Sociodemographic determinants of gender disparity in primary percutaneous coronary intervention in Pakistan.

OBJECTIVES: This study aims to contribute to the body of literature on gender disparities after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: We identified all adult patients who had AMI between January 2017, and December 2022 and were in follow-up at our institute. We collected data on PPCI, revascularization strategy, sociodemographic characteristics, and in-hospital complications in the years following the procedure. RESULTS: A total of 5,872 patients who underwent PCI for AMI were included in the study, out of which 2,058 (35%) were women and 3,814 (65%) were men. Regarding the timing of PCI, female patients had a significantly longer median door-to-balloon time compared to male patients (136 minutes vs 108 minutes, P-value = 0.006). Female patients had a significantly higher rate of in-hospital mortality compared to male patients (5.5% vs 1.2%, P-value = 0.011). Multivariate logistic regression analysis showed that female gender, older age, and lower household income were independent predictors of longer door-to-balloon time. CONCLUSION: This study highlights gender disparities in PPCI in Pakistan, with female patients facing longer door-to-balloon times and higher in-hospital mortality rates. The findings suggest the need for targeted interventions to improve the access and quality of care for female patients with AMI.

Lansoprazole plus levosulpiride versus esomeprazole in participants with gastroesophageal reflux disease and erosive esophagitis: a double blinded randomized control trial.

Aim: The aim was to compare the efficacy and safety of lansoprazole plus levosulpiride over esomeprazole. Methodology: This randomized control trial recruited 1000 participants having symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis and they were blindly randomized into two groups in a 1:1 ratio with appropriate concealment. Group 1 was given lansoprazole plus levosulpiride combination twice daily whereas group 2 was prescribed only esomeprazole twice daily. The primary efficacy endpoint was the healing of erosive esophagitis and GERD at week 49. Secondary assessments included improvement in quality of life. Participants' quality of life was assessed before starting the treatment and post-treatment using a short-form health survey questionnaire (SF-36). Results: The lansoprazole plus levosulpiride group had significantly lower rates of positive postintervention GERD and erosive esophagitis status, and higher rates of sustained resolution of heartburn compared to the esomeprazole alone group. However, the lansoprazole plus levosulpiride group also had a higher risk of nausea. Conclusion: Lansoprazole plus levosulpiride is a more effective and safe treatment for GERD than esomeprazole alone. Participants in the lansoprazole plus levosulpiride group showed a significantly higher rate of sustained resolution of GERD, lower rates of postintervention GERD and erosive esophagitis status, and a higher incidence of nausea compared to the esomeprazole alone group. Although quality of life worsened in both groups, adverse effects did not significantly differ. These findings strongly support the use of lansoprazole plus levosulpiride as a preferred treatment option for GERD and erosive esophagitis, which could have significant clinical implications for managing this common condition.

Respiratory sequelae of dengue fever.

Dengue viral illness is endemic in many tropical countries with temperate climates. The haematological and cardiovascular sequelae of dengue are well known; however, respiratory manifestations are still an area of active medical research. We conducted a literature search on PubMed, Medline CINAHIL, EMBASE and found 64 articles on respiratory sequelae of dengue. All relevant original articles and case reports were included and the relevant information regarding the respiratory manifestations of dengue was retrieved from the relevant eligible articles. Respiratory manifestations of dengue range from mild pleural effusion to acute respiratory distress syndrome. The former was the most common complication, seen in 5.1% of patients, followed by acute respiratory distress syndrome (ARDS) in 1.7%, pneumonia in 0.5%, respiratory distress in 0.3%, pulmonary hemorrhage in 0.1%, and haemothorax in 0.01%. Involvement of the respiratory system indicates severe disease and is difficult to manage. Therefore its early detection is important.

APPENDICEAL TIE SYNDROME: A RARE CAUSE OF SMALL BOWEL OBSTRUCTION.

Acute appendicitis and intestinal obstruction are two common surgical emergencies. Acute appendicitis as a cause of closed-loop bowel obstruction is a rare surgical entity. The first case was reported in 1901 and since then only a few cases have been reported. We report an unusual case of a 25-year-old female who presented with the clinical picture of acute small bowel obstruction and was found to have an appendicular knot intraoperatively, through which a small bowel was herniating. The patient was managed via a midline laparotomy and appendectomy.

Spontaneous perforation of Meckel's diverticulum: A rare entity.

Meckel's diverticulum is the most common gastrointestinal tract's congenital abnormality. Spontaneous perforation of Meckel's diverticulum is very rare and can mimic acute appendicitis. Here we report the case of an 11-year-old male patient, who was presented to the Surgical A unit of Ayub Teaching Hospital, Abbottabad on 21st January, 2021 with one-day history of abdominal pain, predominantly in the periumbilical area and right iliac fossa, associated with nausea. On physical examination his abdomen was tense, tender with guarding and generalized rigidity. A provisional diagnosis of perforated appendix or enteric perforation of a hollow viscus was made. The patient had an emergency laparotomy, where a perforated Meckel's diverticulum was discovered. Resection of the portion of gut containing Meckel's diverticulum was done along with primary anastomosis. Heterotopic gastric mucosa of diverticulitis, associated with perforation was confirmed on histopathology. The patient made an uneventful recovery during postoperative period. This case report is an interesting and an unusual case of Meckel's diverticulum complication. It highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen in this age group.

Fungal Infection: A Rare Cause Of Gastric Perforation.

Gastric perforation is among one of the common indications for a laparotomy. It can occur as a result of an erosive ulcer, long term usage of NSAIDs and malignancy among other causes. Here we report a case of a 70-year-old man with an invasive fungal infection as a cause of his gastric perforation based on histopathological evidence. Although very rare it should be kept in mind as an etiological factor of upper GI perforation especially in old age patients. To the best of our knowledge no previous data on such an association has been reported in our country.