Mitral leaflet separation index correlation with mitral stenosis severity, a reliable easy 2-d echocardiography technique.

Objectives: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis. METHODS: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets. Pearson correlation coefficient was computed for mitral leaflet separation index and mitral valve area. Receiver operating characteristic curve was used to determine the cut-off value of the mitral leaflet separation indexto categorise mitral stenosis. Data was analysed using SPSS 19. RESULTS: Of the 277 patients, 205(74%) were females and 72(26%) were males. The overall mean age was 39.93±11.22 years. The mean mitral leaflet separation index value was 7.65±2.23. The correlation was significant and strong between mitral leaflet separation index and mitral valve area on planimetry (p<0.001), and was significant and moderate when measured by pressure half-time (p< 0.001). Mitral leaflet separation index cut-off value <8.625mm and <8.25mmcould predict severe mitral stenosis with 84% and 86.3% sensitivity and 84.6% and 78.3% specificity on planimetry and pressure half-time, respectively. CONCLUSIONS: The mitral leaflet separation index was found to be an independent, reliable and simple measure for assessing mitral stenosis severity.

Un-ruptured Non-Coronary Sinus of Valsalva Aneurysm with Complete Heart Block.

Sinus of Valsalva aneurysm is a rare cardiac anomaly with wide spectrum of clinical presentation ranging from asymptomatic state to dreadful complications due to compression of vital surrounding structures or aortic dissection. There are only few reported cases of sinus of Valsalva aneurysm presented with cardiac arrhythmias including complete heart block. We herein, present a case of a 50 year male who presented with complete heart block. A large noncoronary sinus of Valsalva aneurysm compressing the surrounding atrioventricular junctional tissue was detected incidentally during echocardiographic study, which was considered to be the cause of patient's complete heart block. This case report implies the importance of clinical suspicion of secondary causes like sinus of Valsalva aneurysm in patients with complete heart block and utility of echocardiography in the evaluation of heart block patients.

Impact of malocclusion on oral health related quality of life in young people.

BACKGROUND: The objectives for this study were to assess Oral Health Related Quality of Life (OHRQoL) in young people aged 15-25 who sought orthodontic treatment, and to measure the association between orthodontic treatment need (using the IOTN), sex, age and education level, and oral health related quality of life (OHRQoL). METHODS: Survey of a consecutive series of 323 young adults aged 15 to 25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi MARA. Participants completed the Oral Health Impact Profile-14 (OHIP-14) and had a clinical examination including the Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC). Data analyses included descriptive statistics, One-way ANOVA and bivariate and multivariate regression models. RESULTS: The mean overall score (± SD) for OHIP-14 in young people aged 15-25 was 22.6 ± 12.5. The psychological discomfort domain was the domain where highest impact was recorded with a mean (± SD) of 4.0 ± 1.9. The regression analyses showed a significant association of IOTN-DHC with overall OHIP-14 score (p<0.05). Although females reported a slightly higher impact than males, this was not significant in both bivariate and multivariate analyses. Age group had a significant negative association with overall OHIP-14 score (p<0.05). The 15-18 year old group showed the highest impact on their quality of life due to malocclusion. Participants with a university education report a significantly higher impact on OHRQoL as compared to participants with only secondary education. CONCLUSION: Malocclusion has a significant negative impact on OHRQoL and its domains. This is greatest for the psychological discomfort domain. Younger people and those with a university education report higher levels of impact. There was no reported difference in impact between male and females.

Frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance.

To assess the frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance we undertook a cross-sectional study conducted from July to December 2018. Women aged 20-45 years, who were pregnant and planned to deliver at the facility, were included. Women were counseled and offered about Human Immunodeficiency virus (HIV) screening. A total of 718 women were included in the study. The screening was accepted by 32.3% of women. Six women tested positive in the study giving a seroprevalence of 0.8% in the population studied. Acceptance of counseling and screening varied significantly with age range, educational status, socioeconomic status, and employment status. Women aged 30 years and above (p = 0.023) and women with higher education (p < 0.001) were more likely to refuse counselling. Similarly, employed women (p = 0.041) and women of higher socioeconomic class (p = 0.039) refused counselling. However, when logistic regression was conducted, only educational status (p < 0.001) and occupational status (p = 0.039) were significantly associated with acceptance of counseling and screening. The acceptance of counselling and testing for HIV in antenatal care attendees was low. Women of higher educational status and having some employment refused counselling and testing more commonly.

Pregnant during the COVID-19 pandemic: Knowledge, concerns, attitudes and practices of Pakistani women.

