CKD-MBD spectrum at the time of initiation of hemodialysis in Pakistani chronic kidney disease patients

Chronic kidney disease (CKD) is associated with mineral and bone disorder (MBD), which results in significant morbidity and mortality. To determine the spectrum of CKD- MBD in the Pakistani population, we performed a retrospective review of the medical records of 63 native Pakistani CKD stage-5 patients at our unit at the initiation of hemodialysis from March 2009 to September 2011. The cohort included 28 males and 35 females, with an age range of 18- 87 years (mean age 51 years). We reviewed the serum parathormone (PTH) levels along with other serum biochemical markers according to the KDIGO 2009 guidelines. There were 25 (40%) patients who had PTH 300 pmol/L. Subgroup analysis and follow-up of patients with initial PTH >300 pmol/L (n = 24) showed treatment response in nine patients (38%). We conclude that at initiation of hemodialysis, a significant number of patients had low PTH and a similar percentage of high PTH in our population states. Therefore, we recommend early assessment of renal bone disease spectrum to prevent morbidity and mortality associated with mineral bone disorder in CKD patients

Multi-vessel versus culprit-vessel-only PCI for STEMI: Where does the jury stand?

The annual incidence of myocardial infarctions (MI) in the United States is 1.5 million. Percutaneous coronary intervention (PCI) is a non-surgical procedure whereby a stent is employed to revascularize a blocked coronary vessel. It has become the preferred modality for the treatment of acute ST-segment elevation myocardial infarction (STEMI) [1,2]. In patients presenting with acute coronary syndrome (ACS), the first question that governs the optimal treatment approach is whether there is an obvious culprit lesion for the patient's underlying presentation. If such a lesion is present alongside ongoing ischemia in a STEMI, emergent PCI of the culprit vessel is recommended. Contrarily, if the culprit lesion is present without ongoing ischemia, the extent of coronary artery disease (CAD) must be evaluated to determine the approach: a single-vessel (PCI of culprit) or multivessel (including the left coronary artery) PCI. The culprit lesion is treated first; however, in patients with multiple coronary artery disease, the distal lesions are treated first. Nevertheless, whether multivessel PCI confers a comparative therapeutic advantage over culprit-vessel-only PCI remains enigmatic.</p

Prasugrel versus ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: A critical appraisal of randomized controlled trials

Every year, millions of coronary stenting procedures are performed for the treatment of ischemic heart disease. Initially, bare metal stents (BMS) were utilized for acute coronary syndromes (ACS) and myocardial infarctions (MIs). While effective, rates of restenosis with BMS were a concern, subsequently leading to the advent of drug-eluting stents (DES). DES were coated with polymers that enabled the slow and controlled release of anti-proliferative agents, such as sirolimus and paclitaxel. Studies thereafter showed that DES indeed led to a marked decrease in the restenosis rate of stented coronary vessels. Nevertheless, despite the plummeting restenosis rates, thrombosis remained an issue, even in DES, where one of the primary concerns was that their non-biodegradable polymers remained after completing drug release. Thereafter, numerous clinical trials and studies have unequivocally demonstrated that treatment with dual antiplatelet therapy (DAPT), a combination of a P2Y12 antagonist and aspirin, is the go-to strategy for these patients.</p

Simultaneous left ventricular aneurysm and ventricular septal rupture complicating delayed STEMI presentation: a case-based review of post-MI mechanical complications amid the COVID-19 pandemic

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic