Role of Cod Liver Oil in Preventing Myocardial Infarction.

INTRODUCTION: Omega-3 fatty acids have for long been shown to reduce the incidence of cardiovascular (CV) diseases. Omega-3 fatty acids mainly exist in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid in fish oils. Cod liver oil is found to have a high concentration of these omega-3 fatty acids. This study aims to explore the benefits of using cod liver oil in reducing the incidence of myocardial infarction (MI) among at-risk patients.  Method: This open-label placebo-controlled two-arm interventional study was conducted in the internal medicine and cardiology unit of tertiary care hospital between January 2018 to January 2021. During this period, 870 patients at risk of CV events were enrolled in the study after obtaining informed consent. The study group received 415 mg cod liver oil daily, in addition to their current treatment, in a bottle without label and the control group received no additional treatment to their standard treatment. Patients were followed up for 12 months or till the development of MI. RESULT: Patients treated with cod liver oil had comparatively fewer incidences of MI; however, the difference was not significant (p-value: 0.09). Furthermore, the difference was non-significant for both fatal and non-fatal MI. The relative risk for total MI incidence was 0.70 (0.44-1.10). CONCLUSION: According to our study, adding cod liver oil to the diet does not play a major role in reducing the risk of MI. Further large-scale studies are needed to understand the role of cod liver oil in reducing the risk of CV events, including MI.

Role of Cod Liver Oil in Reducing Elevated Lipid Parameters.

Introduction The health benefits of cod oil, which includes omega-3 fatty acids, have been of considerable interest to medicine due to its promising results. Studies have shown successful therapeutic effects of a high dietary intake of omega-3 fatty acids by reducing the synthesis of very-low-density lipoprotein, with subsequent low levels of serum triglycerides.  Methods This single-blind placebo-controlled two-arm interventional study was conducted in the internal medicine unit of a tertiary care hospital from October 2020 to April 2021. 600 treatment naïve patients with elevated cholesterol levels and/or elevated low-density lipoprotein (LDL) were enrolled in the study and randomized into two groups. The study group received 415 mg cod liver oil daily as a capsule in a bottle, in addition to 10 mg rosuvastatin. On the other hand, the control group received 10 mg rosuvastatin with placebo capsules in an identical bottle. Participants were followed up on day 30. Results There was relatively more significant reductions in the total cholesterol (152.22 ± 29.75 mg/dL vs. 171.65 ± 31.21 mg/dL; p-value: <0.0001) and LDL (72.41 ± 27.52 mg/dL vs. 79.15 ± 29.12 mg/dL; p-value: <0.0001) in the intervention group compared to the placebo group after day 30. There was a significant reduction in all lipid values in both groups at day 30 as compared to day 0. Conclusion Our study indicates that cod liver oil in addition to rosuvastatin reduces cholesterol more compared to rosuvastatin alone. However, in all cases, lifestyle changes should be the first modification adopted by the patients. Further large-scale trials are needed to examine the role of cod liver oil in reducing lipid values.

Comparison of Iron Profile in Patients With and Without Coronary Heart Disease.

Introduction Atherosclerosis is considered a major cause of coronary artery disease (CAD). Pathogenesis of atherosclerosis involves the oxidation of low-density lipoprotein (LDL) within the lysosomes of macrophages. Ferritin and iron have pro-oxidant properties, and ferritin is an independent positive determinant of oxidized LDL level. In this study, we will determine the association between ferritin and serum iron levels and CAD. Methods This case-control study was conducted in the cardiology unit of a tertiary care hospital in Pakistan from December 2020 to April 2021. After taking informed consent, 400 patients with a confirmed diagnosis of CAD were enrolled. Another set of 400 patients without a history of CAD were included in the control group. A blood sample of 5 ml was drawn and sent to the laboratory to test for ferritin, serum iron, and total iron-binding capacity (TIBC). Ferritin, serum iron, and iron-binding capacity were compared between the case and control groups.  Results Serum ferritin was significantly higher in patients with CAD compared to patients without CAD (921.21 ± 201.21 ug/L vs. 101.21 ± 92.21 ug/L; p-value: <0.0001). Serum TIBC was significantly lower in patients with CAD compared to patients without CAD (302.12 ± 101.75 umol/L vs. 362.12 ± 82.16 umol/L). Conclusion Patients with raised levels of ferritin should consult a physician to manage their ferritin levels since they are at a greater risk of CAD. Treatment ranges from lifestyle changes to pharmacological therapy, thus reducing the overall risk and normalizing the ferritin levels.

Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Incidence of Lung Cancer: A Retrospective Study.

INTRODUCTION: Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blockers (ARBs) are taken as the first treatment option for hypertensive patients. The various global trials have suggested that ACEIs and ARBs may increase risk of lung cancer; however, the results are contradictory and there is no local study available. This study is conducted to compare the incidence of lung cancers in patients on ACEIs and ARBs. METHODS: This retrospective study, conducted in a major cardiology unit of a tertiary care hospital in Pakistan, included patients diagnosed with hypertension, between 2005 and 2010, who were prescribed either ACEIs or ARBs. During the period of 2005 to 2010, 47,823 naïve hypertensive patients were reported in the outpatient department of the cardiology unit. Of which, 22,241 were prescribed ACEI and 25,582 were prescribed ARBs. After sorting patient data based on our inclusion criteria, n = 14,891 participants were included in the ACEI group and n = 19,112 participants were included in the ARB group. RESULTS: The incidence of lung cancer in the ACEI and ARB group was n = 165 and n = 160, respectively. In this study, the overall incidence rates of lung cancer in the ACEI and ARB cohorts were 12.2 and 16.6 per 10,000 person-years, respectively. The hazard ratio was 1.32 (95% confidence interval: 1.06-1.64; p-value: 0.01). CONCLUSION: In this study, the incidence of lung cancer was relatively more among people using ACEIs than ARBs. Hence, patients undergoing long-term treatment with ACEIs need regular follow-up and proper scanning to avoid grave complications.

Effect of Cigarette Smoking on Hearing Levels in Young and Middle-Aged Males.

INTRODUCTION: Smoking is a well-recognized risk factor for many health issues; however, its association with hearing loss has been a debate. Some studies have shown a positive association while others did not. In this study, we aim to identify the effect of cigarette smoking on hearing in our population. METHODS: This cross-sectional study was conducted in a tertiary care hospital in Pakistan from August 2020 to March 2021. Five hundred male smokers (n = 500), with a history of smoking for more than three years between the ages of 21 and 50, were enrolled in the study via consecutive convenient non-probability sampling after informed consent. Five hundred male non-smokers (n = 500) were enrolled as a reference group. Audiometry was performed in a soundproof room. RESULTS: The hearing levels in audiometry were significantly higher in smokers compared to non-smokers (22.8 ± 8.12 decibels vs 18.7 ± 6.12; p-value < 0.0001). Participants who had been smoking for more than 10 years had higher hearing levels in the audiometry test compared to the participants with less than 10 years of smoking history (24.21 ± 8.91 decibels vs. 21.1 ± 8.01 decibels: p-value < 0.0001). CONCLUSION: In this study, smokers were associated with greater loss in hearing compared to non-smokers. In addition to other adverse events associated with smoking, smokers should be counselled about hearing loss related to it.

Impact of Intravenous Vitamin C Administration in Reducing Severity of Symptoms in Breast Cancer Patients During Treatment.

Introduction Alternative medicine during treatment is often used to make the quality of life (QoL) better. Women with early-stage breast cancer, particularly the ones who possess lower QoL, are more prone to opt for complementary medicine. This study aims to explore the effects exerted by intravenous vitamin C (IVC) on symptoms and adverse events associated with breast cancer treatment. Methods This single-center, parallel-group, single-blind interventional study was conducted in the oncology ward of a tertiary care hospital in Pakistan. For this study, after informed consent was taken, breast cancer patients with Union for International Cancer Control stages IIA to IIIb were included in the study. Three hundred and fifty (n = 350) patients were randomized into two groups at a ratio of 1:1. Study group was randomized to receive 25 grams per week of IVC at a rate of 15 grams per hour for four weeks in addition to their current standard treatment, and the control group received placebo (normal saline drip with label removed) in addition to their current standard treatment. Results In patients who had received IVC, there was a significant decrease in the mean severity score after 28 days for the following symptoms: nausea (2.65 ± 0.62 vs. 2.59 ± 0.68; p-value: 0.0003), loss of appetite (2.26 ± 0.51 vs. 2.11 ± 0.52; p-value: 0.007), tumor pain (2.22 ± 0.45 vs. 1.99 ± 0.40, p-value: <0.0001), fatigue (3.11 ± 0.32 vs. 2.87 ± 0.29; p-value: <0.0001), and insomnia (2.59 ± 0.35 vs. 2.32 ± 0.36, p-value: <0.0001). Conclusion Our study showed improvement in the mean severity score of nausea, fatigue, tumor pain, loss of appetite, and fatigue. More studies are also needed to assess the long-term effects of IVC in the cancer management. This shall help incorporate the use of IVC in standard practice to make the journey of cancer management comfortable for the patients.

