This clinical audit aims to evaluate the clinical data regarding the management and outcomes of acute myocardial infarction (AMI) patients requiring mechanical ventilator (MV) support, along with ...identifying factors associated with prolonged MV support and 180-day mortality. In this study, we audited clinical data regarding management, in-hospital and short-term outcomes of adult patients with AMI required MV support. Patients with prolonged MV duration (>24h) and/or 180-day mortality were compared with their counterparts, and associated factors were identified. The binary logistic and Cox regression analyses were performed to determine the predictors of prolonged MV duration and 180-day mortality. In a sample of 312 patients, 72.8% were male, and the mean age was 60.3±11.5 years. The median MV duration was 24 24-48 hours, with 48.7% prolonged MV duration. The admission albumin level was found to be the independent predictor of prolonged MV duration with an adjusted OR of 0.42 0.22-0.82. Overall 7.4% were re-intubated, 6.7% needed renal replacement therapy, 17.6% required intra-aortic balloon pump (IABP) placement, and 16.7% required temporary pacemaker placement. The survival rate was 80.4% at the time of hospital discharge, 74.7% at 30-day, 71.2% at 90-day, and 68.6% at 180-day follow-up. Age, prolonged MV duration, and ejection fraction were found to be the independent predictors of cumulative 180-day mortality with adjusted HR of 1.04 1.02-1.07, 1.02 1.01-1.03, and 0.95 0.92-0.98, respectively. Prolonged ventilator duration has significant prognostic implications; hence, tailored early recognition of high-risk patients needing more aggressive care can improve the outcomes.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Contrast induced nephropathy (CIN) is a common complication seen after primary percutaneous coronary intervention (PCI) which can contribute to increased morbidity and mortality in ...patients of acute ST elevation myocardial infarction (STEMI). Aim of this study was to validate the TIMI Risk Index (TRI) for the risk stratification of CIN in patients undergone primary PCI. Methods: Consecutive patients of STEMI undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patients with history of any PCI and chronic kidney diseases were excluded from this study. TRI was calculated using the formula “” and post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 507 patients were included in this study out of which 82.2% were males and 17.8% were females. In total 8.7% (44) patients developed CIN. In the receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) for TRI was found to be 0.717, 0.649–0.758 for the prediction of CIN. Sensitive, specificity, positive predictive value and negative predictive value of TRI >22.8 to predict the development of CIN were 59.09%, 76.69%, 19.55% and 95.19% respectively. Conclusion: TIMI risk index is and easy to calculate and readily accessible score which has good predictive value to evaluate the risk of CIN in primary PCI setting.
Background: Worldwide, cardiovascular diseases are the major cause of mortality and morbidity with acute coronary syndrome as the most common clinical manifestation. In a typical clinical setup, ...around 30% of the patients presented with “ST-segment elevation myocardial infarction (STEMI)” caused by the complete occlusion of the coronary artery and the remaining 70% with intermittent or partial occlusion of the coronary termed as non-ST elevation The aim of this study was to assess the prevalence and characteristics of non-obstructive coronary arteries among patients presenting with non ST-elevation acute coronary syndrome (NSTE-ACS) at a tertiary care cardiac center of Karachi, Pakistan. Methods: This was a descriptive cross-sectional study, conducted at a tertiary care hospital in Karachi. Study inclusion criteria were patients of either gender admitted with NSTE-ACS and age between 30-70 years. A routine coronary angiogram was performed in all the patients and the absence of ≥50% stenosis in any major epicardial vessel was taken in non-obstructive coronaries. Results: A total of 174 patients (30–70 years) were included, of which 99 (56.9%) were male and the mean age was 59.43±11.24 years. In the distribution of socioeconomic status, 54 (31.0%) were lower class, middle class 81 (46.6%) while upper-class status were 39 (22.4%). Hypertension was observed in 76 (43.7%), chronic kidney disease in 20 (11.5%), and hyperlipidemia in 55 (31.6%). Non-obstructive coronary arteries were noted in 25 (14.4%) patients. Conclusion: It is to be concluded that non-obstructive coronary arteries are fairly prevalent in patients arriving in hospital with NSTE-ACS in our population. Further research is needed to better understand the underlying pathophysiology and optimal management strategies for patients with NOCA in the setting of NSTEMI.
