Drug-coated balloon angioplasty, intraoperatively through left anterior descending arteriotomy access, a novel hybrid revascularization strategy: a case report.

Background: Patients undergoing coronary artery bypass graft (CABG) sometimes have critical proximal lesion in left anterior descending (LAD) artery or chronic total occlusion followed by either skip lesions or diffuse disease of late mid-to-distal LAD artery. Such lesions require endarterectomy or atheroma bridging via long venous or arterial patch (patch-plasty), for which clinical outcomes are conflicting in studies due to a more thrombogenic milieu created by patch-plasty as well as incomplete endarterectomy. We present a hybrid approach with drug-coated balloon (DCB) angioplasty of mid-to-distal LAD through LAD arteriotomy followed by left internal mammary artery (LIMA) insertion to LAD. Case summary: A 35-year-old man who was thrombolyzed for anterior wall myocardial infarction in another city, reported to our hospital four weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch-plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid-to-distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up computerized tomography scan showing patent LIMA and mid-to-distal LAD. Discussion: This case shows a novel technique, first in the world, of performing angioplasty during CABG through arteriotomy followed by graft insertion.

Factors related to the uncontrolled fasting blood sugar among type 2 diabetic patients attending primary health care center, Abha city, Saudi Arabia.

OBJECTIVE: To identify risk factors related to uncontrolled fasting blood sugar among type 2 diabetic patients. METHODOLOGY: A systematic random sampling technique was followed to include 450 diabetic patients attending Al-Qabil Primary Health Care Center in Abha City, Saudi Arabia. Collected data comprised sociodemographic characteristics (age, gender, height, weight, education, employment, body mass index, and smoking), while disease-related characteristics included duration of diabetes, fasting blood sugar control, hypertension, and regularity of follow up visits. RESULTS: Fasting blood sugar was uncontrolled among 76.9% of selected patients with type 2 diabetes mellitus. Overweight and obesity were present among 81.6%. Significant risk factors for uncontrolled blood sugar included older age, male gender (P = .037), illiteracy (P = .020), being employed (P = .003), longer duration of disease (P = .023), hypertension (P = .010), and smoking (P = .001). CONCLUSIONS: Prevalence of uncontrolled fasting blood sugar is high among patients with type 2 diabetes mellitus. Risk factors associated with uncontrolled fasting blood sugar include older age, male gender, illiteracy, being employed, longer duration of disease, hypertension, smoking, and obesity. Therefore, for better control of blood sugar among diabetics, it is recommended to control the blood pressure and body weight of diabetics and avoid smoking.

Integrating GDM management in primary care: Gulf Cooperation Council (GCC) perspective.

Diabetes is prevailing universally and Gulf Cooperation Council (GCC) is no exception. Pregnancies associated with gestational diabetes place women at high risk of natal complications. Statistics from GCC gives variable figures for GDM. Family Physicians are the first level health care providers and their role in management of GDM can be promising. This has been evident from a focused group study where patients prefer screening for GDM in primary care settings. Strengthening of primary care is important universally. Government should have mandatory primary care registration to be referred to secondary level for obstetric follow up and management. An important issue needing attention is presence of multiple criteria for diagnosing and screening GDM. There is need for a single guideline globally to avoid confusion for primary care providers.10 Primary care centers can better be utilized to screen for GDM at early stages. This will decrease the load on secondary and tertiary care centers and can also maintain continuity of care.

False positive Hepatitis B Surface Antigen due to recent vaccination.

OBJECTIVE: Hepatitis B is the most common viral hepatitis, potentially life threatening, with long term complications. Currently, vaccine is the most effective tool against hepatitis B infection. It is worthwhile mentioning that due to rampant use of hepatitis B vaccine (HBV), there have been concerns about hepatitis B surface antigen (HBsAg) reactivity. This article aims to report the false positive results of HBsAg due to recent HBV among healthy male adults. SUBJECTS AND METHODS: The subjects were selected from a Community Health Center, under the umbrella of a tertiary care hospital, Saudi Arabia. The data was retrieved from electronic medical records maintained at the clinic. RESULTS: A total of 130 employees were recruited, only 117 records could be retrieved from the system. The mean age of participants was 31.34 ± 12.73 years. The administration of HBV and HBsAg test was performed simultaneously. The lab reported three cases of HBsAg positivity, a false positive result of 2.56%. Repeat testing after one week for HBsAg was negative for the three cases. CONCLUSION: This study confirmed that HBsAg reactivity might be seen in regular screening programs for healthy adults.

