Predictors and Prevalence of Obstructive Coronary Artery Disease in Patients Who Underwent Elective Invasive Coronary Angiography for Chronic Coronary Syndrome at Catheterization Laboratory of Tikur Anbessa Specialized Hospital and Gesund Cardiac and Medical Center, Addis Ababa Ethiopia: Retrospective Study

Gebeyehu Beka,1 Zekewos Demissie,1 Bekele Alemayehu2 1Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Internal Medicine, Division of Cardiology, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Gebeyehu Beka, Email [email protected]: Coronary angiography remains the standard diagnostic test for evaluating the extent of coronary artery disease (CAD). Guidelines for triaging patients for invasive coronary angiography (ICA) recommend risk assessment and non-invasive testing. The yield of ICA in patients undergoing elective ICA in Ethiopia is unknown.Methods: The study involved patients who underwent elective ICA at catheterization laboratory of Cardiology unit of Tikur Anbessa Specialized Hospital and Gesund Cardiac and Medical Center between January 2019 and September 2022 G.C. Data on patient risk profile, Chest pain characteristics and ICA finding were collected from electronic medical record, patient’s chart and procedure note with the aid of a structured questionnaire. Obstructive CAD was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel. The data was analyzed using SPSS version 26.0.Results: A total 232 patients, with mean age of 59.9 years, were involved. At catheterization 49.6% were found to have obstructive CAD and 43% of patients had normal epicardial coronary arteries. Hypertension and DM were the commonest comorbidity each occurring in 61% and 53% of the patients. The presence of DM, CKD, and smoking and typical chest pain were independently associated with obstructive CAD.Conclusion: In this study only half of the patients undergoing elective ICA for suspected chronic coronary syndrome (CCS) have obstructive CAD. In consecutive patients undergoing elective ICA for suspected CCS in Ethiopian, obstructive CAD was found in 49.6% of patients despite high prevalence of atherosclerotic risk factors like hypertension and Diabetes mellitus. Diabetes, hypertension, typical chest pain and history of smoking were found to be strong predictors of obstructive CAD.Keywords: chronic coronary syndrome, elective, invasive coronary angiography, ischemic heart disease, CCS, IC

Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections

The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

Background: Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. Methods: The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. Results: There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80–90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80–100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35–40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. Conclusions: Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI

City profile: Wa, Ghana

The UN-Habitat III has placed secondary cities at the centre of the new urban agenda, given their roles in global development trajectories in the future. Wa, though a small city, is an important growth pole in North-western Ghana. Wa emerged as a trading town in the colonial era and since independence in 1957 has become a key growth centre in the development of North-western Ghana. However, the confluence of environmental vulnerabilities and pre-existing social inequalities resulting from centuries of colonial and post-colonial neglects, have led to increasing contestations and socio-ecological challenges. We profiled Wa through the lens of Southern urbanism and highlight its socio-economic, ecological and spatial development dynamics as an ordinary city of the Global South. The dynamics reflect a disconnection between capital and labour as well as contested resource flows, and these have implications for a transformative and sustainable urban future. Through this profile, postcolonial urban studies of the Global South must reconsider deepening empirical methods and theories in addressing this unique problem-space. A transformative and sustainable urban future of Wa remains counterproductive if postcolonial urban studies do not engage with unique paradigms of the Global South in understanding and planning cities of the South