Objectives: The prevalence and clinical significance of carotid artery stenosis (CAS) in acute myocardial infarction (AMI) patients remain uncertain. This study aims to evaluate CAS prevalence and ...its association with coronary artery disease (CAD) severity in AMI patients admitted to a coronary care unit (CCU). Methodology: In this cross-sectional study, 100 consecutively selected AMI patients underwent ultrasound Doppler carotid artery assessments, including measurements of carotid intima-media thickness (cIMT), identification of plaque (stenosis >0%), and calculation of internal carotid artery/common carotid artery (ICA/CCA) peak systolic velocity ratio. Angiographic findings, including the number of diseased vessels and Syntax score (SS), were also recorded. Results: Among the study cohort (mean age 55.1±11.2 years, 78 males), 32 patients exhibited CAS, with 8 having cIMT>1.2mm, 3 showing ICA/CCA PSV ratio>2, and 25 presenting plaque. CAS prevalence did not significantly correlate with CAD severity, regardless of the number of diseased vessels or SS. Similarly, CAS rates did not significantly differ based on SS categories (low, intermediate, high). While CAS prevalence trended higher in patients with conventional atherosclerotic risk factors (diabetes, hypertension, smoking, obesity), these associations were not statistically significant. Conclusion: CAS was prevalent in approximately one-third of AMI patients, yet it did not demonstrate a significant association with CAD severity or SS. However, CAS rates tended to increase with the presence of conventional atherosclerotic risk factors. Further research is warranted to elucidate the clinical implications of CAS in AMI patients and its relationship with CAD severity.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives: Contrast induced nephropathy (CIN) is a common complication and found to be associated with increased morbidity and mortality after primary percutaneous coronary intervention (PCI). The ...objective of this study was to validate the Mehran Risk Score (MRS) for the risk stratification of CIN in patients undergone primary PCI.
Methodology: A cohort of consecutive patients undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patents history of any PCI, and chronic kidney diseases were excluded from this study. MRS was calculated at baseline and post procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN.
Results: A total of 547 patients were included, of which 79.3%(434) were male. CIN after primary PCI was observed in 62(11.3%) patients. The area under the curve (AUC) for the MRS was 0.712 0.641 to 0.783. Cut-off value of ≥6.5 had sensitivity of 61.3% 48.1%-73.4% with positive predictive value of 21.2% 17.5%-25.6% and specificity of 70.9% 66.7%-74.9% with negative predictive value of 93.5% 91.3%-95.2%. MRS ≥6.5 was found to be an independent predictor on multivariable analysis with adjusted odds ratios (OR) of 3.86 2.23-6.68 along with multi-vessel diseases with OR of 2.31 1.27-4.19.
Conclusion: MRS has shown to have a good discriminating power. However low positive predictive value of the optimal cutoff value of ≥6.5 for prediction of CIN suggests need of modification to the MRS to improve its clinical utility in the modern era of primary PCI.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To evaluate the surgical outcomes of idiopathic macular epiretinal membrane (IERM) peeling in terms of visual acuity and macular thickness.
Observational cross-sectional study.
Al-Ibrahim Eye ...Hospital, Karachi, from June 2017 to February 2018.
Patients aged >50 years having IERM confirmed with optical coherence tomography (OCT) were included in the study. All patients underwent 3-port pars plana vitrectomy (PPV) followed by epiretinal membrane peeling. Log Mar visual acuity chart was used for documenting visual acuity pre- and postoperatively. OCT was performed for documenting changes in macular thickness pre- and postoperatively. Every patient completed their follow-up of six months.
Mean age of the 43 patients was found to be 59.98 ±6.1 years. Mean pre- and postoperative visual acuity of Log Mar showed 0.59 ±0.21 and 0.33 ±0.21, respectively (p<0.001). Mean macular thickness on OCT pre- and postoperatively were 479 ±82.5 and 315 ±82.4 m, respectively (p<0.001). In thirty-one (72.1%) eyes, there was improvement in best corrected visual acuity (BCVA) postoperatively, 9 (20.9%) eyes remained stable; whereas, 3 (7%) eyes had decreased visual acuity at final follow-up of six months.
Peeling of IERM is a safe surgical procedure. It is associated with significant improvement in best corrected visual acuity postoperatively along with improvement in anatomical outcomes in terms of decrease macular thickness as measured by OCT.
