Early and long term outcome of rescue percutaneous coronary intervention (R-PCI): experience from a tertiary care center in Pakistan: outcome of rescue angioplasty in Pakistan.

BACKGROUND: Thrombolysis is the standard of care for STEMI in Pakistan. Failed thrombolysis has a very high morbidity and mortality. Rescue PCI then remains the only option to salvage the myocardium. We sought to analyze the angiographic, immediate and long term clinical outcome of patients undergoing Rescue PCI at our institution in Karachi, Pakistan. METHODS: 58 consecutive patients who underwent rescue PCI for failed thrombolysis between 2002 and 2005 were reviewed. Clinical characteristics, angiographic and procedural details with clinical outcomes including total mortality, recurrent angina, and repeat revascularization were studied. Sources included cardiac catheterization lab database, medical records and follow up at outpatient clinics. RESULTS: Rescue PCI was performed in 58 patients with a mean age 55 +/- 12 years with 47 (79%) male and 11 (21%) females. CAD risk factors were hypertension (53%), dyslipidemia (48%), smoking (34%) and diabetes (34%). 53% had anterior MI, 39% inferior and 8% had a lateral wall MI. The median time frames were: onset of chest pain to ER = 99 min, door to needle time = 35 min, ER to procedure start time = 250 min. The culprit vessels were: Left Anterior Descending (LAD) (53%), Right Coronary Artery (RCA) (32%) and Circumflex (CX) (15%). TIMI flow grades pre-procedural were 0/I = 52%, II = 34%, III = 14% and post procedure 0/I = 8%, II = 6%, III = 86%. The mean follow-up duration was 16.15 months at which 50 (86%) were alive and 43 (74.13%) had event free survival. CONCLUSION: Procedural success, event free survival and mortality in our series of Rescue PCI from Pakistan are comparable to recent international trials and registries. It should be considered as a reasonable option for patients with failed thrombolysis.

The frequency of urinary symptoms in women attending gynaecology clinics at the Aga Khan University Hospital Karachi, Pakistan.

OBJECTIVE: To determine the frequency of urinary symptoms in women attending Gynecology clinics at Aga Khan University Hospital, Karachi. METHODS: A total of 186 women attending the gynaecology clinics for symptoms of menstrual disorders, vaginal discharge or uterovaginal prolapse were asked to fill the survey questionnaire which included all the details about lower urinary tract symptoms (LUTS). RESULTS: Of the 180 women, 82.8% were aged between 15-44 years with BMI > or = 25. Culture confirmed recurrent urinary tract infection (at least 3 episodes of urinary tract infections evidenced by positive urine culture or treated by repeated use of antibiotics) was reported by 32 (17.2%) women. The frequency of urinary incontinence was 44.4% with 17.2% cases having stress urinary incontinence (SUI). Symptoms of urinary tract infection were not significantly affected by age, parity and mode of delivery. Parity was strongly associated with prevalence of SUI (F=10.48, P<0.001). Both urge and mixed incontinence were significantly related to age (F=20.57, P, 0.001 and F=13.88, P<0.001) but were not affected by parity and mode of delivery. CONCLUSION: The high frequency of urinary symptoms in our community demands a need for more extensive epidemiological study and a specialized unit to provide awareness, treatment and training in this area.