RESUMO
Background Ischemic stroke (IS) is a fatal complication of acute coronary syndrome (ACS). Factors that speed up IS development after ACS are understudied, especially in developing countries like Pakistan. Thus, this study was designed to identify the potential risk factors of IS in patients with a preceding episode of ACS. Methodology This retrospective study was performed on 208 patients whose ACS and its consequent complications such as IS were managed in the cardiac and neurology units of Benazir Bhutto Hospital, Rawalpindi, from January 2022 to March 2023. Patients were enrolled via consecutive sampling and pre-defined inclusion and exclusion criteria. Before data collection, informed consent and ethical approval were obtained. Data were retrieved from the medical records of the patients. A self-structured proforma was applied to collect data. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. The study variables between patients with and without IS were compared using descriptive and inferential statistics. The association between IS and its possible risk factors in patients who had previously experienced ACS was determined using multivariate logistic regression. Results Of the 208 enrolled patients, 24 (11.54%) had IS following ACS. Sedentary lifestyle (odds ratio (OR) = 3.099, 95% confidence interval (CI) = 1.025~4.219, p = 0.009), hypertension (OR = 3.060, 95% CI = 1.798~4.876, p = 0.002), diabetes mellitus (OR = 2.899, 95% CI = 1.126~4.112, p = 0.009), dyslipidemia (OR = 2.907, 95% CI = 1.332~4.254, p = 0.007), history of smoking (OR = 2.760, 95% CI = 1.234~4.122, p = 0.018), and non-adherence to ACS medication (OR = 2.966, 95% CI = 1.300~4.266, p = 0.030), were the risk factors of IS among patients with preceding ACS. Conclusions In the study population, the incidence of IS following ACS was significant. Sedentary lifestyle, hypertension, diabetes mellitus, dyslipidemia, smoking history, and non-compliance with ACS therapy all played a significant role in the development of IS in patients with prior ACS. Proper management of ACS and associated risk factors could lead to the prevention of serious complications such as IS.
RESUMO
Background Coronary artery disease (CAD) is one of the major causes of death all over the world. Its severity evaluation through the Gensini scoring system is quite a complex process as these score systems require complex investigations and cardiologists. Therefore, this study aimed to determine the predictive capacity of neutrophil-to-lymphocyte ratio (NLR) for the severity of CAD in patients with myocardial infarction. Methods This cross-sectional study was performed on 208 patients with acute myocardial infarction whose coronary angiography was performed in the Department of Cardiology of Benazir Bhutto Hospital (BBH), Rawalpindi, Pakistan during the period of one year from January 2022 to March 2023. The enrollment of patients was made through purposive sampling and established inclusion and exclusion criteria. Ethical approval and informed consent were acquired before the data collection. Data was collected through a self-structured form. Vessel score and Gensini score were applied for the assessment of the severity of CAD. Patients were divided into two groups based on the Gensini score system. Data analysis was carried out in the Statistical Package for the Social Sciences (SPSS) version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were used to compare the study variables between the patients with non-severe CAD and patients with severe CAD. Pearson's correlation was used to determine the correlation between the NLR and the severity of CAD. A linear regression model was applied to evaluate the predictive capacity of the NLR for the severity of CAD. A p-value less than 0.05 was set as statistically significant. Results Out of 208 patients, 128 (61.53%) patients had non-severe CAD while 80 (38.47%) patients had severe CAD. Significant differences were observed in the Gensini mean scores, NLR values, and in the frequencies of hypertension, diabetes mellitus, dyslipidemia, and history of smoking, with p≤0.05 for all these variables, between the non-severe CAD group and severe CAD group. NLR was significantly correlated with the severity of CAD (p-value=0.001). Pearson's correlation coefficient was 0.71 for NLR with the Gensini scores. The simple linear regression model was valid (the p-value of the F test was <0.000), with beta coefficients of 2.60 (p=0.002) for NLR. The R2 value was 0.80 (80%). Conclusions In the current study, a significant percentage of patients had severe CAD. Furthermore, a positive and significant association was noted between the NLR with the severity of CAD. This present study suggests that NLR is a reliable predictor of CAD severity; therefore, it could be used for risk stratification of cardiac patients with CAD.
