Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center.

Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.

Outcome at Six Months After Primary Percutaneous Coronary Interventions Performed at a Rural Satellite Center of Sindh Province of Pakistan.

Introduction Primary percutaneous coronary intervention (PPCI) is now a well-established treatment of acute ST-elevation myocardial infarction (STEMI). For the first time in Pakistan, various off-site satellite centers are established to perform PPCI 24-hours. Our population mainly resides in the rural area with low literacy rate and poor socioeconomic conditions. The majority of the patients who are presented in the satellite center had either never received any long-term treatment plan or were non-compliant to their medication. The objective of this study was to determine the outcome of patients at six months who underwent primary PCI at a rural satellite center of Sindh, Pakistan. Methods This study was conducted at Larkana satellite center of National Institute of Cardiovascular Diseases, Karachi. Patients who underwent PPCI for STEMI from October 2017 to March 2018 were enrolled in the study. In case of death of the patient, data were obtained from the attendant of the deceased. Patients, on follow-up visits, were interrogated for post-procedure symptoms. Results A total of 271 patients were enrolled in the study. The mean age ± standard deviation of patients was 54.84 ± 10.64 years. The most common culprit artery was left anterior descending (LAD) artery with 161 (59.4%) patients, followed by right coronary artery (RCA) with 98 (36.2%) patients. Only 41 (15%) patients had a three-vessel disease, while 141 (52%) patients had single-vessel disease. On follow-up, 70 (25.8%) patients complained of chest pain grade II, 20 (7.4%) complained of shortness of breath (SOB) grade II, 44 (16.2%) complained of vertigo, and 16 (5.9%) complained of nonspecific weakness. The mortality rate of 6.3% (17) was observed after six months of PPCI. The mortality rate was found to be lower for patients with LAD disease (p = 0.036) and higher among patients with RCA as the culprit artery (p = 0.045). The mortality rate was significantly associated with the number of diseased vessels and the type of stent deployed. Conclusion Primary PCI, at a rural satellite center, has an overall positive outcome. Steps should be taken to provide free medication along with encouragement towards compliance of dual antiplatelet medication. Furthermore, the facility for subsequent procedures should be provided at the same set-up.

Photosensitizing mechanism and identification of levofloxacin photoproducts at ambient UV radiation.

Levofloxacin (LVFX) is a broad spectrum third generation fluoroquinolone antibiotic, used in the treatment of severe or life-threatening bacterial infections. Photosensitizing mechanism of LVFX was investigated under the ambient environmental intensities of UV-A, UV-B and sunlight exposure. Phototoxic effects of LVFX were assessed on NIH-3T3 and HaCaT cell lines. Results identified first time three photoproducts of LVFX at ambient levels of UV-R by LC-MS/MS. The generation of reactive oxygen species (ROS) was investigated photochemically as well as intracellularly in HaCaT cell line. ROS were significantly quenched by specific quenchers like DABCO, NaN(3), D-mannitol and NAC. Photosensitized LVFX caused lipid peroxidation at different concentrations. Quenching study with superoxide dismutase confirms the LVFX-induced lipid photoperoxidation. Further, photocytotoxicity of LVFX showed significant reduction in cell viability by MTT and neutral red uptake assays. LVFX caused cell arrest in G2/M phases as well as induced apoptosis through ROS-dependent pathway. In addition, photosensitized LVFX also induced upregulation of p21 and Bax/Bcl-2 genes ratio. India is a tropical country and most of the human activities such as agriculture, commerce, sports, etc. take place in bright sunlight; therefore, photosensitive LVFX may lead to skin/ocular disorders and immune suppression. Information is needed regarding the phototoxicity of LVFX for human safety.