INTRODUCTION: Data regarding pregnancy and related outcomes with COVID-19 are inconsistent, which leads to difficulties in counselling pregnant women. This brings uncertainty to pregnant women regarding mode of birth, transmission and issues that may occur in case they contract the disease. We conducted this study to assess the knowledge about COVID-19 risk during pregnancy and childbirth and to assess the concerns, attitudes, and practices of pregnant women during the pandemic. METHODS: A cross-sectional survey was carried out among 376 consenting pregnant women attending antenatal clinics in Karachi, Pakistan, between 1 July and 16 July 2020, using pretested questionnaires. RESULTS: A total of 376 pregnant women participated in the survey. Participants had inadequate knowledge about COVID-19 risk during pregnancy, including potential vertical transmission (58.5%), preferred route of delivery (52%), safety of breastfeeding (50%), birth defects (44.7%), rooming in and skin-to-skin contact (58.5%). The majority (85.1%) had a high concern score, and negative attitude (62.8%). Only 43.6% said that they would not hide their symptoms, while 37.2% stated that they will deliver at hospital if they tested positive. Only 30.9% of respondents had good practices. During visits, 39.4% maintained social distancing and sanitized hands while only 37.2% said that they did not bring more than one person with them. CONCLUSIONS: The study population had inadequate knowledge, negative attitude, and poor practices regarding pregnancy during the COVID-19 pandemic. More than half of the respondents thought that concealing symptoms and delivering at home would be better. Awareness programs are urgently needed.

Perceptions Regarding COVID-19 Vaccination Among a Representative Pakistani Population Coming to Tertiary Care Cardiac Hospital.

BACKGROUND: The deleterious effects caused by coronavirus disease 2019 (COVID-19) infection have been compounded by COVID-19 vaccine hesitancy throughout the world, including Pakistan. We are lacking representative national data regarding the COVID-19 vaccine acceptance. This study aims to determine COVID-19 vaccination acceptance rates and predictors of its acceptance and hesitancy among a representative Pakistani population. METHODS: This cross-sectional study was conducted at the National Institute of Cardiovascular Disease, Karachi, from March 2021 to April 2021. Participants included patients, and their attendants visiting the outpatient clinics and healthcare workers of the institute. Participants were labeled as 'acceptant' or 'hesitant' based on their responses of 'yes' or 'no' and 'not sure' on the willingness to get vaccinated, respectively. The Chi-square test was used to calculate the significant association between different variables. A p-value ≤0.05 was set as a level of significance for all statistical analyses. RESULTS: Overall, 1500 participants were enrolled with a vaccine acceptance rate of only 49%. Factors like male gender, unmarried and employed status, higher education, high socioeconomic class, Punjabi and Sindhi ethnicity, medical professional, and self or family exposure of COVID-19 were positively related to COVID-19 vaccine acceptance. The commonest stated reason for the vaccine hesitancy was distrust in vaccine efficacy or fear of vaccine adverse effects. CONCLUSION: Vaccine hesitancy remains a serious challenge in our population, related to multiple demographic and thought factors. Focused actions and modification of these factors are the keys to conclude this COVID pandemic.

Role of carbonated water technique to enhance Tc-99m tetrofosmin myocardial perfusion imaging by reducing subdiaphragmatic artefacts.

OBJECTIVE: Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is confounded by the extracardiac artefacts cause by hepatobiliary clearance of the radiotracers. Various techniques have been evaluated to lessen those artefacts. In this study, we endeavoured to determine the effect of carbonated water in reducing such infracardiac artefact so to improve MPI image quality, sensitivity and specificity. METHODS: A total of 1000 patients were prospectively enrolled and randomised into two equal groups as A and B. Group A were given 250 ml of carbonated beverages and Group B were given 250 ml plain water immediately after radiotracer injection. Images were evaluated qualitatively and quantitatively for the interfering extracardiac artefacts. RESULTS: The qualitative analysis favoured carbonated water in reducing the interfering intestinal activity during rest as well as stress (p = 0.005 and p < 0.001, respectively). Quantitative calculation showed significant improvement of myocardium to extracardiac ratio with carbonated water ingestion in rest (p = 0.031) and vasodilator stress studies (p = 0.004). However, for exercise stress studies quantitative evaluation were not statistically different between the two protocols (p = 0.855). CONCLUSION: Carbonated water ingestion is an easy and effective way to enhance SPECT image quality by mitigating extracardiac artefacts.

A comparison of antenatally and intraoperatively diagnosed cases of placenta accreta spectrum

Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded. Results: During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04). Conclusion: PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome.

Medication Adherence In Post Myocardial Infarction Patients.

BACKGROUND: Medication non-adherence after acute myocardial infarction is a global problem causing increased morbidity and mortality. This multifaceted problem has not been well studied in our part of the world. Our study aimed to determine the burden of medication non-adherence in post myocardial infarction patients. METHODS: This cross-sectional study was conducted at National Institute of Cardiovascular disease, Karachi, from December 2016 to June 2017. A total of 350 patients were included at the time of discharge after their first myocardial infarction (MI) of which follow up was completed for 315 patients. Baseline characteristics and discharged drug data were collected for each individual. Patients were called at 7th day, 1 and 3months post discharge and were assessed for the medication adherence using Morisky medication adherence scale. They were stratified accordingly into self-reported high, moderate and low groups. Chi- square test was used to determine significant relationship between variables. The level of significance was set at level of p-value ≤0.05. RESULTS: Among 315 patients, only 45% patients were adherent to prescribed drugs at 7th day follow up and the adherence further reduces to 19% at 3rd post MI month (p-value <0.001). High income, male gender, and presence of partner persistently showed significantly higher medication adherence. Factors like younger age, addiction and advance education showed higher adherence only in early follow up periods. However, presence of comorbidities, intervention and specific diagnosis had no significant impact. The most common stated reasons for non-adherence were forgetfulness and poor understanding of drugs. CONCLUSIONS: Adherence to prescribed medication in post myocardial infarction patients was found to be strikingly suboptimal, contributed by multiple factors. Modification of these factors would likely improve patient adherence to medication and eventually long-term outcome.

An Overview of Menopausal Symptoms Using the Menopause Rating Scale in a Tertiary Care Center.

CONTEXT: Due to increased life expectancy worldwide, women are expected to spend a significant portion of their lives in menopause. Proven prevention strategies against serious risks and tested effective treatments for common symptoms may remain unutilized in our population if these women are not asked about these symptoms. AIM: This study aims to assess the prevalence of different menopausal symptoms and their severity according to menopause rating scale (MRS) in women. SETTING AND DESIGN: The present study was a cross-sectional survey, conducted in the outpatient department of gynecology and obstetrics. SUBJECTS AND METHODS: After written and informed consent, 121 women having their last menstrual period at least 1 year ago were included. The menopausal symptoms were assessed using the MRS. The primary outcome measure in this study was the prevalence of menopausal symptoms in these women according to MRS and the severity of these symptoms. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS software program, version 15.0 (IBM, Armonk, New York, USA). RESULTS: The most common symptom was mental and physical exhaustion which was reported by 88 (72%) women, followed by joint and muscular discomfort which was reported by 83 (68.59%). Hot flushes were reported by 54 (44.62%) respondents. Majority of women reported mild-to-moderate symptoms. CONCLUSIONS: The prevalence of menopausal symptoms is high, and a health policy needs to be generated for the region.

Reliability and validity of MicroScribe-3DXL system in comparison with radiographic cephalometric system: Angular measurements.

AIM: The aim of the study was to assess the reliability and validity of cephalometric variables from MicroScribe-3DXL. MATERIALS AND METHODS: Seven cephalometric variables (facial angle, ANB, maxillary depth, U1/FH, FMA, IMPA, FMIA) were measured by a dentist in 60 Malay subjects (30 males and 30 females) with class I occlusion and balanced face. Two standard images were taken for each subject with conventional cephalometric radiography and MicroScribe-3DXL. All the images were traced and analysed. SPSS version 2.0 was used for statistical analysis with P-value was set at P<0.05. RESULTS: The results revealed a significant statistic difference in four measurements (U1/FH, FMA, IMPA, FMIA) with P-value range (0.00 to 0.03). The difference in the measurements was considered clinically acceptable. The overall reliability of MicroScribe-3DXL was 92.7% and its validity was 91.8%. CONCLUSION: The MicroScribe-3DXL is reliable and valid to most of the cephalometric variables with the advantages of saving time and cost. This is a promising device to assist in diverse areas in dental practice and research.

Evaluation of the effect of andrographolide on atherosclerotic rabbits induced by Porphyromonas gingivalis.

Epidemiologic evidence has demonstrated significant associations between atherosclerosis and Porphyromonas gingivalis (Pg). We had investigated the effect of andrographolide (AND) on atherosclerosis induced by Pg in rabbits. For experimental purpose, we separated thirty male white New Zealand rabbits into 5 groups. Group 1 received standard food pellets; Groups 2-5 were orally challenged with Pg; Group 3 received atorvastatin (AV, 5 mg/kg), and Groups 4-5 received 10 and 20 mg/kg of AND, respectively, over 12 weeks. Groups treated with AND showed significant decrease in TC, TG, and LDL levels (P<0.05) and significant increase in HDL level in the serum of rabbits. Furthermore, the treated groups (G3-G5) exhibited reductions in interleukins (IL-1ß and IL-6) and C-reactive protein (CRP) as compared to atherogenicgroup (G2). The histological results showed that the thickening of atherosclerotic plaques were less significant in treated groups (G3-G5) compared with atherogenicgroup (G2). Also, alpha-smooth muscle actin (α-SMA) staining decreased within the plaques of atherogenicgroup (G2), while it was increased in treated groups (G3-G5). Lastly, groups treated with AV and AND (G3-G5) showed significant reduction of CD36 expression (P<0.05) compared to atherogenicgroup (G2). These results substantially proved that AND contain antiatherogenic activity.