Journal of Gandhara Medical and Dental Science
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Predictors of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention
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To identify the specific predictors of acute stent thrombosis in patients after primary percutaneous coronary intervention.METHODOLOGY
This retrospective study was carried out at the Department of Cardiology Hayatabad Medical Complex Peshawar from 1st January to 30th June 2022. All consecutive patients with an angiographically confirmed stent thrombosis were enrolled. Patients gave informed consent for the inclusion of data in this registry. Stent thrombosis was categorized according to the timing of the event as acute (occurrence within the first 24 hours after the index procedure).RESULTSA total of 400 patients were included in the study. Age ranged between 35-70 years, with a mean age of 52.5. There were 260(65%) males and 140(35%) females, with male to female ratio of 1.8:1. All patients underwent primary PCI with stent implantation. According to the elapsed time since stent implantation, 42(10.5%) patients presented with acute stent thrombosis after primary percutaneous coronary intervention. The mean time to develop acute stent thrombosis after primary PCI was ±4.5 hours (range 3-6 hours). In most STEMI patients, 340(85%) received a loading dose of clopidogrel at the time of the index PCI. In 23(54.7%) patients, acute stent thrombosis occurred within 6 hours, 10(23.8%) within 12 hours, 6(14.2%) within 18 hours and 3(7.1%) after clopidogrel loading.CONCLUSIONInadequate stent expansion or mal-opposition, diabetes mellitus, chronic kidney disease, and female gender were the strong predictors of acute stent thrombosis
Lamotrigine Induced Drug Reaction with Eosinophilia and Systemic Symptoms (Dress) Syndrome, Dysphagia and Steroid Pulse Therapy. A Case Report
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Adverse drug reactions are common, and dermatological manifestation is a common indicator. The potentially lethal "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome" is one example of severe drug reactions manifesting within weeks after drug intake. It is characterized by "fever, skin rash, lymphadenopathy, eosinophilia and systemic symptoms". We present a case of DRESS syndrome secondary to anticonvulsants lamotrigine associated with dysphagia and responding to steroid pulse therapy
The Future of Healthcare is in the Cloud
Get PDF"Cloud" is a symbolic definition of Internet storage that can be accessed everywhere. This technology is swiftly gaining fame.1 Cloud computing is the state-of-the-art modernization in Information Technology (IT) and has provided a substitute mode for managing and accessing health data. It caters to various computing services such as intelligence, servers, storage, databases, networking, software, and analytics. Cloud computing administers fast modernization, flexible resources, and a range of economies. It is a colossal change from the traditional method due to its cost-effectiveness, high speed, security, global scale, performance, productivity, and reliability.2 Nowadays, hospitals/clinics successfully address patients needs through the cloud, and tech-savvy healthcare professionals are switching to this advancement for its benefits.3 Furthermore, it is an important step to move health systems and data to the cloud as it has achieved popularity during the pandemic. Cloud computing is accomplishing innovative systems to attain patient portals, offering interoperability and a protective way for important data to be transmitted quickly and efficiently anytime and everywhere. 4 Moreover, experts have predicted that cloud computing can improve services in healthcare and assets in healthcare research that have changed the appearance of information technology (IT).5 Because of these gains, there is a boost in the adoption of cloud computing to establish more satisfaction among patients and healthcare providers with low costs.6 Many healthcare systems still rely on old software systems. Healthcare workers' access to data such as electronic health records (EHR), patients' prescriptions, test results, and images/scans are more equipped to diagnose and identify the good management course. Decisions regarding large amounts of information help researchers and healthcare professionals identify patterns, and clues, uncover insights and provide evidence-based management.7 As a result of the cloud, the healthcare industry is regulated, and it makes sense that the first wave of moves to the cloud is those that have no direct impact on patient care. Healthcare providers are now comfortable with the impressive benefits of the cloud. The next wave of migration of information seems to be quicker and easier. Furthermore, telemedicine is the next strong contender for modernization in the future. A survey estimated that approximately 70 per cent of face-to-face interactions with the medical care provider did not require a routine appointment. A fraction of these interactions, telemedicine, would end in significant cost-effective healthcare delivery. It is a key objective for healthcare providers as insurers, and consumer costs would continue to arise. Another significant rise is patient empowerment tools which are cloud benefits as cloud-based applications (CBA) on smartwatches that help those with health-related chronic diseases, regular monitoring, and daily management. These are nutrition, exercise, medication reminders, and blood glucose monitoring that can be easily tracked through CBA, providing a platform for doctors to improve patient’s management further. Bettering outcomes, increased efficiency, and cost-effectiveness via CBA are important components that impact the healthcare system.8 Compliance and security are the main barriers to implementing community cloud in Pakistan’s healthcare system, and the challenges are fat.9 Pakistan’s medical system is still in the initial stages of shifting to this new technology. Healthcare information, X-Rays, medications, and patient history of government and non-government health services are increasing significantly in size, diversity, and rate in this country. 10 The demand for cloud services in Pakistan is improving daily.11 To sharpen and enhance the healthcare model of the health system, cloud-based solutions provide flexibility. Today, hospitals and physicians are gathering more information from patients and places due to this advancement. Virtual care services have grown over the past year when and where patients receive care. Doctors and physicians now have regular access to patient’s information from smartwatches that help update a patient’s treatment.
Health information systems (HIS) and Health Management systems (HMS) have all the data for improving patient healthcare delivery connected across the healthcare continuum, and almost all healthcare providers have moved to the cloud. Historically it was a challenging process. The command of the cloud in healthcare is innovative in storing health information. It regards permission for the right care at the right time and place. CBS also provides a secure, integrated, and scalable foundation that supports a patient's health information within healthcare premises to develop the changes needed for tomorrow. HMS will provide a cost-effective and secure platform that will be important for data integrity and high-performance data replication for evidence-based decision and management
Preoperative Anemia as a Negative Risk Factor for Coronary Artery Bypass Grafting Surgery: A Retrospective Study
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The objective of this study is to check the effects of Anemia on mortality and morbidity in patients having ischemic heart disease and undergoing coronary artery bypass graft surgery (CABG).
METHODOLOGY
The study involved all the patients who underwent isolated coronary artery bypass graft surgery from July 2019 to December 2022. The clinical data of patients was retrospectively collected from the departmental data pool and was then analyzed using the chi-square test and t-test. A p-value of less than 0.05 was considered significant.
RESULTSThe study included 2570 patients who underwent isolated CABG; 78.2% of patients were males with a mean age of 57.87±9.20. Hypertension was the most common comorbidity (68.9%), followed by dyslipidemia (53.7%) & Diabetes mellitus (49.9%). The preoperative mean hematocrit was 30.05±17.85. Of these 2570 patients, 52.37% were anaemic with a mean age of 58.69±9.05. Anemic patients had a significantly higher rate of IABP insertion (P 0.02) and intra-operative blood product transfusion (P <0.001). Anemic patients had a significantly higher incidence of in-hospital mortality (P 0.04) and a higher rate of postoperative blood product transfusion (P <0.001). There is no significant difference in terms of prolonged ventilation, reintubation, or readmission to ICU; however, nonanemic patients have a significantly higher rate of re-opening for bleeding/ tamponade (P 0.01).
CONCLUSION
Preoperative anaemia increases the mortality and morbidity in ischemic heart disease patients undergoing coronary artery bypass grafting. To improve the outcomes in CABG surgery, preoperative anaemia should be thoroughly investigated and treated to improve the outcomes of surgery
Evaluation of Currently Available Molecular Assays and Performance of Sampling Approaches for Detection of Sars-Cov-2 RNA
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This study aims to identify the essential characteristics of diagnostic tests for SARS-CoV-2 and to discuss the limitations of currently available tests and their impact on the test selection process.
METHODOLOGY
The current study was conducted at Mardan Medical Complex (MMC). One hundred nasopharyngeal-positive samples were collected from February to March 2021. Oropharyngeal swab OPS, sputum, and blood samples were collected from the participants to detect SARS-CoV-2 RNA. RNA extraction of SARS-CoV-2 was done using a BigFish auto extractor. A Qiagen Thermal Cycler was used for genome amplification. Five different molecular assays, namely COVSIGN (N gene) Spain, BGI (ORF1ab gene) China, Maccura(ORF1ab, E and N gene) China, R-GENE (RdRp and N genes) France and Genuru (N gene, S gene and ORF ab/1) were used.
