TOTAL LYMPHOCYTE COUNT AS A SUBSTITUTE TO CD4 COUNT IN MANAGEMENT OF HIV INFECTED INDIVIDUALS IN RESOURCE LIMITED SOCIETY.

BACKGROUND: Pakistan is a resource limited society and gold standard parameters to monitor HIV disease activity are very costly. The objective of the study was to evaluate total lymphocyte count (TLC) as a surrogate to CD4 count to monitor disease activity in HIV/AIDS in resource limited society. METHODS: This cross sectional study was carried out at HIV/AIDS treatment centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of seven hundred and seventy four (774) HIV positive patients were enrolled in this study, and their CD4 count and total lymphocyte count were checked to find any correlation between the two by using Spearman ranked correlation coefficient. Results: The mean CD4 count was (434.30 +/- 269.23), with minimum CD4 count of (9.00), and maximum of (1974.00). The mean total lymphocyte count (TLC) was (6764.0052 +/- 2364.02) with minimum TLC (1200.00) and maximum TLC was (20200.00). Using the Pearson's correlation (r) there was a significant and positive correlation between TLC and CD4 count. (r2=0.127 and p=0.000) at 0.01 level. CONCLUSION: Our study showed a significant positive correlation between CD4 count and total lymphocyte count (TLC), so TLC can be used as a marker of disease activity in HIV infected patients.

Anti-retroviral drugs compliance in intravenous and non intravenous drug abusers.

BACKGROUND: Intravenous drug abuse is often associated with poor adherence to anti-retroviral drugs in HIV/AIDS. Very few studies in Pakistan have determined implications of intravenous drug abuse on anti-retroviral drug compliance in HIV/AIDS patients. The objectives of the study were to assess and compare the adherence to anti-retroviral drugs in intravenous drug users (IDUs) and non-intravenous drug users (NIDUs) and to determine various factors influencing the adherence to anti-retroviral (ARV) drugs in HIV positive IDUs in HIV treatment centre Pakistan Institute of Medical Sciences (PIMS), Islamabad. METHODS: This descriptive observational study was carried out at HIV/AIDS treatment and care centre PIMS, Islamabad. A total of 162 HIV positive male (81 IDU and 81 NIDU) were enrolled in this study. They were followed over a period of five years from 2008-2012. ARV drug compliance and anti-tuberculosis treatment (ATT) outcome in IDUs and NIDUs were assessed using standard outcome parameters. RESULTS: Among IDUs Hepatitis C was positive in 63 (77.77%) cases and negative in 18 (22.22%) cases. In NIDUs hepatitis C was positive in 5 (6.17%) and negative in 76 (93.82%) (p=0.000). In IDUs Pulmonary tuberculosis was present in 61 (75.30%) patients and in NIDUs it was present in 52 (64.19%) (p=0.171). Regarding ATT outcome, amongst IDUs 41 (50.61%) lost to follow up, 16 (19.75%) were compliant to treatment and 4 (4.93%) were transferred out. In NIDUs, 2 (2.46%) patients were lost to follow-up, 38 (46.91%) remained compliant to treatment and 6 (7.40%) were transferred out (p=0.000). Regarding end status of ARVs, in IDUs, 48 (59.25%) were lost to follow-up, 1 (1.23%) was defaulter, 16 (19.75%) were compliant to treatment, 8 (9.87%) were transferred out and 8 (9.87%) expired. In NIDUs, 73 (90.12%) were compliant to treatment, 5 (6.17%) expired, 2 (2.46%) were lost to follow-up. CONCLUSIONS: Due to various socioeconomic and clinical factors, compliance to ARVs in IDUs is poorer as compared to NIDUs. The factors recognized are illiteracy, poor socioeconomic status, unemployment and various comorbidities (Hepatitis B, C and Tuberculosis) which are more prevalent in IDUs.

Assessing in-hospital mortality and predictors in Patients with contrast-induced nephropathy Following primary percutaneous coronary Intervention.

BACKGROUND: The contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (PCI) it has been reported to be associated with an increased risk of mortality. The study reported the in-hospital mortality among patients who developed CIN after primary PCI. METHODS: This descriptive cross-sectional study was conducted on a sample of consecutive who developed CIN after primary PCI at a tertiary care cardiac hospital in Karachi, Pakistan. The CIN was defined as either a relative increase of 25% or an absolute increase of 0.5 mg/dL in post -procedure serum creatinine within 72 hours. The in-hospital mortality status was recorded and clinical and demographic predictors of in-hospital mortality were identified with the help of binary logistic regression analysis. RESULTS: In the study sample of 402 patients, 74.1% (298) were male and the mean age of the study sample was 59.4±11.5 years. The in-hospital mortality rate was 9.7% (39). On multivar iable analysis, an increased risk of mortality was found to be independently associated with inferior wall myocardial infarction (IWMI) with right ventricular (RV) infarction, intra-procedure arrhythmias, and pump failure with an adjusted odds ratio of 3.63 [95% CI: 1.31-10.08; p=0.013], 5.53 [95% CI: 1.39-22.06; p=0.015], and 8.94 [95% CI: 3.99-20.02; p<0.001], respectively. CONCLUSIONS: In conclusion, there is a high rate of mortality for patients who develop CIN after primary PCI, and the risk of mortality is further aggravated by the presence of IWMI with RV infarction, intra-procedure arrhythmias, and pump failure.

Frequency And Predictors Of Radial Artery Spasm During Coronary Angiography/Percutaneous Coronary Intervention.

BACKGROUND: Coronary angiography is the gold standard test for diagnosis coronary artery disease. It can be performed via various intra-arterial routes, i.e., femoral, radial, brachial, ulnar, or axillary arteries. Trans-Radial access for coronary angiography is a good approach with less major vascular complications, increased patient comfort and early mobilization and less hospital stay but is associated with radial artery spasm as the major complication affecting the success of the procedure. METHODS: This study was a descriptive cross-sectional study. It enrolled one hundred and thirty-six (136) consecutive patients who underwent the procedure of coronary angiography/PCI over a 6-month period. The study included both in and outpatients undergoing coronary angiography/PCI. Coronary angiography/Percutaneous coronary intervention was done via trans radial approach and the study participants were observed for development of radial artery spasm using clinical and angiographic parameters. Data was entered and analysed using SPSS-19. RESULTS: The frequency of radial artery spasm was 13.24% (n=18). Radial artery spasm was statistically significant in females (p<0.05), those who had severe pain during radial artery puncture (p<0.001) and those who had unsuccessful first attempt during radial artery puncture (p<0.001). No statistically significant association was found between radial artery spasm and other predictors such as age, hypertension and diabetes mellitus. CONCLUSIONS: Radial artery spasm is a common complication during trans radial approach for coronary angiography/percutaneous coronary intervention particularly in females, those who have unsuccessful first attempt and those who have severe pain during radial artery puncture.

Usefulness Of Neutrophils To Lymphocytes Ratio For Predicting Troponin-I Elevation In Patients Presenting With Suspected Nste-Acute Coronary Syndrome.

BACKGROUND: Most of the admissions to the coronary care unit are patients who are having Non- ST-segment elevation acute coronary syndrome (NSTE-ACS). Inflammation has an important role in the pathogenesis of the acute coronary syndrome. Inflammatory marker such as Leukocyte counts & most importantly Neutrophils to Lymphocyte Ratio (NLR) has been found an important predictor of cardiovascular events. Few studies show the diagnostic role of Neutrophils to Lymphocyte ratio in the patient presenting with NSTE-ACS. The objective of this study was to determine the diagnostic role of Neutrophils to Lymphocytes ratio to predict the elevation of Troponin-I in patients presenting with suspected NSTE-acute coronary syndrome. METHODS: This was a Descriptive Case Series study, conducted in Cardiology department Ayub Teaching Hospital/Ayub Medical College Abbottabad, from 15th May 2017 to30th December 2018. A total of 203 patients with suspected NSTE-ACS were inducted in the study by non-probability, consecutive sampling. RESULTS: Results of this study shown a strong correlation between Neutrophils to Lymphocyte ratio (NLR) & rise in Troponin-I levels. Furthermore, results shown that at 4th quartile of Neutrophils to Lymphocyte ratio (NLR) there is high Specificity (97.8%) and very high positive predictive of value 96.7% for predicting the rise in Troponin-I levels. CONCLUSION: We concluded that there is a strong correlation between rising Neutrophils to Lymphocyte ratio (NLR) and cardiac Troponin-I elevation in patients presenting with suspected NSTE-acute coronary syndrome. Therefore, this parameter can be used to predict the rise in troponin level in patients presenting with suspected NSTE-ACS.

Association Of Degree Of St Segment Depression With Inhospital Mortality In Patients With Non-St Elevation Myocardial Infarction.

BACKGROUND: Ischemic heart disease is responsible for approximately 1/3 of all global deaths, making it a leading cause of cardiovascular mortality. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) which is an acute event in spectrum of coronary artery disease is a potentially lifethreatening emergency, makes up for the majority of admissions to a cardiac unit with one-year mortality rate of 23.5%. The objective of this study was to determine the association of degree of ST segment depression on hospital mortality in patients presenting with Non-ST segment elevation myocardial infarction (NSTEMI). METHODS: This descriptive case-series was carried out in the department of Cardiology, Punjab Institute of Cardiology Lahore. Using Non-probability purposive sampling technique, a total of 250 patients of age between 30-75 years of either gender, who reported during the study period, with NSTEMI were inducted in this study.. RESULTS: In our study, 33.2% (n=83) patients were between 30-50 years and 66.8% (n=167) patients were between 51-75 years of the age. Mean age was 54.64±9.69 years. 43.2% (n=108) patients were male and 56.8% (n=142) were females. Frequency of in-hospital mortality was 4.4% (n=11). Mortality increased with increasing degree of ST segment depression on admission Electrocardiogram (ECG).. CONCLUSIONS: In patients admitted with Non-ST segment elevation myocardial infarction (NSTEMI), degree of ST segment depression on admission ECG predicts In-Hospital mortality.

Procedural Outcomes Of Primary Percutaneous Coronary Intervention In Elderly Patients With Stemi.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, and coronary artery disease (CAD) is the most prevalent manifestation associated with high mortality and morbidity. Older age is independent predictor of cardiovascular mortality and death. Elderly may experience high rates of complications following acute STEMI. Optimal reperfusion strategy in elderly following STEMI remains under debate due to their exclusion from trials evaluating various treatment modalities. Primary PCI has emerged as treatment of choice in patients presenting with acute STEMI in a certain window period. The rationale of this study is to help us determine the outcome of primary PCI in the local elderly population. METHODS: The study was designed as descriptive cross-sectional study and was carried out at AFIC, NIHD hospital Rawalpindi over a six months period. A total of 105 adults with STEMI were included in study. Data was analysed using SPSS-19.0. RESULTS: Total 105 patients were included in the study according to the inclusion criteria of the study. There were 102 (97.1%) patients who successfully achieved TIMI II flow post Primary PCI.. CONCLUSIONS: We concluded that outcome of primary PCI in local elderly population is favourable which leads to a consensus that primary PCI should be offered to every elderly patient presenting to tertiary care hospital with well-equipped Cath lab and experienced staff.