Frequency of diabetes in non St elevation myocardial infarction

Objective: To determine the frequency of diabetes mellitus in non ST segment elevation myocardial infarction

Study Design: Cross-sectional

Place and Duration of Study: The study was carried out at the Armed Forces Institute of Cardiology [AFIC] Rawalpindi, from Apr 2010 to Oct 2010

Material and Methods: In this study three hundred fifty two patients with non ST elevation myocardial infarction [NSTEMI] who fulfilled the inclusion criteria were studied while they were admitted to the hospital. They were divided into diabetic and non diabetic groups. Frequency of age, gender, rising levels of cardiac biochemical markers, plasma glucose and HbA1c were seen in both diabetic and non diabetic patients. Results were obtained by using chi-square method and independent t-test

Results: Out of 352 patients of NSTEMI 193 were diabetics. The study population was categorized in three groups according to age as; 30-45, 46-60, and 61-75 years respectively. It was found that 46-60 years group was most frequently affected with frequency of 46.1%, p<0.001 with male predominance as 67.9% and females as 32.1%. Cardiac biochemical markers were raised with mean for CK 528.51 U/L SD +/- 275.82 and CK MB 79.39 U/L SD +/- 32.5, p<0.001 respectively. Raised fasting plasma glucose was found in 189 patients mean 8.74 mmol/L SD +/- 1.52, p<0.001 and elevated HbA1c seen in 187 patients mean 7.94% SD +/- 0.83, p<0.001

Conclusion: Despite modern therapies for unstable angina [UA]/NSTEMI diabetes is an independent cardiovascular risk factor, therefore we need aggressive strategies to manage the high risk group of patients

Pictorial review of intrathoracic manifestations of progressive systemic sclerosis

Intra-thoracic manifestations of progressive systemic sclerosis [PSS] are not well known particularly the imaging features, which forms the basis of accurate and timely diagnosis. The aim of this study is to familiarize the physicians and radiologists with these features. The diagnosis can remain elusive because of the non-specific nature of symptoms which mimic many common conditions. Thus, the diagnosis of PSS can be missed leading to continuous morbidity if the correct imaging is not pursued. The authors examined the records of rheumatology patient referrals of over a 5 year period. A hundred and seventy patients with systemic sclerosis and mixed connective tissue disorders were chosen for detailed study of the imaging available, which form the basis of this review. The images included conventional chest radiographs, digital radiographs computed radiography [CT] and high resolution computed tomography [HRCT]. Where applicable computed pulmonary angiography [CTPA] and radionuclide scans were also interrogated

Atypical radiological manifestations of thoracic sarcoidosis: a review and pictorial essay

Thoracic sarcoidosis is a common disease, with well-described and recognizable radiographic features. Nevertheless, most physicians are not familiar with the rare atypical often-confusing manifestations of thoracic sarcoid. Although these findings have been previously reviewed, but more recent advances in imaging and laboratory science, need to be incorporated. We present a review of literature and illustrate the review with unpublished data, intended to provide a more recent single comprehensive reference to assist with the diagnosis when atypical radiographic findings of thoracic sarcoidosis are encountered. Thoracic involvement accounts for most of morbidity and mortality associated with sarcoidosis. An accurate timely identification is required to minimize morbidity and mortality. It is essential to recognize atypical imaging findings and relate these to clinical manifestations and histology

Accelerated 2 hour regimen of streptokinase for pulmonary embolism

To assess the safety and efficacy of accelerated 2 hour regimen of streptokinase [SK] in acute massive pulmonary embolism. The primary end point of study was immediate hemodynamic improvement and safe discharge from the hospital. Quasi-experimental study. Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD], March 2010 to Sept 2010. Twenty five patients referred to AFIC-NIHD Rawalpindi with recent symptoms [<5 days] suggestive of acute massive pulmonary embolism were considered for entry into the study. On confirmation of acute massive pulmonary embolism, they were thrombolysed with 1.5 million units of streptokinase over two hours followed by unfractionated heparin infusion intravenously at a dose of 1,000 IU/h. They were observed for immediate hemodynamic and clinical improvement and followed up till discharge from the hospital. Safety of Streptokinase was assessed by observing for major bleed [requiring blood transfusion]/fatal bleeding/intracranial haemorrhage confirmed on CT scan or anaphylaxis secondary to accelerated regimen. Mean age of the patients was 55 years [range 24 to 85 years] and 60% [15] were males and 40% [10] were females. CT pulmonary angiogram in all 25 cases confirmed massive pulmonary embolism. Streptokinase 1.5 million units were given to all 25 patients in infusion form over a period of 2 hours followed by unfractionated heparin infusion at 1000 IU/hour. No bleeding complication was observed in any of these cases. Eighteen [72%] patients showed immediate hemodynamic and clinical improvement but 28% [7] expired on the same day. Average hospital stay of the patients was 6 days. Mortality of patients with massive pulmonary embolism is high even after thrombolysis. Accelerated 2 hour regimen of streptokinase can be routinely used in patients with massive pulmonary embolism without obviously compromising efficacy or safety but further randomized controlled trials to compare the two SK regimens are required to better predict the efficacy and outcome of the two regimens

