Neurological complications are avoidable during CABG

Objective: To review the incidence of stroke in patients undergoing CABG and the impact of a preventive strategy adopted at tertiary care unit of cardiac surgery

Methods: The data of all patients who underwent isolated CABG [N= 722] from July 2016 to August 2017 at Faisalabad Institute of Cardiology was retrieved for this retrospective study. All operations were done on cardiopulmonary bypass and cold blood cardioplegia. Numeric data was summarized as Mean +/- Standard Deviation while categoric variables were summarized into frequency and percentage

Results: Mean age of patients was 53.83 +/- 8.8 years. Mean Parsonnet and Logistic EuroScore were 4.3 +/- 3.2 and 3.3 +/- 0.9 respectively. Forty nine patients [6.78%] had significant carotid artery disease. Mean number of grafts was 2.8 +/- 0.82. Diabetes was present in 27.8% patients. Neurological complications were noticed in 14 patients [1.94%] who included 12 permanent paralyses. Further subgroup analysis revealed that 67 patients who were operated by single clamp technique remained free of neurological complications. This is clinically remarkable finding but due to small population size it is statistically non- significant

Conclusion: The incidence of neurological complications can be reduced significantly by adopting the appropriate preventing measures. Use of Single Clamp technique may be the reasons of such a low incidence of stroke in this study

Thoracic trauma: one year surgical audit at Arar Central Hospital, Saudi Arabia

Background: Thoracic trauma is increasingly encountered now a days in emergency room

Objective: To determine the pattern and management outcome of thoracic trauma patients at area central Hospital Saudi Arabia

Methodology: Study Design: Crosssectional study. Place and Duration of Study: This study was conducted on 104 patients at the ER, ICU and Surgical floor of Arar Central Hospital, Northern Border Region, Saudi Arabia from 1 January to 31 December 2015. Information consisting of patients particulars, pattern and modes of injuries and hospital stay were recorded. Complications and deaths were analyzed by database to determine the morbidity and mortality. Patients irrespective of their age and gender were included in our study. The data was entered and analyzed by using SPSS version 11

Results: Sample size of 104 patients was included. Male to female ratio was 4:1. Patients age raised from 4 years to 82 years, mean age was 29.6 years. Blunt Trauma was most prevalent [72.11%], followed by Penetrating injuries [19.23%] and combined injuries [8.65%]. Extra thoracic injuries included orthopedic injuries in 35[33.65%] patients, 28[26.92%] patients has neurological injuries whereas in 23[22.11%] patients blunt abdominal trauma was noted. Most frequent injury pattern seen was Fracture Ribs 70 [67.30%] patients with underlying haemothorax in 27[25.96%]patients. Most of the patients treated either conservatively or with tube thoracostomy 53.84% and 43.27% respectively. Complications were encountered in 35 [33.65%] patients. 10 [9%]patients has Chest tube site infection whereas 7[6.73%] developed atelectasis treated successfully by Bronchoscopy. Overall 6 [5.76%] deaths were recorded during study duration

Conclusion: Thoracic injuries remain major trauma related issues in this part of country. Highest priority must be given to the chest injured patients in order to decrease the morbidity and mortality. Moreover surgical audit should be expanded to other facilities also in order to improve the health care facilities provided to patients

Total arterial myocardial revascularization: analysis of initial experience

Total arterial myocardial revascularization is an attempt to overcome the problems of late vein graft atherosclerosis, occlusion and need for coronary re-operations. Despite increasing evidence of efficacy, the use of arterial conduits has not been accepted as a primary practice in most of the centers in Pakistan for various reasons. We analyze our initial experience to assess the feasibility of total arterial revascularization as a primary strategy in patients requiring first time coronary artery bypass grafting. METHODS: Two hundred patients undergoing first time CABG at our institution, from January 2000 to April 2001, were studied. Group 1 consisted of 100 patients undergoing total arterial revascularization [using bilateral internal thoracic and radial arteries] and Group 2 consisted of 100 patients undergoing conventional CABG [using one internal thoracic artery and supplemental veins]. Thirty-day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. Patients in Group 1 were younger [56.2 +/- 10.4 vs. 60.3 +/- 9.8 years; P<0.001], had lower Parsonnet scores [4.8 +/- 0.4 vs. 9.6 +/- 1.8; P<0.001], and had better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularization rose from 20% in the first three months to over 65% in the three later three-month periods. Overall 30-day mortality was 1.5%, one patient [1%] in Group 1 and two patients [2%] in Group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. Total arterial revascularization can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity

Emergency off-pump coronary artery surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Off-pump coronary artery bypass grafting is fast-becoming a procedure of choice for elective revascularization in high-risk patients with multi-vessel coronary artery disease. However, the role of off-pump coronary artery bypass grafting for patients with acute coronary syndromes requiring emergency revascularization still requires validation. We present our experience to show the feasibility of off-pump coronary artery surgery as an emergency revascularization technique.</p><p><b>METHODS</b>From April 2001 to September 2003, emergency (operation within 24 hours after hospitalization) coronary artery bypass grafting without cardiopulmonary bypass (CPB) was performed in 66 patients with a mean age of (66.9 +/- 5.4) years (range 49-72 years). They presented acute coronary syndromes with 38 patients on platelet glycoprotein IIb/IIIa receptor antagonists. All patients underwent off-pump coronary artery bypass surgery via sternotomy with the intention of complete coronary revascularization.</p><p><b>RESULTS</b>An average of 2.9 grafts per patient were performed and the posterior descending artery and marginal branches of the circumflex artery were grafted in 83.3% of the patients. There were 4 events of intraoperative cardiac instability, precipitated by occlusion of right coronary artery or positioning of a cardiomegaly heart, leading to immediate conversion to CPB. The mortality rate was 3% (2/66). Two patients suffered postoperative stroke while three needed hemofiltration for acute renal failure. Post surgery elective coronary angiography (n = 46) showed no significant stenosis.</p><p><b>CONCLUSION</b>Emergency off-pump coronary artery surgery with complete revascularization is feasible in patients with acute coronary syndrome with low morbidity and mortality and excellent early results.</p>

