Coronary artery ectasia: clinical and angiographic features

Objective: to investigate the clinical and angiographic characteristics of coronary artery ectasia [CAE] and its relation with the inflammatory marker, HsCRP

Study Design: an observational study

Place and Duration of Study: rawalpindi Institute of Cardiology, Rawalpindi, from April 2015 till November 2016

Methodology: eighty-one patients with CAE and 57 age matched patients with stenotic coronary artery disease [CAD], but without CAE, were included in the study. Clinical, angiographic, and laboratory data were documented. Chi-square test was used to compare coronary risk factors between two groups. T test was used to compare means between the groups. Analysis of variance was used to analyse HsCRP levels among various types of ectasia. Correlation analysis was used to study association of ectasia with different risk factors

Results: males were predominant in both with and without CAE. Hypertension, smoking and obesity were significantly more common among CAE patients than those without [60.5% vs. 52.6%, 56.8% vs. 43.9% and 80.2% vs. 14%, respectively]. Diabetes was much less in CAE group [32.1% vs. 42.1%]. HsCRP was higher in patients with CAE than those without and was significantly higher in patients with more extensive ectasia. Majority [65.4%] of CAE patients had significant CAD; whereas, only 7.4% had isolated CAE. Most common artery involved was RCA [70.4% of total] and most common pattern was single ectatic vessel

Conclusion: obesity and smoking predispose to CAE, along with male sex and hypertension. While diabetes is negatively associated with CAE. HsCRP levels tend to be higher in ectasia patients, especially those with severe forms. Finally, CAE has a predilection for RCA

Association between angiographic severity of coronary artery disease and high sensitivity C-reactive protein

Objectives: To determine correlation between blood levels of high sensitivity c-reactive protein [Hs CRP] and severity of coronary artery disease [CAD] on coronary angiography measured through Gensini scoring system

Study type, settings and duration: The descriptive case study was conducted at Rawalpindi institute of cardiology. The duration of study was six month

Patients and Methods: Adult patients of both genders between age 25 to 60 years visiting to outpatient department of the institute and registered for coronary angiogram were included. From each of the enrolled patient about 5cc venos blood sample was collected and Hs-CRP was performed. Severity was measured through Gensini score after coronary angiography. Angiographic Gensini scores were correlated with Hs-CRP using Pearson's correlation [2-tailed]. Value of < 0.05 was considered statistically significant

Results: Total 87 patients fulfilling the inclusion criteria were enrolled among them 81.6% [n=71] were males and 18.4% [n=16] were females. The correlation coefficient was found to be 0.043, implying that there is negligible relationship between Hs-CRP and Gensini scores at p= 0.696

Conclusion: There is no significant correlation between Hs-CRP and severity of CAD measured through Gensini scores on coronary angiography

Effect of maternal depression during pregnancy on birth weight of babies

Objective: To determine the frequency of low birth weight [LBW] babies amongst women who suffer from prenatal depression during 3rd trimester of pregnancy by comparing with control in a military care setup

Study Design: Prospective cohort study

Place and Duration of Study: Study was conducted in Armed Forces Institute of Mental Health [AFIMH] in collaboration with the Department of Gynecology, Military Hospital [MH] Rawalpindi and completed in six months from Mar 2012 to Sep 2012

Material and Methods: Consecutive non-probability sampling was done. Sample size of 172 cases was calculated by World Health Organization [WHO] calculator. Level of significance was 5%, confidence interval 95%, relative risk 2.2 and power of test was 80%

Results: Total 172 cases were enrolled predominantly between 26-30 years i.e. 45.35% [n=39] in cases and 47.67% [n=41] in controls, confidence level was 95% and relative risk was 2.2, mean and SD calculated was 28.32 +/- 3.43 in cases and 27.87 +/- 3.16 years in controls, mean birth score [in grams] of the neonates was 2192.302 +/- 114.22 in cases and 2629.744 +/- 75.33 in controls, comparison of frequency of low birth weight revealed 39.53% [n=34] in cases and 17.44% [n=15] in controls had low birth weight while 60.47% [n=52] in cases and 82.56% [n=71] in control subjects had normal birth weight, Relative risk of outcome variable was 2.23. A p-value of 0.001 showed a significant difference between the two groups

Conclusion: Frequency of LBW babies amongst women who suffer from depression during 3rd trimester by comparing with control is found to be higher

Phenomenology of delusions and hallucinations in schizophrenia in central Punjab, Pakistan

To examine the variations in the frequency and contents of delusions and hallucinations in schizophrenia and correlates the significant findings with other studies across culture. Case series study. Psychiatry Department CMH Kharian for four year duration. Eighty consecutive patients of schizophrenia [62 men and 18 women] were registered and evaluated for frequency of different delusions and hallucinations. The patients belonged to central Punjab [Pakistan]. DSM-IV diagnostic criteria were used for diagnosis. Most patients i.e. 72.25% belonged to lower social class. Auditory hallucinations were the commonest [81.25%] followed by tactile hallucinations [14.75%] and visual hallucinations [7.5%]. Delusions of persecution were found in very high percentage [91.25%] delusions of reference in 42.5% and delusions of control in 31.25%. The patients believed that they were influenced by magic, demons and pirs. First rank symptoms of schizophrenia were present in 76.25% of patients; made affect, made impulse and made volition were present in [40.8%] and somatic passivity were present in [18%] of cases. Sociocultural background of the patients is likely to contribute in shaping the phenomenology of delusions and hallucinations and it is recommended that more elaborate/different diagnostic criteria may be designed for diagnosis of schizophrenia in developing countries