Case Series: Removal of Rectal Foreign Bodies.

INTRODUCTION: Foreign rectal body is one of the less common presentations in the emergency department and has a variety of etiologies. Our aim is to study the mode of injury, clinical presentation, diagnosis, surgical intervention and outcomes associated with a rectal foreign body. METHODS: This cross-sectional case series was conducted from January 2019 to July 2019 in the surgical unit of a tertiary care teaching hospital in Pakistan. Mode of injury was classified as voluntary - for sexual gratification, involuntary ingestion, assault and fall. We also noted the presenting complaint, diagnosis, surgical intervention and outcome of the case. RESULTS: Foreign body in the rectum was more common in men (86.3%) than women (13.7%). The mean age of participants was 40 ± 15 years. Various causes include sexual gratification (45.4%), involuntary ingestion (27.2%), assault (22.7%) and history of fall (4.5%). Participants were diagnosed with sub-acute intestinal obstruction (59%), peritonitis (22.7%) and perianal injury (36.3%). CONCLUSION: Sexual gratification was the most common reason for the retained rectum body. Timely diagnosis and management are required to prevent perforation and improve prognosis.

The Effect of Preoperative Hematocrit Levels on Early Outcomes After Coronary Artery Bypass Graft.

Introduction Coronary artery bypass graft (CABG) is the most potent of surgical procedures; in this procedure, the narrowing of the coronary artery due to atherosclerotic plaque is bypassed by forming an alternate route for blood flow to the heart. There are various risk factors associated with the procedure. The aim of this study was to observe if postoperative outcomes are affected by preoperative hematocrit (hct) levels in patients. Methods  This longitudinal study was conducted from April 2019 to December 2019. Eighty-two (82) participants who were to undergo CABG surgery were divided into two groups based on their preoperative hct levels. Group 1 had 42 participants with lower levels of hct (less than 35.5% for women and 38.3% for men), whereas group 2 consisted of 40 participants with normal hct levels (greater than 35.5% for women and 38.3% for men). Results The results showed that participants undergoing CABG with lower than normal hct levels had increased blood loss through drainage as compared to participants who had normal hct levels (680.1 ± 301 mL vs. 500.7 ± 412 mL; p-value: 0.02). Group 1 participants also had an increased need for blood and blood product transfusion as compared to group 2 (3.2 ± 1.8 units vs. 1.8 ± 0.9 units; p-value: <0.0001). Furthermore, the participants in group 1 had longer stays in the ICU relative to the other group (5.2 ± 3.1 days vs. 3.4 ± 2.5 days; p-value: 0.003). Conclusion Based on our findings, patients who undergo CABG surgery with lower than normal hct levels are at increased risk of certain complications, including excessive blood loss, need for transfusion, and increased duration of ICU stay. Therefore, preoperative hct levels should be routinely checked in patients undergoing CABG to prevent these complications.

Correlation of Leptin With Acute Myocardial Infarction: A Case Control Study.

INTRODUCTION: Leptin, a satiety hormone, has the ability to inhibit hunger and is thus, a regulator of body weight. Leptin is also elevated in cardiovascular events such as acute myocardial infarction (AMI) and hence is considered as modifiable risk factors for AMI. The purpose of this study is therefore to investigate the correlation of leptin with AMI. METHODOLOGY: In this retrospective study, data of patients were taken from the database between January 2017 to December 2019 from a cardiovascular unit of tertiary care hospital in Pakistan. Patients were divided into two groups, based on participants who had suffered from AMI and other groups who had not suffered an AMI. Leptin levels were compared for both groups. Age, body mass index (BMI), and smoking history were noted in a self-structured questionnaire. In addition, mean blood pressure and cholesterol levels were also noted for both groups. RESULTS: Leptin was significantly higher in patients with first time AMI (29.21 ± 9.21 ng/mL vs. 11.23 ± 3.12 ng/mL: p-value, <0.0001). BMI (27.2 ± 3.2 kg/m2 vs. 24.9 ± 2.8 kg/m2: p-value, <0.0001) and percentage of smokers (40.9% vs. 22.9%: p-value, 0.032) were also significantly higher in patients with AMI. CONCLUSION: A positive correlation was found between AMI and serum leptin levels in smokers and obese patients. Hence, we suggest that cardiologists should stress upon controlling these modifiable risk factors to reduce the incidence of AMI in the future.

