ABSTRACT
Objective: Objective of study was assessment of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion
Study Design: Observational / cross sectional study
Place and Duration of Study: This study was carried out at orthopedic department of a tertiary care Hospital, Peshawar from March 2014 to July 2015
Materials and Methods: In all patients, the initial resuscitation was performed as soon as admitted to the emergency room. Blood samples were obtained at admission and after 24 h. Part of the serum was frozen and stored at -70°C for determination of fibrinogen and albumin by an immunoturbidometric assay. Electrolytes, hemoglobin, and hematocrit levels were measured on admission. For early restoration, normal saline or ringer was used, clinical events were recorded thereafter until death or hospital discharge
Result: We were studied forty six traumatic patients with severe limb injuries and result showed that 20 patient [41.3%] and 27 [58.7%] were alive
There was significant difference outcome observed in fibrinogen level after 24 h and in case of albumin levels, there was no significant difference observed
Conclusions: When orthopedics traumatic patients received massive transfusion, fibrinogen level play significant role in determination of these patients, while serum albumin is not important factor
ABSTRACT
Numerous remarkable advances have been made in the perioperative care of both adults and children undergoing cardiac surgery. Improvements in the technology of CPB, advances in the techniques of surgery, a better understanding of the pathophysiology of the postoperative period, and refinements in anesthetic and ICU care have led to changes in the perioperative management of these patients. These changes have resulted in improved outcomes and shortened hospital stay. Fast track strategy [FTS] is one of the major advances in the sub-specialty of cardiac anesthesia practice. FTS is applicable to all moderate to low risk elective open heart adult and pediatric surgeries. The role of anesthesiologist in Fast Track extubation [FTE] is very crucial and decisive as perioperative physician. Teamwork in FTE execution is very important. Every team member should respect the opinion of other team member provided the opinion is in the best interest of the patient. Multiple studies conducted as clinical audits and case series to validate the safety and feasibility of fast track extubation in adult and pediatric open heart surgical patients at our institution. Fast track extubation was practically evolved at our institution in 2007. FTE cannot be predicted in all the cases as it depends upon intra-operative and post-operative course. Safety is the priority in the decision about fast track extubation
ABSTRACT
Intraoperative use of transesophageal echocardiography [TEE] for monitoring and diagnostic purposes has increased over the years in cardiac surgical patients and anaesthesiologists have taken a lead to develop expertise in performing this examination. TEE has proved to be helpful in the management of non-cardiac surgical and Intensive care unit patients particularly those patients who are haemodynamically unstable. It provides important information about ventricular and valvular anatomy and its function. Certain structures which are difficult to visualize by transthoracic echocardiography can be demonstrated easily by TEE. Several guidelines have been established for performing comprehensive TEE examination and cardiologists and anaesthesiologists follow these guidelines to identify any cardiovascular abnormality. TEE use is limited to very few centres in Pakistan, mainly due to the equipment cost and lack of expertise. In addition, there are no established TEE training institutes. The main purpose of this article is to provide basic information about transesophageal echocardiography machine, TEE probe and how to obtain standard images by probe manipulation
ABSTRACT
Fast‑track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post‑TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2–3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.
Subject(s)
Airway Extubation/methods , Child , Child, Preschool , Developing Countries , Feasibility Studies , Female , Humans , India , Male , Safety , Tetralogy of Fallot/surgery , Tetralogy of Fallot/therapyABSTRACT
No abstract available.
