DIABETES AS A RISK FACTOR OF IN – HOSPITAL MORTALITY IN PATIENTS WITH PREMATURE CORONAY DISEASE PRESENTING WITH ACUTE MYOCARDIAL INFARCTION.

Background; Recent data from various parts of the world have led to the conclusion that more than 80 % of CVD deaths occur in developing countries like Pakistan. This high burden of heart diseases is largely attributed to the industrial and technological progress which is associated with economic and social transformations which have lead to life style modification and sedentary life style. This study was planned to ascertain mortality rate of premature coronary artery disease in patients with AMI as it directly affects main workforce of our national economy. Objective; To determine role of diabetes with mortality in premature coronary artery disease patients with acute myocardial infarction.  Material and methods; A total of 145 patients having premature coronary artery disease presenting with acute myocardial infarction were included in this descriptive study. This study was conducted in the department of medicine, Nishtar Hospital, Multan from June 2018 to May 2019. These patients were followed during current hospitalization to see mortality in these patients and all the findings were noted in the proforma. Results; Of these 145 study cases, 96 (66.2%) were male patients and 49 (33.8%) were female patients. Mean age of our study cases was noted to be 47.67 ± 7.59 years. Mean time taken before presentation at hospital was 113.79 ± 54.36 minutes. Hypertension was present in 58 (40%), smoking in 39 (26.9%), family history of IHD in 67 (46.2%) and obesity in 49 (33.8%) of our study cases. Mortality was noted to be in 19 (13.1%) of our study cases, post MI angina was seen in 36 (24.8%) and cardiogenic shock was noted in 29 (20%). Diabetes was present in 48 (33.1%) of our study cases while in – hospital mortality among diabetic patients was 18 /48 (37.5%) (p=0.001). Conclusion; Our study results indicate that diabetic patients with premature coronary artery disease having acute myocardial infarction (AMI) have high rates of mortality. Positive family history, hypertension, obesity and diabetes were major risk factors noted in our study. Life style modification and early screening of the cases with positive family history in first degree relatives can help prevent heart diseases in our population as it hits main workforce and has negative impact on national productivity. Keywords; Premature coronary artery disease, mortality, diabetes, Myocardial infarction. DOI: 10.7176/JMPB/55-14 Publication date:May 31st 201

Hepatic encephalopathy in chronic liver disease: predisposing factors in a developing country

Objective: To fi nd out the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease. Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder that is caused by liver damage. In its pathology, alterations in normal brain function are associated with an increase in blood ammonia, benzodiazepine like substances, products of neurotoxic fatty acids, and other gut derived toxins, which gain access to the brain as a result of liver dysfunction. Study Design: Hospital based descriptive, cross sectional study. Settings: Medical Unit 1, Ward- 5, Jinnah Post Graduate Medical Centre, Karachi. Duration: July 2013 to December 2013. Patients and Methods: About 150 patients admitted in medical unit 1 with a diagnosis of chronic liver disease in a state of hepatic encephalopathy were included in this study. Patients suffering from viral or bacterial encephalitis, stroke, brain tumor, Wernicke’s encephalopathy were excluded from the study. Results and Observations: There were 96 (64%) female and 54 (36%) were male patients. Mean age of the patients was 52.45 (±12.271) years. 80 (53.33%) patients were having constipation. Infection was found in 55 (36.66%) cases. Upper GI Bleed was present in 51 (34%) patients. 44 (29.33%) patients had moderate to severe electrolyte imbalance as the cause. Constipation alone was the cause in 11.33% of cases. More than one factor was found to be responsible in around 56% of patients while in 6.6% of cases none of these precipitating factors was isolated. Conclusion: Constipation is the commonest cause of hepatic encephalopathy followed by infection, upper GI bleed and electrolyte imbalance

