Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Background: There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin. Method: A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function. Results: Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) presented during pregnancy and 31 (68.8%) after delivery. All patients presented with CHF and three (6.6%) were complicated with ventricular tachycardia (VT) at presentation. LV systolic dysfunction was present in 39 (86.66%) patients and RV dysfunction in 15 (33.3%) patients. Two patients had LV clot and thromboembolic stroke occurred in another 4 patients. All patients received standard treatment except three patients who had asthma and could not be given beta blockers. Echocardiogram was repeated after 6 month and in 32 (71.1%) patients LV functions recovered to normal. RV function improved in all except 2 (4.4%) patients. All patients were discharged in stable condition. Conclusion: Significant numbers of PPCMP patients, who had severe LV dysfunction at presentation recovered their LV functions at six month follow u

Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Objective: There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin. Methods: A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function. Conclusion: TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress

Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome.

We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2 h duration. The examination revealed irregular pulse of 138 bpm, blood pressure 115/75 mm Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with β blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed dissection in the left coronary system extending into the branch vessels and 30-40% stenosis in the right coronary artery. The patient underwent coronary artery bypass graft as an emergent case. He suffered a mild stroke postsurgery with complete functional recovery. He is being followed up in the clinic and has performed well

Bioassay evaluation of toxicity reduction in common effluent treatment plant

This paper investigates the utility and validity of bioassay toxicity testing using Daphnia magna straus as test organism for monitoring the common effluent treatment plant (CETP) receiving both industrial as well as domestic effluent. The average daphnia toxicity (Gd) at inlet, after primary settling tank (PST), secondary settling tank (SST) and tertiary treatment unit were reported as Gd-16, Gd-12, Gd-4 and Gd-1 respectively. However, a cumulative percentage removal in toxicity after PST, SST and tertiary treatment units was observed as 25%, 75% and 100%, respectively, during entire study period. It showed that a complete removal in daphnia toxicity (Gd) i.e.100% had been achieved only after tertiary treatment unit involving Dual Media Filters followed by activated carbon filters. Further attempts have been made to establish the relationship between key wastewater constituents i.e. Chemical Oxygen Demand (COD) and Suspended Solids (SS) with respects to daphnia toxicity (Gd). It was observed that COD and SS show a statistically significant correlation (r2) with daphnia toxicity (Gd) i.e. 0.89 and 0.81, respectively. Thus COD and SS can serve as a regulatory tool in lieu of an explicit toxicity standard (to check and improve the operational status of wastewatertreatment plants in time)

Mode of coronary revascularization and short term clinical outcomes in patients with chronic kidney disease

Abstract BACKGROUND AND OBJECTIVE: Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients. METHODS: In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction (MI), or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes. RESULTS: Out of 159 patients with CKD, 85 (53.5%) received PCI and 74 (46.5%) received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD. CONCLUSION: Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD

The gametophyte of acrostichum aureum L.

The spores of A. aureum are trilete and granulose. On germination, a 6-10 cells long germ filament is produced, in which growth is mainly by intercalary formation of new cells rather than by cell elongation. One or two of the terminal cells become quiescent soon, and the intercalary cells form a prothallial plate. Cells on one side of the plate are more active than those on the other, and a broad ameristic lateral lobe is developed by their activity. As the lobe becomes spatulate, a multicellular meristem is differentiated from marginal cells on the side facing the posterior end of the germ filament. By the activity of the meristem the prothallus becomes cordate, with the meristem at the bottom of the notch. A midrib is formed behind the notch and the prothallus grows to become asymmetrically cordate. The mature prothallus is naked and with ruffled wings. Juvenile leaves possess entire, naked lamina

Types of refractive errors in northern Pakistan: a hospital-based survey

Background: The World Health Organisation (WHO) reports that about 314 million people are visually impaired worldwide, and in 153 million of them the impairment is due to uncorrected refractive errors. Hence, uncorrected refractive error is one of the leading causes of blindness around the globe. The aim of this study is to assess the prevalence and patterns of different types of refractive errors among the people attending the eye clinic in Northern Pakistan. Material and methods: A hospital-based retrospective audit was done on patients who presented to the Ophthalmology Outpatients Department of Ayub Medical Complex Abbottabad between 1st June 2017 and 31st July 2017. The data of 662 patients were analysed using IBM SPSS Statistics v. 22.0. Results: Refractive errors were found in 487 (73.5%) of the total participants. The crude prevalence of myopia, hyperopia, and astigmatism was found to be 33.5%, 21.9%, and 18.1%, respectively. The refractive error status was found to be independent of gender (p = 0.075), but it varied among different age groups (p = 0.000). Conclusion: Myopia seems to be the most common refractive error in northern Pakistan, followed by hyperopia. The results of our study can be useful for the planning of eye care services in our country so that we can achieve the goal of VISION 2020 with proper care and planning