Improving general practitioners' knowledge regarding blood pressure measurement in selected cities of Pakistan through workshop.

The objective of this study was to evaluate enhancement in the knowledge of general practitioners (GPs), from the urban cities in the province of Sindh, Pakistan, regarding blood pressure measurement through workshop. This was a quasi-experimental study that involved GPs from 5 cities of Sindh province, Pakistan. The GPs were required to complete a pretested self-administered questionnaire before and after the workshop session. The questionnaire included few demographic variables and 17 questions based on the American Heart Association recommendations. The mean pretest and posttest scores were compared using Student's t test. A total of 350 GPs returned completed questionnaires, with a preponderance of males (n = 264, 75.4%) than females (n = 86, 24.6%). The mean correct responses increased significantly after the workshop session from 8 ± 2.1 to 14 ± 2.5 (P = .01). The knowledge of GPs was almost doubled after the workshop and was significantly different for variables such as qualification, affiliation with teaching hospital, and number of years of practice (P = .001). This survey, a representation of GPs from the Sindh province, indicated a significant doubling in knowledge after the workshop, proving that continuing medical education sessions play an important role in increasing awareness and staying updated.

Assessment of renal insufficiency in patients with normal serum creatinine levels undergoing angiography.

OBJECTIVE: To determine the frequency of patients with underlying renal insufficiency having normal serum creatinine level proceeding for coronary angiography. METHODS: A total of 693 patients from September 2009 to February 2010 undergoing diagnostic coronary angiography at the National Institute of Cardiovascular Diseases (NICVD) with normal serum creatinine < 1.5 mg/dl were selected. Glomerular filtration rate (GFR) was calculated for each patient using the Cockcroft-Gault (C-G) equation and a GFR < 80 ml/min was labeled as renal insufficiency. RESULTS: The mean age of males was 51.86 +/- 10.19 years and 51.52 +/- 9.80 years for females. Almost one-third (n=236, 34.1%) of patients had GFR <80 ml/min; comparison between male (n=168, 31.2%) and female (n=68, 43.9%) was significant (p-value 0.003). Age group breakdown showed majority of patients (n=196; 83.05%) with GFR <80 ml/min ranged between 40-69 years (p-value 0.001). CONCLUSION: This study has shown that most of the patients with normal serum creatinine have abnormal GFR. Serum creatinine, which is considered to be an important screening test in patients with renal impairment, might remain in the normal range despite the renal function being significantly impaired. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

Students' opinion regarding application of Epidemiology, Biostatistics and Survey Methodology courses in medical research.

OBJECTIVE: To assess students' opinion regarding the application of Epidemiology, Biostatistics and Survey Methodology courses in medical research. METHODS: A cross-sectional study was conducted to assess the opinion of the third and fourth year students regarding the relevance of Epidemiology, Biostatistics and Survey Methodology courses, which are taught in the first two years, to medical research through a pre-tested, self administered questionnaire. The questionnaire was filled by 126 students of third and fourth year MBBS through convenience sampling. RESULTS: The majority (76%) of the students agreed that the Epidemiology, Biostatistics and Survey Methodology courses were relevant in the first two years of MBBS curriculum. Epidemiology and Survey Methodology were termed as most useful courses for critical reading sessions, literature review and medical writing. No significant difference was observed in the opinion of third and fourth year medical students (p > 0.05) CONCLUSION: Research methods courses conducted in the first two years of MBBS are considered relevant and useful by the medical students. The application of these courses should be encouraged by involving the students in research projects during their undergraduate years.

Knowledge, attitude and perception of water pipe smoking (Shisha) among adolescents aged 14-19 years.

OBJECTIVE: To study the impact of educational intervention on knowledge, attitude and practices with regard to water pipe smoking among adolescents (14-19 years old) in Karachi. METHODS: A cross-sectional survey of adolescents aged 14-19 years studying at different educational institutions of Karachi, Pakistan was conducted through multistage sampling on a pre-tested self-administered questionnaire. They were divided into high, middle and lower socioeconomic strata on the basis of monthly fee structure. The impact of health messages was assessed two months after education sessions through post-test of only high and middle socioeconomic strata. RESULTS: A total of 646 students were surveyed for the pre test and 250 students for the post test. A significant association was found for water pipe smoking among the socioeconomic class (p < 0.001). Water pipe is more addictive as compared to cigarettes was marked by more students after the sessions (54% vs 68%; p < 0.001). A significant difference was seen for water pipe being more socially acceptable (58% vs 80%; p < 0.001), it is part of our cultural heritage (29% vs 58%; p < 0.001). CONCLUSION: Shisha smoking was more prevalent among the high socio economic group, which might be because of the cost, accessibility and availability. The knowledge of the students regarding water pipe smoking improved after the health awareness sessions.

Awareness of bird flu amongst young college students.

OBJECTIVE: To assess the awareness among students about the disease, their attitude during the outbreak, along with their perceptions about treatment, and severity of disease. METHODS: A cross sectional study was conducted among 220 intermediate students. The data was collected through a self filled questionnaire after taking verbal consent. The variables included in this study were age, gender and department (medical/non-medical). RESULTS: A total of 220 students participated with mean age of 17 +/- 1 year. There were 132 (61%) males and 84 (39%) females. The students were divided into pre-medical 110 (50%) and non-premedical 110 (50%). About 211 (96%) students said that they had heard about bird flu but only 86 (39%) correctly identified it as a disease of birds and humans both. One hundred and fifty-four (70%) participants said that virus causes it and the most common source of knowledge was media (T.V) by 153 (70%) followed by newspaper 113 (51%) respondents. Flu like symptoms were identified by 77 (35%) and 160 (73%) considered birds to human as the most likely route of transmission. Regarding vaccine, 133 (70%) replied that it is not available and 80 (41%) said that there is a treatment for the disease. About 143 (73%) thought that it is life-threatening. According to 105 (48%) the suitable preventive measure taken by the government would be to kill susceptible chickens. CONCLUSION: The awareness regarding bird flu was quite low among students. As bird flu is a world wide public health problem therefore increasing awareness would be a solution to avoid its spread and complications.

Knowledge regarding breastfeeding practices among medical students of Ziauddin University Karachi.

OBJECTIVE: To assess knowledge among medical students of a private medical college regarding breast-feeding practices. METHODS: A cross sectional survey of medical students from first year to final year at a private medical college was conducted on a pretested self-administered questionnaire. Students were divided into preclinical and clinical years for analysis. RESULTS: A total of 344 students participated with 159 (47.6%) from the preclinical group and 185 (53.7%) from the clinical group. The mean age of respondents was 22 +/- 1.5 years. Overall 69% students knew that breastfeeding should be initiated immediately after birth, 42% said that exclusive breastfeeding should be continued for 4-6 months and 33% said that weaning should be started between 4-6 months. Regarding giving colostrum to the newborn, 14% students felt that it should be discarded and 12% from both groups thought that colostrum was harmful. Over two-third (76%) from clinical group and 61% from preclinical group were of the opinion that breastfeeding should be started immediately after birth (p = 0.009). Correct age to start weaning was identified by 71% of the clinical group, whereas, the preclinical group stated it to be 7-9 months of age (p < 0.001). CONCLUSION: The knowledge of students regarding breastfeeding was more in the clinical group as compared to the preclinical group, whereas, overall knowledge of the students regarding breastfeeding was low. Medical students being the future physicians will be the first line in dealing with mothers and breastfeeding related problems. The medical curriculum should lay emphasis on counseling regarding maternal and child nutrition.

Awareness of hypertension among patients attending primary health care centre and outpatient department of tertiary care hospital of Karachi.

OBJECTIVE: To compare awareness of hypertension among patients attending Primary Health Care Centre (PHC) and outpatient department (OPD) of a tertiary care hospital of Karachi. METHODS: Cross sectional survey of patients more than 18 years of age without any complication of hypertension in a squatter settlement of Karachi through non-probability convenient sampling. RESULTS: A total 202 patients were approached, 49 (24%) were males and 153 (76%) were females. Majority of the patients attending tertiary care OPD (80%) and 56% from PHC group believed that hypertension could lead to cardiovascular disease (CVD). On inquiring the duration of taking antihypertensive drugs, 61% from tertiary care OPD group and 31% of PHC group said they are taken only for few months (p < 0.001). Over two-third (77%) of patient of tertiary OPD were not doing exercise and not avoiding oily and heavy food to keep their weight under control. Large number of OPD patients (91%) used oil for cooking in comparison to PHC group (78%) who utilized ghee (p < 0.001). CONCLUSION: This study showed a marked difference in awareness regarding hypertension in urban slum and middle class community, which can be attributed to the level of education. This outcome reveals need for more awareness campaigns especially in the squatter settlement with special emphasis on lifestyle modifications along with pharmacological therapy for the better control of hypertension.