Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis.

Objective To evaluate characteristics and outcomes of patients presenting with mechanical prosthetic valve thrombosis in a tertiary cardiac center in Pakistan. Methods This was a prospective and interventional study conducted at Rawalpindi Institute of Cardiology over a period of two years. The clinical characteristics of patients presenting with clinical suspicion of prosthetic valve thrombosis were recorded. They were, then, subjected to streptokinase, redo surgery and heparin based on their hemodynamic stability, thrombus burden and surgical risk. The patients were then followed for the outcomes of the study. Results Out of 576 patients with mechanical valve replacement during the study period, 70 patients had developed prosthetic valve thrombosis. Out of 70 patients, there were 41 female (58.50%) and 29 male (41.50%) participants. The mean age of the participants was 48.40±15.00 years. The overall incidence of mechanical prosthetic valve thrombosis was 12.15%. There were 30 patients (42.80%) with a suboptimal international normalized ratio (INR) and 28 patients (40.00%) were non-compliant to warfarin therapy. The overall incidence of adverse clinical outcome was 18.00%, while the overall mortality rate was 10.00%. The mortality was higher for patients who underwent redo surgery (16.60%) as compared to patients who had received fibrinolytic therapy (9.60%). Conclusion Poor compliance with warfarin and suboptimal INR are the important factors causing mechanical prosthetic valve. Because of lower mortality rate, fibrinolysis with streptokinase is a reasonable treatment option for mechanical prosthetic valve thrombosis.

Successful treatment of a radial artery pseudoaneurysm in an octogenarian.

The transradial approach for coronary catheterisation has gained rising popularity owing to its fewer access site complications compared with the transfemoral approach. A rare but recognisable complication of the procedure is radial artery pseudoaneurysm (PSA). We report a case of radial PSA occurring 2 h following percutaneous coronary intervention in an 85-year-old woman, which was successfully treated by ultrasound-guided thrombin injection. This non-surgical technique has recently gained rising popularity as a relatively novel modality of managing radial PSA.

Severe post-dialysis hypokalaemia leading to quadriparesis.

A 36-year-old male developed acute renal failure and severe metabolic acidosis following acute severe gastroenteritis. Two hours following haemodialysis he developed generalized muscle weakness, which progressed to quadriplegia over the next 4 hours. Electrocardiography (ECG) revealed classic signs of hypokalaemia. Serum potassium (K+) levels were 0.98 mmol/L. He was immediately started on intravenous (i/v) and oral potassium supplementation. He gradually improved and his ECG changes also reverted as potassium levels normalized. Postdialysis hypokalaemia can be a serious complication in patients who are already in total body potassium deficit. Dialysis fluid potassium levels should be kept higher in such patients.

Comparison of calcium acetate with calcium carbonate as phosphate binder in patients on maintenance haemodialysis.

BACKGROUND: Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis. METHODS: This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium > 2.54 mmol/l, and phosphate binding power as serum phosphate < 1.61 mmol/l. RESULTS: Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l (SD 0.33) vs. 1.46 mmol/l (SD 0.34), p = 0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy (2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01). Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate. CONCLUSIONS: It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate.

A case of chronic liver disease. Hev induced or cryptogenic?

Hepatitis E virus (HEV) infection is known to cause epidemic outbreaks as well as sporadic disease in many parts of the world. Clinical presentation of hepatitis E varies from acute icteric viral hepatitis to severe disease with fulminant hepatic failure, and anicteric infection (no jaundice but with ALT elevation). According to available data HEV infection does not lead to chronic liver failure. We are reporting a case of 37 years old army soldier who was admitted as a case of HEV induced acute viral Hepatitis. Later he was found to have chronic liver disease (CLD) with persistence of HEV antibodies and absence of any other detectable cause of CLD.

Significance of occult HBV infection in patients with chronic hepatitis C.

OBJECTIVE: To determine the frequency of occurrence of occult Hepatitis B infection in chronic hepatitis C patients and its impact (if any) on the effectivity of standard chronic hepatitis C treatment. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Medicine, Military Hospital, Rawalpindi, and Virology Department, Armed Forces Institute of Pathology, Rawalpindi, for a period of nine months from January 2003 to September 2003. PATIENTS AND METHODS: This study was conducted on 30 HBsAg negative patients with chronic hepatitis C liver disease who were receiving combination therapy with interferon and ribavirin. Occult hepatitis B infection was assessed by carrying out HBV DNA by polymerase chain reaction (PCR) in the sera of these patients. Markers of previous hepatitis B infection i.e; anti-HBs and total anti-HBc antibodies were also tested. Response to treatment for hepatitis C (with interferon and ribavirin) was assessed at the end of six months of therapy by measuring ALT levels and HCV RNA by PCR in the serum. RESULTS: In our study only one patient (3.33%) was found to be harbouring HBV DNA in the serum detectable by PCR, with markers of previous HBV infection (both anti HBc antibodies and anti HBs antibodies were positive). A total 14 patients (46.67%) had markers of previous HBV infection, while 16 patients (53.33%) had no such seromarkers. Twenty-five out of 30 patients (83.33%) responded to treatment and 5 (16.66%) turned out to be non-responders. The single case of occult hepatitis B detected in this study responded to hepatitis C treatment. CONCLUSION: Occult hepatitis B is not a common occurrence in chronic hepatitis C patients and it did not alter the outcome of treatment for hepatitis C in our study.