RESULTS100 % positivity was recorded in the sputum of all individuals, followed by 91 % OPS and 21% blood. The highest positivity rate for different genes was observed. ROC (Receiver operating characteristic curve) was developed through SPPS version 26.00 to compare the sensitivity and specificity.
CONCLUSION
By comparing the results of different diagnostic kits, it was found that BGI and Maccura are the most sensitive and specific for diagnostic purposes against COVID-19
Complex Pyogenic Liver Abscess: Outcome of Open vs Laparoscopic Drainage
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Our study aimed to evaluate the safety and efficacy of laparoscopic drainage as a management of complex pyogenic liver abscesses in comparison to open surgical drainage.
METHODOLOGY
The comparative research design was used to compare the outcomes, complications, perioperative morbidity, mortality, and potential recurrence of 60 patients with a complex pyogenic liver abscess who were hospitalized at the General Surgery Department of Hayatabad Medical Complex Peshawar and treated either laparoscopically or openly from January 2019 to December 2020. 30 patients had open drainage management, while 30 patients received laparoscopic drainage management. For all patients, pus was examined for culture sensitivity. Patients with a small, solitary and unilocular pyogenic liver abscess that improved with antibiotic therapy and or/and percutaneous drainage were excluded. Each patient had a thorough clinical evaluation, lab tests, ultrasound, computed tomography, or magnetic resonance imaging of the pelvis and abdomen.
RESULTS
All patients underwent abdominal ultrasonography & sonographic diagnosis was made in 43(71.7%), followed by a computed tomography scan (CT) in 12(20%) & magnetic resonance imaging (MRI) diagnosis was made in 5(8.3%) patients respectively. Diabetes mellitus was present in 15(25%) patients, severe chronic obstructive pulmonary disease in 10(16.7%) and severe anemia in 9(15%) patients. All individuals associated with co-morbidity were considered high-risk patients.
CONCLUSION
Laparoscopic drainage of liver abscess has a shorter surgical time, lower morbidity rate, and shorter hospital stay as compared to open surgical drainage
The Role of Magnetic Resonance Venography in Headache Due to Suspected Cerebral Venous Sinus Thrombosis in the Presence of Normal T1 and T2 Dural Sinus Signal
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Cerebral venous sinus thrombosis (CVST) is an important but uncommon aetiology of stroke. The presentation of CVST is extremely variable clinically, moreover its onset can be either acute or subacute, and less frequently, chronic. Headache is the most common symptom of CVST. The headache is typically diffuse and progressing in severity over days to weeks. MRI and MRV have very high sensitivity and specificity and have become the modality of choice to confirm the diagnosis of CVST. The aim of this study was to weigh the benefits of added MRV in patients with headache, after a negative MRI for CVST.
METHODOLOGY
The total number of patients included was 207, with chief complaints of headache and suspicion of CVST. The MRV sequence used was dynamic coronal by using the time-of-flight technique. The diagnosis of CVST was made by the loss of normal signal void both on T1WI and T2WI as well as on non-visualization on MRV.RESULTSOut of these 207 patients, CVST was present in 52 patients. Superior sagittal sinus was involved in 8 cases, right transverse sinus in 2 cases, left transverse sinus in 7 cases, left sigmoid sinus in 3 cases, and multiple sinuses in 32 cases. 34 cases out of 52 had infarction which was mostly haemorrhagic i.e. 27. A total of 97 cases (46%) had aplastic/hypoplastic transverse segments which were mostly the left one (87, 42%) and 10 cases (4.8 %) on the right side. In none of the patients, CVST was picked by MRV alone after a negative T1 and T2 MRI.
CONCLUSION
In patients presenting with headache and suspected CVST additional MRV is only required if the routine MR sequences are not able to pick up the thrombus and the suspicion of CVST is very high
The Accuracy of Pre-Operative Ultrasonography in Localizing Parathyroid Adenoma for Minimally Invasive Parathyroidectomy (MIP)
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To determine the sensitivity of pre-op ultrasonography in localizing parathyroid adenoma for minimally invasive parathyroidectomy (MIP) technique.
