RESUMEN
Background We hypothesize that neck circumference (NC) is a better predictor of acute myocardial infarction (AMI) compared to the waist-hip ratio (WHR) in patients presenting with acute coronary syndrome (ACS). The objective of this study is to investigate the association between NC and WHR with AMI and determine whether NC is a superior predictor of AMI in ACS patients compared to WHR. Methods This cross-sectional observational study was conducted in the Department of Cardiology at the Medical Teaching Institute, Lady Reading Hospital, Peshawar. The study lasted from February 20, 2018, to September 12, 2018. Patients having ACS who presented to the emergency department were enrolled via non-probability convenient sampling. Demographic data and baseline variables, including NC and WHR, were documented using a pre-designed pro forma. SPSS V.20 (IBM Corp, Armonk, NY) was used for data analysis. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Chi-square tests were performed to determine the association between variables, and logistic regression models were used to measure odds ratios (ORs). Results In this study, 180 patients were included, with a mean age of 54.48±8.48 years and a male predominance of 51.5%. The results indicated a significant association between increased NC and WHR with AMI. The chi-square values for NC and WHR were 78.26 (p≤0.001) and 43.38 (p≤0.001), respectively. As NC increased from <37 cm to >38.5 cm, the OR for AMI increased from 0.46 to 4.51. Furthermore, the prevalence odds ratio (POR) of AMI increased by 2.185 times with an increase in WHR from 0.90. Conclusion Increased NC and increased WHR are statistically significantly associated and strong predictors of AMI in ACS patients. However, NC being more reliable, effective, and user-friendly should be the preferred measure.
RESUMEN
BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is a benign rectal condition associated with defecation disorder that has multifactor pathologies and variable findings on presentation, endoscopy, and histopathology. A diagnostic dilemma with an overlap of differentials and step-wise management that starts with conservative therapies and goes up to repeated surgeries in case of failure of the conservative approach. OBJECTIVE: This study aims to observe clinical, endoscopic, and histological features of SRUS in patients presenting with lower gastrointestinal bleeding. MATERIAL AND METHODS: The study was conducted at the Department of Gastroenterology, Medical Teaching Institute, Lady Reading Hospital Peshawar from October 2018 to April 2020. After written informed consent, 257 patients (149 males and 108 females) from ages 15 to 70 who presented with lower GI bleeding were included via non-probability convenient sampling. Sociodemographic details were recorded in a pre-designed proforma. A colonoscopy was performed with the Colonoscope CF200 Z, Olympus Tokyo, Japan, and findings were noted. Suspected lesions were magnified, dyed with 0.2% indigo carmine, biopsied from the middle and edges of the ulcer, and sent for histopathology. All data were recorded and analyzed in SPSS-20. The mean with SD was calculated for quantitative variables, and frequency and percentages were calculated for qualitative variables. The chi-square test was used to check the significance, and a p-value of <0.05 was considered statistically significant. RESULTS: SRUS was found in 17 (6.6%) patients with lower GI bleeding, with a male predominance of 57% (n=11). Perirectal bleeding, constipation, mucous discharge, abdominal pain, and anemia were common clinical findings. Solitary lesions, ulceration, and anterior rectum location were the most common endoscopy findings. Obliterated lamina propria with collagen, ulceration, crypt distortion, and inflammatory infiltrates were common histopathological findings. CONCLUSION: SRUS is a benign defecation disorder commonly presenting with lower GI bleeding, constipation, straining, and abdominal pain. It needs a stepwise approach with conservative management, medical management, biofeedback, and surgeries as a last resort.
RESUMEN
Introduction Coronary artery disease is the leading cause of death not only in Pakistan but also worldwide. Coronary artery disease is prevalent in diabetes and is the major cause of morbidity and mortality. This study aims at comparing the long-term outcomes of patients with and without diabetes undergoing percutaneous coronary interventions (PCI) in in a tertiary care hospital. Methods This is a prospective study including 200 patients undergoing PCI for stable ischemic heart disease. All the patients were followed up over three, six months, and then over one year for major outcomes, including death, nonfatal myocardial infarction, and revascularization, including target vessel revascularization (TVR), and target lesion revascularization (TLR), as well as the outcome of a major adverse cardiovascular event (MACE). Results The mean age (standard deviation) of the non-diabetic with stable ischemic heart disease (SIHD) patients was higher (57.4±8.9 years) than diabetes mellitus (DM) patients. All baseline characteristics were not statistically significant between the two groups. Triple vessel disease prevalence was more in DM than in the non-DM patients with SIHD, although it was not statistically significant. The number of stents implanted per patient (2.8±0.7 vs 1.9±0.8) was more in DM patients than in non-DM patients with SIHD. In-hospital adverse outcomes, including death due to cardiovascular causes, periprocedural myocardial infarction, hyperacute stent thrombosis, and bleeding complications, were insignificant between the two groups. Contrast-induced nephropathy was more prevalent in diabetics with SIHD. Although one-year major adverse cardiovascular outcomes were common in the diabetic group, these were statistically insignificant. Conclusion PCI for complex lesions in stable ischemic heart disease, both with and without diabetes, is associated with favorable in-hospital and long-term outcomes with regards to MACE and ischemia-driven revascularization.