Coronary artery ectasia: clinical and angiographic features

Objective: to investigate the clinical and angiographic characteristics of coronary artery ectasia [CAE] and its relation with the inflammatory marker, HsCRP

Study Design: an observational study

Place and Duration of Study: rawalpindi Institute of Cardiology, Rawalpindi, from April 2015 till November 2016

Methodology: eighty-one patients with CAE and 57 age matched patients with stenotic coronary artery disease [CAD], but without CAE, were included in the study. Clinical, angiographic, and laboratory data were documented. Chi-square test was used to compare coronary risk factors between two groups. T test was used to compare means between the groups. Analysis of variance was used to analyse HsCRP levels among various types of ectasia. Correlation analysis was used to study association of ectasia with different risk factors

Results: males were predominant in both with and without CAE. Hypertension, smoking and obesity were significantly more common among CAE patients than those without [60.5% vs. 52.6%, 56.8% vs. 43.9% and 80.2% vs. 14%, respectively]. Diabetes was much less in CAE group [32.1% vs. 42.1%]. HsCRP was higher in patients with CAE than those without and was significantly higher in patients with more extensive ectasia. Majority [65.4%] of CAE patients had significant CAD; whereas, only 7.4% had isolated CAE. Most common artery involved was RCA [70.4% of total] and most common pattern was single ectatic vessel

Conclusion: obesity and smoking predispose to CAE, along with male sex and hypertension. While diabetes is negatively associated with CAE. HsCRP levels tend to be higher in ectasia patients, especially those with severe forms. Finally, CAE has a predilection for RCA

Reliability of trans-abdominal ultrasonography in determining exact location of placenta in patients of placenta previa major

Objective: To determine the reliability of trans-abdominal ultrasonographical localization of placenta in cases of placenta previa major, by taking peroperative finding as gold standard

Study Design: Validation study

Place and Duration of Study: Maternity ward, Obstetrics and Gynecology department, Military Hospital Rawalpindi from 2007 to 2008

Patients and Methods: A total of 100 patients fulfilling the inclusion and exclusion criteria were recruited for the study. These patients were admitted to the maternity ward, where trans-abdominal ultrasound was performed, site of the placenta and its relation to the internal os was documented. These patients under went elective cesarean section, during which the site and relation of the placenta to the internal os was confirmed

Results: The mean age of patients was 34.23 +/- 6.76 years. Transabdominal ultrasound had a sensitivity of 93.4% in localizing major placenta praevia while the specificity was 83%. Positive predictive value was 94.7%, negative predictive value was 80% and accuracy 91%

Conclusion: Trans-abdominal ultrasound was found highly effective in diagnosing and localizing placenta previa

Neutrophil lymphocyte ratio: a prognostic marker in acute ST elevation myocardial infarction

Objective: To investigate if neutrophil lymphocyte ratio [NLR] predicts in-hospital adverse events and mortality, and shortterm [30-day] mortality in ST-elevated myocardial infarction [STEMI] patients thrombolysed with streptokinase [SK]

Study Design: An observational study

Place and Duration of Study: Rawalpindi Institute of Cardiology, from June 2014 till January 2015

Methodology: The STEMI patients, thrombolysed with SK had blood samples at admission, analysed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Mann-Whitney test was used to compare median NLR between patients died and discharged alive. Logistic regression analysis was used to estimate predictive ability of NLR for 30-day mortality

Results: A total of 145 [45.3%] patients had complications; 49 [15.3%] died in hospital, and 13 [4.06%] died in 30 days. Patients in high NLR group had higher rate of complications [63.5% vs. 25.5%, p <0.0001] and death [19.2% vs. 11.1%, p=0.046] in hospital than those in low NLR group. Cardiogenic shock [27.5% vs.11.1%, p <0.0001], heart failure [19.2% vs. 7.2%, p=0.002], arrhythmias [18% vs. 6.5%, p <0.0001], reinfarct/angina [9.6% vs.2% p=0.004] occurred more in high NLR group. Median NLR in patients died was higher than those discharged alive [7.46 vs. 4.70, p <0.0001]. Regression analysis showed NLR an independent predictor of mortality [OR 1.131 at 95% CI, p = 0.029]. Age, serum creatinine, Killip class were other predictors [p=0.002 and p=0.02, respectively]. ROC curve showed AUC 0.908 [p <0.0001]

Conclusion: A high NLR predicted increased in hospital complication rate, and in-hospital as well as 30-day mortality in STEMI patients thrombolysed with streptokinase

Efficacy of dydrogesterone in the management of threatened miscarriage in the first trimester

To study the efficacy of dydrogesterone in pregnant women with threatened miscarriage in the first trimester. Randomized control trial. Department of Obstetrics and Gynaecology, Military Hospital Rawalpindi from Jan 2008 to Dec 2008. One hundred and fifty two pregnant women presenting to the Gynae and Obs department [MH Rwp] before 12[th] gestational week were selected on the basis of slight pain or vaginal bleeding, no cervical dilatation and a viable pregnancy on ultrasound. They were divided randomly into two groups each containing 76 patients with the help of simple random number table, after obtaining their consent and explaining all the risks and benefits to them. Bias was controlled by double blinding. Patients in group A received oral dydrogesterone [10mg twice daily] and patients in group B received placebo. Treatment was continued till the 12[th] gestational week and patients were followed up 4 weekly after the completion of treatment till the 20[th] gestational week. Improvement was judged by continuation of pregnancy and remittance of symptoms. Patients in group A had a greater improvement in the symptoms of pain and vaginal bleeding but the difference between the two groups was not statistically significant. However the number of patients who had a normal growth and whose pregnancies continued was significantly higher in group A. It was concluded that the continuing pregnancy success rate was significantly higher in women treated with dydrogesterone compared with women who received placebo treatment