Safety and Efficacy of Single vs Dual Antiplatelets Therapy After Atrial Septal Defect Device Closure.

BACKGROUND: Atrial septal defect device closure has become a standard procedure. Antiplatelet therapy is used to prevent thrombus formation in the device. There is no clear recommendation about the antiplatelets drugs. This study aims to evaluate the safety and efficacy of Aspirin vs (Aspirin +Clopidogrel) after device closure. METHODS: A cross-sectional study was conducted among all consecutive adult patients (?18 years) who underwent atrial septal defect device closure from May 2019 to April 2020 and meet the inclusion criteria were included. After successful ASD device closure patients were treated with ASA or combination of ASA and Clopidogrel for six months on physician discretion. Patients were followed up for six months to observe for Transient ischemic attack, Stroke, thrombus in the device, myocardial infarction, major bleeding, minor bleeding and increases in headache episodes compared to baseline. RESULTS: This study consisted of 130 patients: 65 in the Aspirin Group, and 65 patients in Aspirin and Clopidogrel group. There was no Transient ischemic attack, Stroke, Myocardial infarction, thrombus, major bleeding in both groups. There was no significant difference between two groups in ecchymosis; Aspirin group 4(6.1%) vs. aspirin and Clopidogrel group 3(4.6%) [Difference, 1.54% {95, % CI, -1.45%to 4.53%}]; P=0.648. There was no significant difference in increase in headache episodes compared to baseline for six months after the device closure in Aspirin Group 3(4.6%) VS Aspirin and Clopidogrel group 2 (3.0%) group [difference, 1.54% {95% CI, -1.45%to 4.53%}]; P=0.648. CONCLUSIONS: Our study suggests that single antiplatelet therapy with Aspirin is as safe and effective as aspirin and clopidogrel after device closure.

Correlation between Myocardial Strain by 2-D Speckle-Tracking Echocardiography and Angiographic findings by Coronary Angiogram in Stable Angina.

Background and aims: Identification of coronary artery disease by non-invasive means is a subject of interest for all. Myocardial strain has shown some promising results. This study intends to see if change in strain value correlates with the angiographic findings in patients with stable angina. It is also assessing whether myocardial strain can predict the presence of coronary artery disease (CAD) in stable angina patients. Method: This cross-sectional study was carried out on 84 stable angina patients with no previous cardiac history and normal LV function undergoing coronary angiogram for guideline-based indication. After careful history, clinical examination and investigations, including conventional echocardiography, selected participants underwent 2-D speckle tracking echocardiography for measurement of myocardial strain by automated functional imaging. All participants underwent coronary angiogram and stenosis >70% was considered significant. Gensini score was calculated. The myocardial strain value and Gensini score were correlated. Results: Global longitudinal strain (GLS) was significantly lower in patients with significant CAD than those with non-significant CAD (-16.1±2.6% vs -19.4±2.2%; p < 0.001). The optimal cut-off value of GLS, which discriminated between patients with and without significant coronary artery disease, was -18.05% (sensitivity=81.8% and specificity=85%). Also, GLS declined incrementally with the increasing severity of CAD defined by increasing number of stenotic vessels. There was an inverse correlation between GLS and severity of CAD (expressed in Gensini score) in this study (r = 0.669, p< 0.001), meaning that GLS decreased with increasing severity of CAD. GLS remained an independent predictor for the presence of significant CAD after multivariate adjustment for other significant baseline characteristics and echocardiographic parameters. Conclusions: The myocardial strain by 2DSE correlates with the angiographic severity by coronary angiogram in patients with stable angina. It is an independent predictor of significant coronary artery disease, which it can detect with good sensitivity and specificity.

In Hospital Complications of Atrial Septal Defect Device Closure at Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

BACKGROUND: Atrial deptal defect device closure has become the preferred method in the treatment of atrial septal defect. We aim to study the in-hospital complications of atrial septal defect device closure procedure. METHODS: It was a single center, retrospective study conducted from Febuary 2016 to January 2019. Cardiac catheterization laboratory records of all consecutive patients who underwent atrial septal defect device closure was included and the in-hospital complications were been retrospectively reviewed. RESULTS: During the study period, a total of 566 patients were attempted for device closure. In 557 (98.4%) of cases device was implanted. Among the 557 patient in which device was implanted 401(71.9%) were female. Age ranged from 5 years to 72 years with the mean of 30.9 years. Transient ST segment elevation 15 (2.6 %)was the commonest complication followed by pericardial tamponade 4 (0.7%), and cardiac arrhythmias 3 (0.5%). CONCLUSIONS: Atrial deptal defect device closure can be done safely with a high success rate and a low complication rate.

Antimicrobial Sensitivity Trend in Blood Culture Positive Enteric Fever.

BACKGROUND: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered. METHODS: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study. RESULTS: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi. CONCLUSIONS: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity.