The use of intra aortic baloon pump in patients undergoing coronary artery bypass grafting at the Aga Khan University Hospital, Karachi

Objective: To review the experience in the use of Intra Aortic Balloon Pump (IABP) in patietits undergoing Coronary Artery Bypass Grafting (CABG) at a tertiary care hospital with a new Open Heart surgery program. Design: Retrospective study. Setting: The Aga Khan University Hospital, Karachi. Patients: Medical records of all patients undergoing CABG between November 1994 and July 1997 were reviewed and those in whom IABP device was used, were included in this study. Results: A total of 15 patients had IABP suppOrt during the study period. Four surgeries were done urgently while two were emergencies. There were three mortalities. Ejection fractions in all hut one patient were impaired. Among the surviving patients, the average pre-IABP Cardiac Index was 2.6 litres/mm/meter2 which registered an average increase of 21.15% after the initiation of the IABP. The Pulmonary Artery Wedge Pressure also showed an average reduction of 29.11% from the pre IABP levels reflecting an increase in the cardiac output with the use of the IABP. Conclusion: This series represents the early experience of a new cardiac surgery center in Pakistan in the use of IABP. Although the numbers in this study are too small to derive any conclusions, the overall morbidity and mortality in this short series are within acceptable limits in the high risk patients include

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan. METHODS: Hospital charts of 95 patients (mean age 58.8 (± 10.4) years; 78.9% male) undergoing IABC between 2000–2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality. RESULTS: The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01–1.11] for every year increase in age); diabetes (OR 3.68 [1.51–8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92–12.2]). Furthermore, prior CABG (OR 0.12 [0.04–0.34]), and in-hospital revascularization (OR 0.05 [0.01–0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05–1.22] for every year increase in age); diabetes (OR 6.35 [1.61–24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33–42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003–0.12]) conferred a protective effect. The overall complication rate was low (8.5%). CONCLUSIONS: Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country

Pediatric urolithiasis: To cut or not to cut

Urolithiasis is a major source of morbidity in children of the third world. Since its advent in 1982 and despite uncertainties about the long-term effects on the kidney, extracorporeal shock wave lithotripsy (ESWL) has rapidly replaced traditional surgery in the management of this condition. A retrospective study was conducted to compare the outcome of ESWL with that of open surgery in the management of paediatric urolithiasis in a single institution between November 1988 and December 1991. Emphasis was placed on the rate of stone clearance, complications, duration of follow-up, and cost of treatment of each modality. A total of 83 patients under 14 years of age underwent management of 101 stones; the stones were located in the kidneys (63), ureters (13), or bladder (25). Thirty-one patients who enrolled directly through the Lithotripsy Clinic underwent a total of 65 ESWL sessions for 44 calculi (mean, 2.1 sessions per patient). The overall stone clearance rate was 82%, with an 83% clearance rate for renal stones. There were three failures. Nine patients did not return after the first ESWL session, and by the end of 6 months, 93.5% were lost to follow-up. The cost of ESWL ranged from $600 to$1,000 (mean, $780). Fifty-two children were managed through the Pediatric Surgery Clinic and underwent open surgery (57 stones). The overall stone clearance rate was 96$520 to $900 (mean,$580). The authors believe that with the present level of knowledge, use of the lithotriptor should be restricted to children with small stones and/or those for whom long-term follow-up is possible

Experience of a New Kind: External Review of a Bioethics Centre

10.1353/asb.2015.0037Asian Bioethics Review74345-35

Conversations with Kidney Vendors in Pakistan: An Ethnographic Study

Asian Bioethics Review12108-13