Subject(s)
Female , Humans , Leishmaniasis, Visceral , Lupus Erythematosus, SystemicABSTRACT
To assess the effect of heart rate [HR] on haemodynamic parameters in patients with Mitral Stenosis [MS]. The study was conducted at Cardiology department, Lady Reading Hospital, Peshawar from November 2010 to April 2011. Patients with MS, regardless of severity, were included. Patients with severe heart failure, other valvular or structural heart disease were excluded. Echocardiographic parameters were recorded at slow and fast HR. Patients with tachycardia were given beta-blockers and patients with bradycardia were given parenteral Atropine. A total of 60 patients were included, females were 57 [78%]. Mean age was 31 +/- 9 years. Mean slow and fast HR was 77 +/- 12bpm and110 +/- 13 bpm, respectively. Peak mitral valve gradient [PMVG] slow vs. fast HR was 12.8 +/- 4.80 and 14.93 +/- 7.18 mm Hg [p=0.000]. Mean mitral valve gradient [MMVG] at slow vs. fast HR was 6.62 +/- 3.29 and 8.15 +/- 4.88 mm of Hg [p=0.000]. E pulse Doppler [E] at slow vs. fast HR was 168 +/- 35 and 181 +/- 40 cm/s [p=0.013], while E tissue Doppler [E] velocity was 10.47 +/- 2.81 and 10.97 +/- 2.38 cm/s / [P=0.098], respectively. E/E ratio for slow and fast HR was 17 +/- 5.63 vs. 17 +/- 5.41 [P=0.792]. Right ventricular systolic pressure [RVSP] at slow vs. fast HR was44 +/- 16 vs.49 +/- 17.05mm of Hg [P=0.001]. The above parameters had insignificant change with the HR when there was accompanying more than mild MR. Slowing HR in patients with MS significantly decreased PMVG, MMVG and RVSP. LV function did not change significantly with HR. Rate control drugs may be used in preference to improve symptoms in moderate and severe MS
ABSTRACT
To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52 +/- 7years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1 +/- 0.3 and 11.5 +/- 1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, readmission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization
ABSTRACT
Post infarction ventricular septal defect carries high mortality and the management of these patients is challenging both for cardiologist and cardiovascular surgeon, because of the patient hemodynamic instability and tissue friability which make the intervention difficult. We report one of our patient who had anterior M I followed by apical ventricular septal defect with cardiogenic shock .The patient was subjected to PCI and the defect was closed successfully with ASD closure device. The patient was discharge successfully from hospital
ABSTRACT
Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies
Subject(s)
Humans , Adult , Anesthesia , Heart Failure , Perioperative Care , Intraoperative Care , Hypoxia , Eisenmenger Complex , Hypertension, Pulmonary , Postoperative CareABSTRACT
Drug therapy is mostly employed in the management of supraventricular tachycardias [SVTs]. However, radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of SVTs. The current study is aimed at sharing our experience of 320 patients who presented with SVTs, and were treated with radiofrequency catheter ablation. This descriptive study was carried out in the Cardiac Electrophysiology Laboratory of Lady Reading Hospital, Peshawar from October 2006 to December 2009. Standard 4-wire electrophysiological study was carried out to identify the mechanism of SVT in 320 consecutive patients. Radiofrequency catheter ablation was used to interrupt the tachycardia circuit. Out of a total 320 patients who underwent electrophysiologic study, 168 were found to have atrioventricular nodal re-entry as underlying mechanism; 121 patients were having accessory pathway responsible for re-entry [of these 95 presented with orthodromic reciprocating tachycardia and 26 as antidromic reciprocating tachycardia]; 19 patients were having focal atrial tachycardia, 4 atrial fibrillation and 8 atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success of 94% and a complication risk of complete AV block in 0.3% and recurrence rate of 3%. Radiofrequency catheter ablation is safe and highly effective mode of treatment of SVTs
ABSTRACT