To study the outcomes of intravitreal injection of Bevacizumab and laser photocoagulation in the treatment of diabetic macular edema (DME).
Seventy-two eyes of 59 patients with diabetic macular edema ...were divided into two groups of 41 eyes (Group-A) and 31 eyes (Group-B). Subjects in group-A were treated with three intravitreal injections of Bevacizumab (IVB), and that of group-B with macular photocoagulation. Duration of study was 9 months. Follow up pattern for both groups was1, 2, 3 and 6 months. Best Corrected Visual acuity on log MAR (BCVA) for distance as well as near in each visitwas recorded. Retinal OCT for central macular thickness (CMT) was performed on baseline. SPSS version 20.0 was used to analyze the data.
Mean age of the patients was 53.76 ± 8.82 ranging to 36-71 years. Out of 59 patients, 40 (67.8%) were male and 19 (32.2%) female. It was observed that the difference of results among both groups was not significant. Fig.2 documents visual acuity recorded as Improved; Stable and Worse.
The improvement in BCVA was significant at 6 months in both treatments. The final improvements in BCVA has been almost similar between both the treatment groups although it was noted that IVB group showed early improvement in BCVA at follow-ups of 1 and 3 months. A long term follow-up is required in these cases to see the effect of both these treatment strategies.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To know the outcomes of cystoid macular oedema after phacoemulsification in patients with and without type 2 diabetes mellitus using optical coherence tomography.
This non-concurrent, clinical, ...prospective study was carried out at Al-Ibrahim Eye Hospital, Karachi, from January to August 2015. After phacoemulsification with injectable posterior chamber intraocular lens implantation, eyes of patients were analysed. The patients were divided into diabetic and non-diabetic groups visual acuity, optical coherence tomography and dilated fundus examination were performed preoperatively (baseline) and post-operative 1st week and 6th week. SPSS 20 was used for data analysis.
Of the 100 subjects, there were 50(50%) each in diabetic and non-diabetic group. Subsequently, 14(14%) patients were lost to follow-up, and 86 eyes of 86(86%) patients were analysed. Of them, 37(43%) were male and 49(57%) were female. The mean age of participants was 52.21±7.43 years (range: 38-62years). The non-diabetic group had 41(47.7%) patients and the diabetic group had 45(52.3%). There was no clinically significant cystoid macular oedema in either group. Central foveal thickness > 43.94 µm was observed in 1(2.5%) eye in the non-diabetic group and in none in the diabetic group at 1st post-operative week. At the 6th post-operative week, none of eyes in the non-diabetic group and 2(4.44%) eyes of the diabetic group showed macular oedema. There was no statistically significant difference in mean foveal volume between both groups at 1st week (p=0.896) and 6th week (p=0.230).
Cystoid macular oedema after phacoemulsification was equally present in both diabetics and non-diabetics without any retinopathy.
To compare the stone clearance of upper with middle and lower ureteric stones by using ureteroscopic pneumatic lithotripsy.
The study was conducted in the Department of Urology, Liaquat National ...Hospital, Karachi, from February 2009 to February 2010. A total of 90 patients were selected and divided into three groups of 30, each according to the location of stone in the ureter. All patients underwent ureteroscopic pneumatic lithotripsy with 8.5 Fr Wolf rigid ureteroscope and Wolf 2mm probe used for stone fragmentation. All patients were evaluated with X-ray KUB, ultrasound KUB and IVU. Follow-up studies included X-ray and ultrasound KUB performed on 1st postoperative day, after 1 week and at the end of 2nd week. Presence of stone after last follow-up was considered as failure of the procedure.
Total number of patients were 90 and mean age was 27.47 +/- 5.8 years. Male female ratio was 2.1:1. Mean stone size was 11.44 +/- 1.41mm. According to the location of the stones, the success rate of pneumatic lithotripsy for upper, middle, and lower ureteral stones was 86.7%, 93.3%, and 96.7% respectively. Completely fragmented stones cleared spontaneously within two weeks in 83 of 90 cases so the overall stone-free rate was 92.2%.
Ureteroscopic Pneumatic Lithotripsy is an acceptable form of treatment for upper ureteric calculi in addition to middle and lower ureteric calculi. It is a simple, reliable, effective, rapid and safe procedure.
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