Management and outcome of post-myocardial infarction ventricular septal rupture-A Low-Middle-Income Country Experience.

BACKGROUND: Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients. METHODS: Data of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve. RESULTS: Mean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1-5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%). CONCLUSION: High in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.

Assessment of inhalation technique among patients of chronic respiratory disorders in Civil Hospital Karachi: A cross sectional study.

OBJECTIVE: To evaluate the inhaler technique of patients and the awareness acquired during pulmonary teachings given in the beginning of the treatment. METHODS: This cross-sectional study was conducted at Civil Hospital, Karachi, from December 2013 to July 2014, and comprised patients diagnosed with obstructive broncho-pulmonary diseases and who were using inhaler therapy. A questionnaire was designed to assess the technique by an inhaler technique checklist, which was pilot-tested and was filled after obtaining verbal consent. SPSS 19 was used for data analysis. RESULTS: Of the 202 participants, 110(54.45%) were women and 92(45.54%) were men. Moreover, 168(83.2%) used metered-dose inhaler while 34(16.8%) used dry-powder inhaler. Besides, 134(79.8%) patients showed incorrect technique while using metered-dose inhaler while 22(61.1%) used dry-powder inhaler improperly. CONCLUSIONS: In spite of the guidelines given, improper inhalation technique persisted in population leading to uncontrolled asthma and poor treatment compliance.

KNOWLEDGE AWARENESS AND BEHAVIOUR OF NON-MEDICAL STUDENTS ABOUT CARDIOVASCULAR DISEASES.

BACKGROUND: Cardiovascular diseases is the leading cause of death worldwide, yet very little data is available assessing the awareness of the younger population of Pakistan. The purpose of this study was to evaluate the awareness, knowledge and the preventive measures taken to avoid the health issues related to cardiovascular diseases. METHODS: It was a community based cross sectional descriptive study to assess the awareness and behavior in young non medical students. A questionnaire was developed and survey was conducted on 300 non medical students enrolled in different universities of Pakistan. Data analysis was performed using SPSS-16. RESULTS: The sample consisted of 300 students aged between 16 and 32 years. 6.7% of the participants had history of blood pressure, 0.7% had diabetes, and 68.3% had a family history of cardiovascular diseases. 17.4% students were smokers. In the knowledge section, only 22% respondent scored above 20 out of 28 showing lack of knowledge. 42.7% participants were concerned about developing coronary artery diseases. 43.3% and 6.7% knew their blood pressure and cholesterol level respectively.33.3% and 41.7% regulate their dietary fat and salt intake respectively. CONCLUSION: Our study elucidates that cardiovascular diseases are not perceived as major risk by Non Medical Students. Lack of knowledge, physical inactivity, and high positive family history render the target population prone to cardiovascular diseases. The findings of study indicates the need for heart disease awareness campaigns for young population, to escalate the preventive actions and adoption of healthy lifestyles so as to lower the incidence of cardiovascular diseases in Pakistan.