The aim of this study was to know the frequency of CVD risk factors in teachers of Peshawar. Data for this study was derived from Peshawar Heart study [PHS]. PHS was conducted by Cardiology Department Postgraduate Medical Institute, Lady Reading Hospital, Peshawar to determine various cardiovascular risk factors like diabetes hypertension, hypercholesterolemia, obesity, physical inactivity etc. in various occupational groups of Peshawar. Data of 174 school teachers recruited in Peshawar Heart Study [PHS] was analyzed for the frequency of CVD risk factors. Their mean age was 42.95 +/- 8.29 years. Mean BMI was 26.11 +/- 4.53 Kg/m[2] and 35.05% [n=61] were overweight and 47.07% [n=83] were found to be obese. Mean systolic blood pressure was 131.2 +/- 18.16 mmHg and 33.33% [n=58] had systolic blood of >/= 140 mmHg. Mean diastolic blood pressure was 89.25 +/- 12.13 mmHg and 59.77% [104] had their diastolic pressure >/= 90 mmHg and 5.75% [n=10] were known hypertensive. Mean cholesterol was 168 mg/dl while 20.68% [n=36] had cholesterol of >/=180mg /dl. Out of 174 school teachers 4% [n=7] were known diabetic and 6.32% [n=11] had RBS of >/=140 mg/dl. CAD was found in 3.44% [n=6]. Family history of CAD was positive in 18.96% [n=33]. Fifty eight percent subjects admitted to regular exercise. ECGs were also analyzed and it was found that 2.88% [n=5] were having LVH, 1.75% [n=3] were having right bundle branch block [RBBB] and 2.88% [n=5] have changes of previous myocardial infarction. It was demonstrated in this study that CVD risk factors especially lack of exercise, obesity and hypertension were common in school teachers
ABSTRACT
The case report of a 2 year old boy with steroid refractory DBA, treated with allogeneic PBSCT from an HLA matched sibling is presented. Anti-IL2 receptor antibody Daclizumab was used as a prophylaxis for graft versus host disease [GvHD]. Complete recovery without any evidence of GvHD ensued
ABSTRACT
The case report of a 2 year old boy with steroid refractory DBA, treated with allogeneic PBSCT from an HLA matched sibling is presented. Anti-IL2 receptor antibody Daclizumab was used as a prophylaxis for graft versus host disease [GvHD]. Complete recovery without any evidence of GvHD ensued
Subject(s)
Humans , Male , Anemia, Diamond-Blackfan/surgery , Graft vs Host Disease/prevention & control , Stem Cell Transplantation , Transplantation, Homologous , Steroids , Drug Resistance , Receptors, Interleukin-2/immunologyABSTRACT
To present the survival and evaluate the demographic characteristics as risk factors for acute and chronic graft versus host disease [GvHD] in 100 recipients of HLA identical related allogeneic peripheral blood stem cell transplantation. Indications for transplant were non-malignant and malignant haematological disorders. Bu/Cy conditioning was given for haematological malignancies and b-Thalassaemia major, Cyclophosphamide was given in aplastic anaemia. GvHD prophylaxis was Cyclosporin and Methotrexate. The patients received a median nucleated cell dose of 7.93 108/kg. Of 100 recipients, 72 were males and 28 females. Median age was 13.5 years [range 1.5-44]. There were 65 male and 35 female donors. Median age was 15 years [range 4-45]. Grade-I aGvHD was noted in 18 [18%], Grades-II in 6 [6%], Grade-III in 3 [3%] while Grade-IV in 1 [1%] patients. Diagnosis was found to be a significant risk factor for aGvHD. Kaplan Meyer analysis showed that malignancy, aGvHD, recipients above 14 years of age, female patients and engraftment after 12 days were associated with poor outcome. Of 78 patients alive beyond 100 days, 19 [24%] developed cGvHD. Mean follow up was 466 days [range 30-1766]. Median survival of this cohort of patients was 338 days [mean 479 days, 95% CI 72 - 729]. Incidence of acute and chronic GvHD was similar to published data. Grade of aGvHD, extent of cGvHD, female patients and haematological malignancies were associated with higher rate of aGvHD and a worse outcome
Subject(s)
Humans , Male , Female , Survival Rate , Graft vs Host Disease/prevention & control , Graft vs Host Disease/therapy , Acute Disease , Chronic Disease , Stem Cell Transplantation , Transplantation, HomologousABSTRACT
Gastro intestinal stromal tumors [GISTs] are a subset ofGI mesenchymal tumors of varying differentiation. With the advent of immune histochemical staining techniques now available in Pakistan, they are recognized as a distinct group of mesenchymal tumors. This case demonstrates that rare stromal neoplasms have to be taken into account in the differential diagnosis of gastrointestinal tumors even ifendoscopic biopsies are negative for neoplastic changes. Because of the uncertain biological behavior of the GISTs an early surgical intervention is recommended
ABSTRACT
A case of amoebic liver abscess presenting as myeloid Leukemoid reaction in a forty year male is reported. The presenting white cell count was 144.8 x 10 / I and peripheral smear mimicked chronic myeloid leukemia - chronic phase. Treatment with metronidazole resulted in complete clinical and haematological cure. The recognition of the condition presenting as myeloid Leukemoid reaction is stressed in an endemic setting