quality of Life, subjective health

Impact of hyperinsulinemia on morbidity and mortality following acute myocardial infarction

To study the association of hyperinsulinemia, insulin resistance and its impact on morbidity and mortality following acute myocardial infarction [AMI]. This prospective observational study was carried out at cardiology department, Lady Reading Hospital, Peshawar from May to December 2008. A total of 110 patients with first acute myocardial infarction were assessed for fasting insulin and grouped on the basis of normal or high insulin level. The patients were given standard therapy and evaluated for morbidity and in hospital mortality. More patients in high insulin group were obese [72% vs. 23%, p=0.001], hypertensive [70% vs. 23%, p=0.001], diabetic [70% vs. 16%, p=0.001] and had higher evidence of heart failure i,e Killip class II and III[60% vs. 34%, p=0.04] and Killip class IV[20% vs. 7%, p=0.17]. These patients also had higher fasting glucose [158% +/- 25 vs. 103 +/- 18 mg/dl, p=0.02] and triglyceride [245 +/- 40 vs. 165 +/- 35 mg/dl, p=0.01]. More patients among non survivors had high insulin [80% vs. 38%, p=0.002] in survivor group. Hyperinsulinemia is positively associated with obesity, diabetes, hypertension and higher morbidity and mortaliy following acute myocardial infarction.

Frequency of cardiovascular disease risk factors among doctors

To find out frequency of risk factors for cardiovascular disease amongst doctors. This was a cross-sectional study involving doctors [working at Lady Reading Hospital] recruited in Peshawar Heart Study [PHS]. All participants were interviewed in detail including present and past medical history, family history, smoking, drug and dietary history. Pulse, blood pressure, body mass index [BMI] and waist/hip ratio were measured. Random blood sugar and total cholesterol was checked. A supine resting ECG was recorded. Data was analyzed for frequency of cardiovascular risk factors using SPSS Version 16. A total of 208 doctors were interviewed. Mean age was 30.33 +/- 7.0 years. Mean BMI was 24.69 +/- 4.73.Mean waist size was 84.68 +/- 10.571cm. Mean waist/hip ratio was 0.86 +/- 0.068. Mean systolic BP was 121.82 +/- 13.70 mm Hg while mean diastolic BP was 78.89 +/- 09.36 mm Hg. Mean random blood cholesterol was 163.97 +/- 27.93 mg / dl. Mean random blood sugar was 95.79 +/- 24.57 mg /dl. Most [98.55%] of doctors had random blood sugar of less than 180 mg /dl. The big majority of the doctors was not performing any regular exercise [n=157, 75.5%]. Mean duty hours per day were 8.98 +/- 2.073.Active smokers were 39 [18.8%], while 9 [4.3%] were using Naswar. None of the doctors enrolled in study was drinking alcohol. Among modifiable risk factors hypercholesterolemia, diabetes, and hypertension were less frequent amongst doctors while physical inactivity, obesity, unhealthy eating, and smoking were relatively more frequent

comparative analysis of frequency of in-hospital arrhythmias in patients with successful versus failed thrombolysis following acute myocardial infarction

To compare frequency of in-hospital arrhythmias in patients with successful and failed thrombolysis using streptokinase in patients presenting with acute myocardial infarction [AMI]. This was a comparative study conducted at department of Cardiology, Lady Reading Hospital,Peshawar from October 2006 to October 2007 .Two hundred patients with first AMI were divided into two groups: group A [successful thrombolysis] and group B [failed thrombolysis] using ECG criteria. A total of 200 patients were studied. Group A included 136 [68%] patients while group B included 64 [32%] patients. Among these 24 [12.0%] patients developed arrhythmias. Of these 8 patients were in group A and 16 patients were in group B [5.9% vs. 25.0%, p=0.003].Ventricular tachycardia was the most common arrhythmia. It was documented in 9 [4.5%] patients, with 2 patients in group A and 7 patients in group B [1.5% vs. 10.9%, p=0.003]. The other arrhythmias which included atrial fibrillation, ventricular fibrillation and supraventricular tachycardia were statistically insignificant between the two groups [p=0.174]. In hospital mortality was more common in patients with failed thrombolysis [6 [9.4%] vs. 3 [2.2%] [p=0.023]]. Failed thrombolysis is associated with complex arrhythmias and high in- hospital mortality

Comparision of in-hospital complications between diabetic hypertensive and diabetic normotensive patients with acute myocardial infarction

To compare the frequency of in-hospital complications between diabetic hypertensive and diabetic normotensive patients presenting with acute myocardial infarction [MI]. This observational cohort study was carried out in the department of Cardiology, Lady Reading Hospital, Peshawar. A total of 444 diabetic patients with acute MI were studied from December 2009 to September 2011. Among these half of patients were hypertensive while rests were normotensive. After enrolment in the study, patients were monitored for in- hospital complications of acute MI. Most of the baseline characteristics were similar between the two groups of patients. However patients in diabetic hyper tensive group had a long history of diabetes, high heart rate and blood pressure on presentation. Complication rates were not different statistically between the two groups. Complication rates between diabetic hypertensive and diabetic normotensive groups were; atrial fibrillation [AF] 15.3% vs. 12.12% p=0.204 respectively while ventricular tachycardia [VT] 14% vs. 12.6% p=0.390, ventricular fibrillation [VF] 4.5% vs. 3.8% p=0.405, type 1 second degree heart block 8.6% vs. 6.8% p=0.296, type 2 second degree heart block 2.3% vs. 1.4% p=0.362, complete heart block[CHB] 11.7% vs. 9.9% p=0.323, acute congestive heart failure [CHF] 13.1% vs. 9.5% p=0.269, left ventricular failure [LVF] 19.9% Vs 16.7% p=0.147, cardiogenic shock[CS] 14% vs. 10.4% p=0.080, recurrent MI [Re-MI] 14% vs. 10.8% p=0.194 and death rate 14% vs. 12.2% p=0.336 respectively. Hypertension in diabetic patients is not associated with an increase risk of in-hospital complications after acute MI