Prognostic significance of ischaemic electrocardiographic changes during stress testing in patients with normal nuclear myocardial perfusion imaging

Objective: To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted. Data was analysed using STATA 14.2.Results: Of the 2770 patients whose data was initially checked, 296(10.6%) developed ischaemic electrocardiogram changes during the stress test but had normal myocardial perfusion scan. Of them, 181(61%) patients were male, and the overall mean age was 62±15 years. Follow-up data was available for 280(94.5%) of these patients, with a mean follow-up of 48±7 months. Of these patients, 8(2.8%) died, and 1(0.3%) of them died due to inferior wall myocardial infarction. Myocardial infarction was found in 2(0.7%) patients, and 1(0.3%) patient was hospitalised with heart failure. Also, 12(4.3%) patients underwent revascularization for stable angina, 9(3.2%) underwent percutaneous transluminal coronary angioplasty, and 3(1.07%) needed coronary artery bypass grafting.Conclusions: Ischaemic electrocardiographic changes during stress testing in patients with normal myocardial perfusion scan were not associated with adverse outcomes, and the risk of cardiovascular events was relatively low for an intermediate follow-up period

Neurological Improvement after Decompression for Dorsal Spine Tuberculosis (TB)

Objectives:  To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading. Materials and Method:  Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented. Results:  Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery. Conclusion:  Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization. Keywords:   Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization

Long-term clinical outcomes of percutaneous coronary intervention in saphenous vein grafts in a low to middle-income country

Background: Revascularization of saphenous vein grafts (SVGs) is challenging and debated for the last few decades. The percutaneous revascularization of SVGs was reported to have poorer long-term outcomes than native coronary artery revascularization.Purpose: We aim to study the peri-procedural complications and long-term outcomes of the percutaneous revascularization of SVGs in a low-middle-income country.Methods: In this retrospective study, we included 110 patients who underwent percutaneous revascularization from January 2011 to March 2020 and followed them retrospectively for long-term outcomes and major adverse cardiovascular events.Results: The mean age was 71 ±9, and 81% were male. The most common reason for the presentation was non-ST segment elevation myocardial infarction (NSTEMI) (46%). The mean follow-up period of the study was 48±27 months. The most common comorbidity was hypertension (86%). A drug-eluting stent (80%) was placed in most of the patients, followed by a bare-metal stent (BMS) (14%) and percutaneous balloon angioplasty (POBA) (6%). We did not find any significant difference in major adverse cardiac events (MACE) (P=0.48), target vessel revascularization (TVR) (p=0.69), and target lesion revascularization (TLR) (p=0.54) with drug-eluting stent (DES) as compared to either BMS or POBA. The mean period from coronary artery bypass grafting (CABG) to SVG percutaneous coronary intervention (PCI) was 15± 5.5 years. Multivariate Cox regression analysis showed that an acute coronary syndrome (ACS) event, stroke, and female sex were independently associated with MACE.Conclusion: The long-term outcomes of SVG PCI are not affected by the types of stents. Female gender, ACS, and stroke are the independent predictors of MACE after SVG PCI, and statin therapy has a positive impact on the long-term outcomes of SVG PCI

Reorganising for COVID-19 pandemic: A review of structural modifications by the department of internal medicine in low to middle-income countries

Scientists classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a novel coronavirus on January 7, 2020. The World Health Organization (WHO) acknowledged the SARS-CoV-2 outburst a public health emergency of international concern on January 30, 2020. Since its origin, this virus has disrupted the best healthcare systems, economies, and strained financial resources; and for underdeveloped countries\u27 healthcare systems, the virus has become a crisis. To tackle the potential hazards from this virus, our Department restructured the services that not only helped us to cope with the pandemic, but also provided an example to copy for other contemporary institutes. This article aims to describe the measures and structural changes undertaken by the Internal Medicine Department, Aga Khan University Hospital (AKUH), Karachi, Pakistan. Key Words: COVID-19, Internal medicine, Structural modifications, Pandemic

Peringkat Daerah Rawan Pangan Berdasarkan Data Spasial Di Provinsi Aceh1 (Analise of Food Insecurity Base on Spatial in Nanggroe Aceh Darussalam Province)

Tujuan penelitian ini dalah untuk mengelompokkan daerah rawan pangan dan memetakanwilayah rawan pangan tingkat kabupaten/kota di Provinsi Aceh, mengidentifikasi karakteristik danfaktor-faktor penyebab rawan pangan pada setiap wilayah. Penelitian dilaksanakan di ProvinsiAceh yang meliputi 23 kabupaten/kota selama 8 bulan. Penelitian menggunakan metode survey,analisis secara deskriptif terhadap data sekunder yang meliputi : data pertanian, kesehatan, dan sosialekonomi. Hasil penelitian menunjukkan ada dua tingkatan wilayah rawan pangan di Provinsi Acehyaitu; tingkat kerawanan pangan sedang (21,7%), dan tingkat kerawanan tinggi (78,3%).Jumlah Kabupaten/kota dengan kategori kerawanan pangan tinggi lebih dari 3 kali lipatdibandingkan dengan daerah tingkat kerawanan sedang

Cross-sectional study identifying forms of tobacco used by Shisha smokers in Pakistan