Sero-diagnosis for viral hepatitis in 93 patients admitted with acute hepatitis in three different teaching hospitals in Lahore

Serodiagnosis was done in 93 patients admitted with acute viral hepatitis [AVH] to three teaching hospitals in Lahore. Five [5.4%] had hepatitis A, 39 [41.9%] hepatitis B [2 of these were anti delta positive], 44 [47.3%] probable hepatitis E and 3 [3.2%] had HAV/HBV co-infection. Antibody to hepatitis C [anti HCV] was detected in 6 patients [6.4%]; 2 with HBV and 4 with probable HEV infection. Excluding 39 patients with hepatitis B and 3 with HBV as part of co-infection, there was evidence of previous HBV infection in 39 out of the remaining 51 patients. In the subset of 6 children, 3 had hepatitis A and 3 hepatitis E. Of these, 5 had evidence of previous exposure to HBV and one was also positive for anti HCV. Our results are suggestive of a strong background of HBV infection raising concern about its chronic sequelae in the community

Experience with anti-hypertensive drug therapy in a hypertension clinic-1972-1983: a retrospective analysis

Retrospective experience with drug therapy in 747 patients with essential hypertension registered from 1972-1983 is reported. Five hundred patients were seen between 1972 to 1978 and 247 between 1979-1983; the latter group was characterised by the use of beta blockers as first line drugs.Hypertension was graded according to level of diastolic blood pressure as mild, moderate and moderately severe or severe in 423, 211, and 113 patients, respectively. The overall response to treatment at 6 months was satisfactory in 66.2% of mild, 50.2% of moderate and 58.4% of severe grades of hypertension. A large number of patients in both the groups having varying grades of severity needed at least 2 to 3 drugs for the control of hypertension. The side effects of drugs were generally mild which included general weakness with diuretics; skin rash, nasal congestion and pruritus with methyldopa; cold extremeties with beta blockers and palpitations with prazosin

Prevalence of obesity in patients with essential hypertension of varying severity

Five hundred patients with essential hypertension of varying severity were reviewed for ponderal index values. They were divided into 4 grades, i.e., mild, moderate, moderately severe and severe according to the level of diastolic blood pressure. The prevalence of obesity in the overall group was 56.2%. The mean ponderal index values in various groups did not show any significant difference. Hypertensives with diabetes mellitus who comprised 23.4% of all the patients did not materially affect the prevalence of obesity amongst hypertensives

Clinical evaluation of 'tenormin' [atenolol] in hypertension

An open 4 week study for evaluating the efficacy of Tenormin [100 mg 'Atenolol' once daily] with or without chlorthalidone was carried out in 52 hypertensive patients with uncomplicated mild to moderately severe essential hypertension. A tablet count at the end of study enabled patient compliance to be judged. Of the 52 patients, 41 completed the study; 8 patients were lost to follow up and in 3 drug had to be withdrawn because of side effects. A statistically significant fall in systolic and diastolic blood pressure was observed in 15 patients taking Tenormin alone and in 26 when combined with Chlorthalidone. 84% patients showed fair or excellent compliance to therapy over this short period. 5 of 44 patients taking the drug suffered from side effects which included gastrointestinal disturbances [2], skin rash [1], retrosternal discomfort [1] and numbness of hands and feet [1]

Serum uric acid values in diabetics

Serum uric acid! values in 1113 male and female diabetic subjects were estimated and compared with 60 controls. There was a sample but significant elevation of mean serum uric acid! values in the diabetic group as compared to the controls. The serum uric acid! values in the female diabetics were correlated significantly with obesity, but not in the males. No case of hyperudcaemic [uric acid > 7 mg%] was recorded In the diabetic and control groups

Profile of hyperlipidaemia in various patient groups and controls

With a view to assess the problem of hyperlipidaemia and pattern of lipoprotein abnormality in various patients groups and normal controls, a study on blood lipids was done on 415 males and females belonging to four clinical groups and a control group. The subjects studied included 125 male patients with first attack of myocardial infarction [IHD group], 80 males and females newly diagnosed non-obese diabetics, 50 males and females newly diagnosed non-obese hypertensives and 100 controls, in IHD group 32% had hyper-lipidaemia out of which 24.8% had type IV, 4% type llb and 3,2% type IIa abnormality. In the diabetic group 42% had hyper-lipidaemia out of which type IV was found in 30.0%, type IIb in 11.25% and type IIa% in 1.25%. In hypertensive group 48% had hyperlipidaemia with type IV in 32%, type llb in 10% and type IIa in 6%. in patients on oral contraceptives 20% had hyperlipidaemia with type IV in 18.3% and llb in 1.7% in control group the prevalence of hyperlipidaemia was 12% with type IV abnormality in all. In view of a significant prevalence of hyperlipidaemia in various clinical groups, the lipid abnormality need more attention in our clinical practice

Comparative study of antihypertensive effect of a thiazide diuretic, propranolol and prazosin in mild to moderate hypertension

A short within patient trial was carried out to compare the anti-hypertensive effects of a Thiazide diuretic, Propranolol and Prazosin in 10 female patients with uncomplicated mild to moderate hypertension. The results show that all the three anti-hypertensive agents were reasonably effective in controlling the blood pressure in this group of patients. All the three drugs were well tolerated but Thiazide diuretic has the advantage of being cheaper than the others