Double stick approach for chronic total occlusion of coronary arteries

To describe experience of double stick access to arterial system with contralateral injection of the opposite artery to visualize the distal cross filling vessel when a totally occluded vessel has no antegrade flow. A Quasi-experimental study. Armed Forces Institute of Cardiology / National Institute of Heart Disease Rawalpindi from Jan 2009 to Aug 2010. Retrospective analysis of 20 coronary angiograms performed for CTO at the cardiac catheterization laboratory of AFIC/NIHD were included in the study. Double stick access was gained through femoral artery in the groin 1cm apart. Twenty patients with chronic total occlusions underwent PCI with contralateral injection technique. Out of them 70% were male and 30% were female. The mean age was 53.65 years. Multivessel coronary artery disease was seen in 45% of patients. Left anterior descending artery lesion was present in 60%, while right coronary artery lesion in 40%. There was no LCX lesion. Single wire was used in 55% of cases while 40% required a second wire which was stiffer and heavier than the previous one. Pilot 50 was successful in 70% and 10% required cross it 200. Predilation was done in all cases using multiple balloons. DES was used in 93.75% cases of CTO. The procedure was successful in 80% while in 20% it was unsuccessful. There was no death during the procedure, nor any other periprocedural or access site complications. We conclude that double stick approach with contralateral injection is a safe and effective way to cross total occlusion

Guidelines for the role of FDG-PET/CT in lung cancer management

Fluoro-2-deoxy-D-glucose [FDG]-positron emission tomography [PET] and PET/computed tomography [FDG-PET/CT] is regarded as a standard of care in the management of non-small-cell lung carcinoma [NSCLC] and is a useful adjunct in the characterization of indeterminate solitary lung nodules [SLN], and pre-treatment staging of NSCLC, notably mediastinal nodal staging and detection of remote metastases. FDG-PET/CT has the ability to assess locoregional lymph node spread more precisely than CT, to detect metastatic lesions that would have been missed on conventional imaging or are located in difficult areas, and to help in the differentiation of lesions that are equivocal after conventional imaging. Increasingly FDG-PET/CT is employed in radiotherapy planning, prediction of prognosis in terms of tumor response to neo-adjuvant, radiation and chemotherapy treatment. Evidence is accumulating of usefulness of PET/CT in small cell lung cancer.

Initial experience of fractional flow reserve in 30 patients with moderate coronary artery lesions at armed forces institute of cardiology

To evaluate our initial experience of Fractional Flow Reserve [FFR] for decision making in coronary revascularization in moderate lesions. A descriptive study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases from August 2009 to August 2010. A total of 30 consecutive patients who underwent FFR at AFIC/NIHD from August 2009 to August 2010. These were the cases in which decision regarding PCI was difficult on visual assessment alone as experienced operators differed in their opinion. A 0.014" FFR wire was used and pressure gradients across the lesions were noted A total of 30 patients with 44 moderate lesions on coronary angiography were evaluated in our initial experience. Amongst these, 27 [61.4%] LAD lesions were studied [20 lesions had an FFR > 0.80 while 7 [15.9%] had an FFR 0.80 or less]. Seven [15.9%] lesions of LCX were evaluated [5 had an FFR > 0.80 and 2 had 0.80 or less]. Seven [15.9%] lesions were of RCA [4 had an FFR >0.80, 3 had 0.80 or less]. One case of LMS lesion was found to be non-critical. Two [4.5%] vein graft lesions were included of which one was found to be angiographically critical, [FFR 0.72]. Out of the total 44 lesions studied 14 [31.82%] lesions were critical with an FFR 0.80 or less, which were stented. Thus 30 stents were saved. This reduced the cost, as well as the un-necessary hazards and risks associated with PCI and the issue of difference in opinion was put to rest. We thus conclude that FFR is a very important tool in guiding the interventionist for planning PCI in moderate lesions

Pulmonary vascular complications of chronic liver disease: pathophysiology, imaging, and treatment

To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease

Imaging lung manifestations of HIV/AIDS

Advances in our understanding of human immunodeficiency virus [HIV] infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome [AIDS] remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis

calcified lung nodule: what does it mean?