OBJECTIVES: To estimate the frequency of different forms of tobacco intake such as smoker\u27s tobacco, chewable tobacco and snuff tobacco among shisha smoker\u27s and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan. METHODS: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18. RESULTS: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65 (16%) chewed tobacco and 33 (8%) snuffed it. The median age at initiation of Shisha smoking was 20 years. 280 (69%) considered Shisha smoking to be less deleterious to health than cigarettes. Respiratory disease was the most commonly cited health effect reported. Most 248 (61%) of the participants were infrequent shisha smokers. CONCLUSION: There is high frequency of tobacco usage in the form of cigarettes, chewable tobacco and snuff tobacco among shisha smokers of Pakistan. The highest frequency is for cigarette smoking. The rise in Shisha smoking as a trendy social habit appears to be occurring despite emerging scientific evidence of its potential health risks

Response of eltrombopag in immune thrombocytopenia and acquired idiopathic aplastic anemia: A single-center experience

Eltrombopag has been used in ITP and found its use in AA armamentarium recently. We retrospectively analyzed 61 patients at a tertiary care center in Pakistan from January 2015 to January 2021. They included patients with severe AA who were refractory to at least one course of immunosuppressive therapy and persistent/chronic ITP who have received at least one previous treatment for ITP. Responses to Eltrombopag in our population were comparable to real-world experiences while tolerable hepatotoxicity and GI issues were notable. We found Eltrombopag to be a safe and efficacious agent for treating patients with ITP and AA

Frequency of Congenital Anomalies in Newborns and Its Relation to Maternal Health in a Tertiary Care Hospital in Peshawar, Pakistan

Background: Congenital anomalies are a major cause of perinatal and neonatal deaths, both in low- and high-income countries. They are relatively common worldwide, affecting 3% to 5% of live births. Methods: A cross-sectional study was conducted from January 2014 to June 2014 at the Khyber teaching hospital in Peshawar. Specific patient information was obtained from patient records at the beginning of the study. Those individuals found to have at least one birth defect were approached and their attendants (mothers) were interviewed. Information regarding various risk factors was collected. Descriptive analyses were carried out. Results: Out of 1062 deliveries, 2.9% (31) of newborns had various congenital anomalies.b Hydrocephalus (22.6%), anencephaly (12.9%), and spina bifida (9.7%) were major anomalies. The maternal age ranged from 18 years to 46 years (mean: 30 ± 8). Most of the anomalies (35.5%) were present in the 26-30 years age group. Out of 31 babies, 6.4% had multiple anomalies. The preponderance of various congenital anomalies was seen in parity 1 (35.4%); parities 2 to 4 had lower incidences (35.4%). The consanguinity rate was 67.7%; only 32.3% of patients were using folic acid. History of passive smoking was positive in 16.1% of cases. Conclusion: Anencephaly and hydrocephalus were the most prominent anomaly detected; early prenatal diagnosis may be helpful in decreasing mortality by offering early termination. Low intake of folic acid and a high consanguinity rate were the most common associated risk factors for congenital anomalies. These risk factors may be reduced by creating awareness regarding the avoidance...

Spice-derived bioactive compounds confer colorectal cancer prevention via modulation of gut microbiota

Colorectal cancer (CRC) is the second most frequent cause of cancer-related mortality among all types of malignancies. Sedentary lifestyles, obesity, smoking, red and processed meat, low-fiber diets, inflammatory bowel disease, and gut dysbiosis are the most important risk factors associated with CRC pathogenesis. Alterations in gut microbiota are positively correlated with colorectal carcinogenesis, as these can dysregulate the immune response, alter the gut’s metabolic profile, modify the molecular processes in colonocytes, and initiate mutagenesis. Changes in the daily diet, and the addition of plant-based nutraceuticals, have the ability to modulate the composition and functionality of the gut microbiota, maintaining gut homeostasis and regulating host immune and inflammatory responses. Spices are one of the fundamental components of the human diet that are used for their bioactive properties (i.e., antimicrobial, antioxidant, and anti-inflammatory effects) and these exert beneficial effects on health, improving digestion and showing anti-inflammatory, immunomodulatory, and glucose- and cholesterol-lowering activities, as well as possessing properties that affect cognition and mood. The anti-inflammatory and immunomodulatory properties of spices could be useful in the prevention of various types of cancers that affect the digestive system. This review is designed to summarize the reciprocal interactions between dietary spices and the gut microbiota, and highlight the impact of dietary spices and their bioactive compounds on colorectal carcinogenesis by targeting the gut microbiota

Outcomes of patients with double/triple expressor diffuse large B-cell lymphoma (DLBCL) treated with R-DA-EPOCH/R-CHOP: A single-center experience

In Pakistan 76.4% of all NHLs to be diagnosed as DLBCLs. The survival of R-CHOP is better compared to the DA-REPOCH treatment regimen. A prospective follow-up study was conducted with 113 patients to study the outcomes of treatment. Multivariable cox-proportional hazard model was used to estimate the hazard ratios in patients receiving these treatment regimens considering p-value ≤0.05 significant. The survival rate among double/triple expressor lymphoma patients received R-DA-EPOCH was 82.8%, and 83.3% received R-CHOP. For double/triple expressor lymphoma patients received R-DA-EPOCH. The findings of our study demonstrated that the survival rate in both R-CHOP and R-DA-EPOCH is mostly similar