METHODOLOGY
The study was conducted at the department of ENT and Head & Neck Surgery, MTI Hayatabad Medical Complex Peshawar. It included a retrospective analysis of records of patients who underwent MIP from Jan 1, 2019, to July 31, 2022. All patients had pre-operative meta-iodobenzylguanidine (MIBG) scans, and serum PTH, Serum calcium levels were determined. A pre-op ultrasound scan was acquired to mark the site of the parathyroid adenoma. MIP was carried out using a 3.5 to 4 cm transverse skin incision over the marked site to expose the thyroid gland. If the marked parathyroid gland was identified without using any other aids, the result was labelled as "True positive". The sensitivity of pre-op ultrasonography was calculated using SPSS v 26.0.
RESULTS
A total of 53 cases were included in the study. The male: female ratio was 1:1.8. The ages of patients ranged from 23-70 years with a mean age of 48.49 years with a standard deviation of +_ 10.818. Pre-op ultrasonography accurately localizes the site of parathyroid adenoma in 49 patients. Statistical analysis showed this to be a significant finding.
CONCLUSION
Pre-op ultrasonography is significantly helpful in localizing the parathyroid adenoma. Therefore its routine use is recommended to help localize the adenoma in minimally invasive parathyroidectomy
Mortality Rate Prediction in the Critically Ill Patients by Using Apache-II Scoring Tool
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The study’s objective was to implement a methodological approach, "Acute Physiological and Chronic Health Evaluation II (APACHE-II),” to classify critically ill patients based on severity.
METHODOLOGY
A retrospective study design was conducted at Shaukat Khanum Memorial Cancer Hospital Lahore, Pakistan, from May 2019 to May 2020. A pilot study of 6 months was conducted by reviewing the medical record of 30 adult patients following convenient sampling after the approval of the proposal by ASRB/IRB of Shaukat Khanum hospital. The record of both male and female patients was studied, while no record of paediatric or adult patients outside the ICU was studied. Each patient’s severity score was obtained using the patient’s parameters with the help of the APACHE-II table.
RESULTS
Among the patients, three out of 30 scored 25, 29 and 30 on APACHE-II. These patients later passed away in ICU. This indicates that the mortality rate increases with an increase in the APACHE-II score. Thus, the scoring system is very beneficial in predicting adult ICU patients' mortality rate.
CONCLUSION
It is concluded that APACHE II is one of the best severity scoring systems in predicting the critical condition of patients
Anti-Biofilm Forming Activity of Natural Products Extract Punica Granatum L. and Magnifera Indica L
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o evaluate the biofilm activity of Escherichia coli and the anti-biofilm forming activity of Pomegranate peels Punica granatum L. and Mango leafs Mangifera Indica L. extracts against Escherichia coli and their combined synergistic effect using 96 well microtiter plate.
METHODOLOGY
The study design was a cross-sectional study. The sample size was 150. The samples were collected from patients at PNS Shifa Hospital Karachi. The age group of the individuals included was from 15 to 50 years. The specimens received in the lab were inoculated on CLED agar, Blood agar, and MacConkey’s agar culture plates. Escherichia coli was identified by colony morphology, gram staining, TSI, and further biochemical test analysis. After identification, the samples were processed for biofilm activity on 96 well microtiter plate method and using serial dilution method to assess the anti-biofilm activity of natural product extracts. Patient's age, gender, and hospital number of patients were recorded on specially designed proforma with ERC approval no 83/2021.
RESULTSAmong 150 patients, 64% were males, and 36% were females. Overall mean age was (33.79±9.94) and (34.02±10.59) years. 90% of samples showed biofilm formation. We found a significant relationship between culture and examination (p-value 0.000), while no significant association was found between gender (p-value 0.69), age (p-value 0.44) and biofilm formation (p-value 0.57). Anti-biofilm forming activity of pomegranate peel extract against Escherichia coli was (24.46±19.09) with mean and standard deviation. Anti-biofilm forming activity of Mango leaf extract against Escherichia coli was (14.90±9.56). Significant synergistic relation was observed in both extracts, Punica granatum L. and Mango leaf extract Mangifera Indica L. used in combination.
CONCLUSION
It was concluded that a novel combination of natural product extracts had shown higher effectiveness against the rapid emergence of biofilm-forming pathogens