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules [PN] to aid diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, harmartome, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging

Angina pectoris; role of trimetazidine

To assess the clinical efficacy, cost effectiveness and side effect profile of trimetazidine in the management of stable angina pectoris. An open label, uncontrolled study was conducted in 200 patients with stable angina in armed forces institute of cardiology, Rawalpindi Pakistan. Patients were treated for 4 weeks with modified release trimetazidine tablet [35 mg] twice daily in addition to their conventional therapy. As compared to base line trimetazidine significantly reduced the number of angina episodes per week from 10 to 3 [p<0.005], improved exercise duration time on standard exercise tolerance test [ETT] [410 vs. 370 sec; p<0.01], time to onset of typical angina [380 vs. 290 sec; p<0.05], time to 1mm or more ST segment depression [340 vs. 290 sec; p<0.01]. There was no drop out of patients due to side effects or non compliance. These results indicate that trimetazidine is effective and well tolerated when used in combination with existing antianginal therapy in patients with angina pectoris

Frostbite: Severity and predisposing factors amongst Pakistan troops in Siachen

To know the severity and find out the exact causes and predisposing factors of frost bite, so that certain guidelines can be formulated for the troops and the people in command channel in order to minimize significantly the frequency and severity of this disability. Descriptive, questionnaire-based study Study was done in field hospitals of Siachen sector from May 2002 to April 2003. A total of 130 patients who suffered from frostbite in this duration were included, excluding injuries due to other causes. Proforma with questionnaire was completed by the doctor him self. The cumulative incidence was 29/1000 in one year. Maximum injuries were 1st degree [37.7%] and 2nd degree [33.1%]. Feet [56.9%] and hand's [26.9%] involvement was most common. There was a significant relation between lack of proper equipment or lack of knowledge and the injury. Maximum cold injuries [52.3%] were due to ill fitted, defective and soaked boots, socks and gloves. Majority of troops [47.6%] did not have basic knowledge to protect themselves from cold injuries. Maximum cases [about 84%] were seen in peak cold weather i.e. November - February. High altitude serving troops should wear appropriate clothing, properly fitted quality boots, socks and gloves. They should have proper education and training regarding how to deal with cold weather. They should also avoid wet clothing, movement in blizzard, prolonged exposure to severely cold wind, and should be replaced after short intervals from their posts

To correlate the clinical picture with computed tomography scan findings in 200 cases of stroke

To study the accuracy of clinical data [history and physical examination] in distinguishing the ischaemic from haemorrhagic stroke. A prospective cross sectional case control study. Two hundred patients male and female patients between ages of 16 to 85 years visiting CMH Lahore with acute neurological deficits were included in the study. Out of 200 patients, 144 were males and 56 were females. One hundred seventy five patients were diagnosed as ischaemic and twenty five patients were diagnosed as haemorrhagic clinically. The males suffered from stroke more than females and ischaemic stroke is more common than haemorrhagic stroke

Comparison of di-isopropyl iminodiacetic acid with methyl isobutyl isonitrile in the work-up of infants with prolonged jaundice

The study group comprised of 16 jaundiced children [mean age 3.16 months] with bilirubin levels of more than 8mg/dl. The clinical differential diagnosis included biliary atresia versus neonatal hepatitis. Informed consent was taken from all the parents. Parents were advised to omit the morning feed. All children were pretreated with phenobarbitone [5mg/ kg/day for 5 days] and imaged twice on two different days: first with Tc-99m-DISIDA and dose of 37MBq was injected intravenously. Liver images were obtained at 1, 2, 3 and 24 hours following injection. Then injection of Tc-99m-MIBI with a dose of 37MBq was injected intravenously. Anterior abdominal images with 350k counts were obtained at 10, 20, 30 and 40 minutes post injection and where appropriate delayed additional views were taken to optimize radionuclide intestinal transit. Two nuclear medicine physicians visually analyzed the scintigrams. On the basis of biliary-enteric kinetics the patients were subdivided into sub-groups: Group 1: Included 12 patients with no bowel activity with DISIDA scan but demonstrable bowel activity with MIBI liver scan with the appearance of central or peripheral abdominal activity. Group 2: Consisted of 4 patients with no bowel activity with both DISIDA and MIBI liver scans. Of the 4 patients 2 had biliary atresia confirmed at laparotomy whilst 2 children were lost to follow-up since the children had traveled from remote parts of the country