Hysteria: a symptom or a syndrome

A descriptive follow up study of 100 consecutive cases of hysterical [dissociative/ conversion] disorders was conducted from 1995-1998 at CMH Kharian to describe find out the relative frequency of hysterical disorders and other underlying conditions in the patients presenting with hysterical symptoms and also to see the long term validity of this diagnosis. The findings of this work indicated that in 40% of the cases there was either a physical or psychiatric underlying cause of these symptoms i.e. depression [40%], anxiety state [15%], adjustment disorder [17.5%], personality disorder [5%] and medical illnesses [25%]. In 60% of the cases of hysterical disorder who responded to the follow up questionnaire, the diagnosis of hysterical disorder was sustained. The prevalence of hysterical disorder was more in women, among young, undereducated and lower socio-economic groups. In majority of the patients, a psychosocial stress was identified. Convulsions, sensory loss, visual symptoms, aphonia, headache, amnesia and possession state dominated the presenting complaints. Further sound methodological studies using the structured instruments are needed to replicate these findings

Psychiatric aspects of primary infertility in females

This study is designed to investigate the prevalence and pattern of psychiatric morbidity in females with primary infertility and to identify risk factors for psychiatric morbidity. One hundred females having primary infertility, who visited various outpatient departments at MH Rawalpindi and CMH Kharian, have been screened using General Health Questionnaire [GHQ 12] for the possible psychiatric morbidity. Another hundred females with one live issue have been taken as control and screened for psychiatric morbidity. They were ultimately evaluated by two psychiatrists on clinical psychiatric interview and final diagnosis made on ICD 10 diagnostic criteria. In 100 infertile women, psychiatric morbidity was detected in 76% of the cases, while 32% psychiatric morbidity were found in the control. Amongst those having the psychiatric illness, depression was the most common illness 46.03%. Other common diagnosed categories were somatization disorder 20.63%, conversion disorder 15.87% and generalized anxiety disorder 9.52%. obsessive compulsive disorder [OCD] was found in 4.76%, whereas panic disorder and phobic disorder were found in 1.58%. A positive correlation between depression and the duration of infertility was found. Anxiety and related disorders were found in earlier age group whereas depression was found in later age group. A significant proportion of women suffering from primary infertility have psychiatric morbidity. Early detection of these symptoms by screening instruments like General Health Questionnaire [GHQ 12] can enhance the early detection of psychiatric morbidity, formulate psychiatric interventions and possible reduction in morbidity and cost of the treatment. Efforts should be made to increase the awareness among the general population and to impart training in community health care workers to address the psychiatric issues in females who are treated for infertility

Frequency of anxiety, depression and cognitive impairments in Parkinson's disease

Aim of the present study was to determine the frequency of Anxiety, Depression and Cognitive impairments in Parkinson's disease. One hundred patients between the ages of 40-80: both sexes [male= 88; female=12] suffering from Parkinson's disease were included. Hospital Anxiety and Depression Scale [HADS] was used to detect anxiety and depression while Mini Mental State Examination [MMSE] was used for cognitive deficits in all these patients. Final diagnosis of anxiety and depression was made using ICD-10 diagnostic criteria. Forty eight% of the study sample was found to be either suffering from anxiety, depression or cognitive impairments. Depression was present in 31%, Anxiety in 7% and Cognitive impairments in 10%. This study reveals that a significant number of patients of Parkinson's disease suffer from Anxiety Depression and Cognitive impairments. These manifestations cannot be the out come of chronic disabling disease alone but has a distinctive psychological pattern which needs further investigation with methodologically sound studies

Preliminary cardiovascular activity evaluation of cappardisine, a spermidine alkaloid from capparis decidua

Capparidisine, a novel spermidine alkaloid obtained from Capparis decidua was evaluated for cardiovascular activity on isolated rabbit heart. Over all effect of this compound on force of contraction, heart rate and coronary flow was found to be depressant which was dose dependent

critical assessment of the experimental techniques for cardiac performance

Classical haemodynamics has been notably successful in defining the normal physiology of the Cardiovascular system, but failed to provide a clear definition and early diagnosis of a functional impairment of the myocardium, this failure is possibly attributable to inadequacy of the monitored variables of the conventional haemodynamics studies. In this article, two common parameters of cardiodynamics, viz., cardiac output and first derivatives of the ventricular pressure [dP/dt], are discussed in order to find properties of cardiac muscle which could help in distinguishing alterations of ventricular performance

Techniques used for the assessment of myocardial contractile force

Although several cardiovascular parameters are available to define the normal physiology as well as the pathophysiology of cardiovascular system yet a clear definition and early diagnosis of a functional impairment of the myocardium is lacking. The reason for this lacking may be the inadequacy of the monitoring of these variable parameters. One of the parameters among these is myocardial contractile force. This important variable has been evaluated in both experimental as well as clinical conditions in this present paper