RESUMO
Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population, 69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CS group.
RESUMO
Background Postoperative acute heart failure (AHF) in elderly patients after hip fracture surgery is a common complication. Therefore, this study aimed to identify the risk factor of AHF after hip fracture surgery among the older population. Methods This retrospective cohort study was performed on 88 admitted patients whose hip fractures were fixed via internal fixation surgery in a tertiary care hospital in Rawalpindi, Pakistan, from January 2022 to March 2023. Recruitment of patients was made through established inclusion and exclusion criteria. Ethical approval and informed consent were also gained before the data collection. A self-designed form was used to collect data. Data analysis was carried out in the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were applied to compare the attributes of the patients with AHF and patients without AHF. Multivariate logistic regression was used to evaluate the association between the postoperative AHF and its potential risk factors. Results Out of 88 enrolled patients, 12 (13.64%) had developed postoperative AHF. Age ≥ 65 years (OR = 2.606, 95% CI = 1.035~4.160, p = 0.010), anemia (OR = 3.178, 95% CI = 1.847~5.990, p = 0.029), hypertension (OR = 2.019, 95% CI = 1.110~4.034, p = 0.012), diabetes mellitus (OR = 2.003, 95% CI = 1.115~4.012, p = 0.015), hypoalbuminemia (OR = 2.486, 95% CI = 1.218~4.619, p = 0.030), and operation time ≥ 120 minutes (OR = 1.702, 95% CI = 1.099~2.880, p = 0.018), were the risk factors of postoperative AHF in elderly patients after hip fracture surgery. Conclusions In the study population, the incidence of postoperative heart failure was significant and age ≥ 65 years, anemia, hypertension, diabetes mellitus, hypoalbuminemia, and operation time ≥ 120 were significantly involved in the development of it. Preoperative identification and management of AHF risk factors could lead to the prevention of postoperative complications.
RESUMO
Background Knee osteoarthritis (KOA) is a chronic and progressive disease of the knee joint characterized by articular cartilage destruction. It is the most common cause of knee disability and pain globally. Various treatments are used for the management of KOA; however, the role of intra-articular injections in KOA management in Pakistan remains understudied. Therefore, this study aims to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) and corticosteroids in the management of KOA. Methodology This randomized, prospective, comparative study was conducted among 88 patients diagnosed with KOA in the outpatient department clinic of orthopedics in Benazir Bhutto Hospital, Rawalpindi, from January 2022 to January 2023. For patient enrolment, structured inclusion and exclusion criteria and a simple random sampling technique were used. Before data collection, ethical approval and informed consent were obtained. Data collection was done via a self-structured and interview-based proforma. Data analysis was performed through descriptive statistics and independent t-tests using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results KOA was more prevalent in women (60, 68.18%) than men (28, 31.82%). The means for study variables such as age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 58.08 ± 7.89 years, 7.66 ± 1.8, and 71.86 ± 8.90, respectively. The incidences of right-sided and left-sided KOA were 57 (64.77%) and 31 (35.23%), respectively. Likewise, the frequency of grade II KOA was 55 (62.50%), while the frequency of grade III KOA was 33 (37.50%). Differences in the mean scores of both VAS and WOMAC between study groups were statistically significant at the second-week, sixth-week, and third-month follow-up visits. However, the mean scores of VAS and WOMAC were lower in group B than in group A at the second-week follow-up visit, whereas the scores were lower in group A compared to group B after the sixth week and third month of intra-articular injections. Conclusions Intra-articular injections of both HA and corticosteroids were adequately effective in the management of KOA-associated pain and functional restrictions; nevertheless, the benefits of corticosteroids were acute and short-term, whereas the outcomes of HA were gradual and long-term.