The Association between Iron-deficiency Anemia and Adverse Pregnancy Outcomes: A Retrospective Report from Pakistan.

Background Anemia is one of the most common conditions that affect pregnancies, with dietary iron deficiency being its most common cause. Maternal anemia has been associated with increased risks of both maternal and neonatal adverse outcomes. This study aimed to analyze the maternal and neonatal outcomes in women with third-trimester anemia. Methods This was a retrospective report from a Pakistani public hospital. It included data records of the childbirths in the hospital, with at least one record that documented the hemoglobin (Hb) level in women in the first or second trimester and one in the third trimester. The duration of the study was from January 1, 2019 to June 30, 2019. Women with Hb level of <10mg/dL in the third trimester were categorized as anemic, and those with Hb level of >10mg/dL were categorized as non-anemic. Pregnancy outcomes were assessed for both mothers and babies. All data were processed through SPSS version 21.0 for Windows (IBM Corp., Armonk, NY). Results The study evaluated 235 (37.8%) anemic and 387 (62.2%) non-anemic women. Adverse maternal outcomes were compared between the two groups. In anemic women, gestational hypertension (56% vs. 27%; p: <0.0001), preeclampsia (65% vs. 25%; p: <0.0001), antepartum hemorrhage (32% vs. 19%; p: =0.0001), postpartum hemorrhage (79% vs. 28%; p: <0.0001), transfusions (94% vs. 5%; p: <0.0001), prolonged/obstructed labor (49% vs. 20%; p: <0.000), urgent induction of labor (24% vs. 2%; p: <0.0001), and urgent caesarean section (CS) (45% vs. 29%; p: 0.0001) were significantly more common as compared to non-anemic women. Adverse neonatal outcomes such as low birth weight (LBW) (59% vs. 29%; p: <0.0001), small-for-gestational-age (SGA) (73% vs. 23%; p: <0.0001), preterm delivery (39% vs. 15%; p: <0.0001), stillbirth (8% vs. 3%; p: 0.01), and early neonatal death (9% vs. 2%; p: 0.000) were associated more with anemia. There was no report of maternal mortality in either group. Conclusion: Anemia in the third trimester of pregnancy is associated with adverse maternal and neonatal outcomes including neonatal death. Efforts are required to ensure adequate maternal nutritional status in order to prevent poor outcomes.

Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Introduction Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. In 2012, a comprehensive score was developed to predict the risk of in-hospital mortality in AECOPD called the dyspnoea, eosinopenia, consolidation, acidemia, and atrial fibrillation (DECAF) score. We conducted this study to assess the value of the DECAF score as a clinical prediction tool that claims to stratify all patients with AECOPD by risk accurately. Methods We conducted a prospective study of patients admitted to the intensive care unit (ICU) of the Department of Pulmonology in Civil Hospital, Jamshoro, from January 2016 to December 2018. Our inclusion criteria were that the patient must be age 35 years or older, have a primary clinical diagnosis of AECOPD, spirometry consistent with airflow obstruction, and have a smoking history of ≥10 cigarette pack per year. We excluded patients who had domiciliary ventilation, survival-limiting comorbidities (such as metastatic malignancy), and a primary reason for admission other than AECOPD. All sociodemographic data were collected at the time of admission, including age, gender, co-morbidities, housebound status, and number of previous AECOPD. Clinical data collected included plain chest x-ray, spirometry, electrocardiogram, arterial blood gases analysis, complete blood count, kidney function test, liver function test, and serum electrolytes. A DECAF score was applied to each patient. We noted in-hospital mortality and compared the characteristics of survivors and non-survivors. Data were analyzed using IBM SPSS for Windows, version 19.0 (IBM Corp, Armonk, NY). Results A total of 162 patients were included in the study. The mortality rate was 13% (n=21). More survivors had a DECAF score from zero to three than non-survivors. The difference in the number of survivors vs. non-survivors was statistically significant for DECAF scores zero and one. For DECAF scores four and five, there were more patients in the "non-survivors" group, and the differences were statistically significant. None of the patients scored six on DECAF. Conclusion Patients with a DECAF score of four or higher have a significant risk of mortality. DECAF is a simple tool that predicts mortality that incorporates routinely available indices to stratify AECOPD patients into mortality risk categories.