OUTCOME OF VAGINAL VERSUS ABDOMINAL ROUTE OF HYSTERECTOMY

Background; Hysterectomy is “Surgical removal of all or part of uterus”. Abdominal and vaginal route of hysterectomies are both predominant operative techniques being employed by the gynecologists all the world for various uterine conditions. Indications to select any particular technique in any of the hospital setting might not be optimally defined. This study was planned to evaluate particular route of hysterectomy (vaginal hysterectomy and abdominal hysterectomy) as there was no such study available which could document the data of our local population so this study was planned to be conducted to determine burden of problem and deficiencies for clinicians to opt better treatment options among targeted population. The results of this study will not only add in national data but will also be comparable with other international studies. Objective; To determine outcome of vaginal versus abdominal route of hysterectomy at a tertiary care hospital. Material and methods: A total of 240 women meeting inclusion and exclusion criteria of this study were registered in this study. Informed consent was taken from each patient. All the relevant data were recorded on pre-designed proforma. Data were entered and analyzed using SPSS-17. Results: A total of 240 subjects fulfilling the inclusion and exclusion criteria were registered in this study for abdominal hysterectomy and vaginal hysterectomy. Out of these 240 cases, 79 (32.9%) had undergone vaginal hysterectomy and 161 (67.1%) underwent through abdominal hysterectomy. Mean age of the study cases was 42.72±5.18 years (minimum age was 31 years while maximum age was up to 50 years). Mean parity of the study cases was 5.67±2.08 (minimum para 1 and maximum para 10). Pyrexia was seen in 90 (37.5%) of the study cases, of these 27 (30%) had undergone through vaginal hysterectomy and 63 (70%) underwent abdominal hysterectomy. Minimum duration of the surgery was 45 minutes and maximum duration of the surgery was 90 minutes, mean duration of the surgery was 69.75±14.92 minutes. Minimum Hospital stay was 3 days ranging to maximum hospital stay being 10 days, mean hospital stay in these study cases was observed to be 4.42±1.65 days. Conclusion; Vaginal route of hysterectomy is associated with lesser postoperative complications in terms short duration surgery, significantly short hospital stays and lower rates of postoperative pyrexia than that of abdominal route of hysterectomy. Keywords; Abdominal Hysterectomy, Vaginal hysterectomy, Uterovaginal prolapse. DOI: 10.7176/JMPB/55-05 Publication date:May 31st 201

Fuzzy decision making in Business intelligence in the context of Gilgit-Baltistan

The main purpose of this paper is to investigate and implement fuzzy decision based on unequal objectives and minimization of regret for the decision making in the business intelligence and to compare the weight of products while the minimization of regret that uses regression of products in Gilgit-Baltistan. Here we will convert the verbal expressions in to linguistic variables and use in fuzzy decision making model, which influences the main two factors, one is effect of the influence on the product and second its payoff for the most effectiveness on the products

Catheter ablation of the valsalva region using intracardiac echocardiography guidance

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Birth Asphyxia - Clinical Experience and Immediate Outcomes

To find out immediate outcome ofneonates with birth asphyxia and its associationwith risk factors.Methods: This cross sectional study included allconsecutive babies admitted with diagnosis of birthasphyxia . Babies with congenital heart disease,congenital malformations and prematurity wereexcluded. Biodata and clinical parameters includingplace of delivery,dai handling,time of arrival inhospital,mode of delivery, grades of hypoxicischemic encephalopathy, outcome in terms ofdischarge and death were recorded.Results: Sixty one patients were included in thestudy. Majority (80.3%) were male..Mothers havingregular antenatal checkup were 65.5%. Eleven (18%)babies were home delivered and 50(82%) in hospitalsetup. In 16.4% babies there was history of daihandling. 60.7% babies were delivered by SVD and39.3 % by C- section. Majority (83.6 %) presentedwithin 6 hours. Hypoxic ischemic encephalopathystage I, II and III was seen in 39.3%, 49% and11.5%respectively. Forty eight (78.7%) babies weredischarged and 13(21.3%) died. No evidence ofassociation was found between outcome at dischargeand time of arrival at hospital (p value=0.33)and daihandling (p value= 0.114). Significant associationwas found between outcome at discharge and placeof delivery (p value=0 .031) and outcome at dischargeand hypoxic ischemic encephalopathy stage (pvalue=0.000).Conclusion: Asphyxiated newborns havesignificant short term mortality in association withhome deliveries and hypoxic ischemicencephalopathy stage II