Sex-stratified outcomes of primary percutaneous coronary intervention: A tertiary care experience.

BACKGROUND: ST elevation myocardial infarction (STEMI) is an acute cardiac manifestation that requires immediate revascularization preferably through primary percutaneous coronary intervention (PCI). This study aims to describe gender stratified outcomes and epidemiological profile of STEMI patients undergoing treatment at a tertiary care hospital in Karachi, Pakistan. METHODS: A 5-year, retrospective analysis of hospital records was undertaken on confirmed STEMI patients admitted between 2010 and 2014, undergoing primary PCI. Information was retrieved on demographic variables, risk factors, total ischemia time, door to balloon time, angiographic findings, and treatment strategy and in-hospital outcomes. RESULTS: A total of 603 patients were available for analysis. Mean age of the participants was 58 ± 11 years, with 78.6% being males. The most common risk factors were hypertension (48.1%), diabetes (37%), and smoking (22.2%). Gender stratified analysis revealed poorer clinical presentation and prolonged ischemia time among women when compared to men (410 vs. 310 min, respectively). Total in-hospital mortality was 9.6% and was higher in women (19.3%), patients with non-anterior infarction (12%), Killip class >2 (39%), advanced age (14.6%), and multi-vessel disease (12%). CONCLUSION: Our study describes the common risk factors and treatment outcomes for STEMI patients undergoing primary PCI at a tertiary care hospital in Karachi. In-hospital mortality and total ischemia time were higher among women compared to men in our study. Moreover, the risk profile, treatment related complications, and outcomes were poorer in women compared to men. We suggest further research to investigate the effect of prolonged ischemia time on long-term clinical outcomes.

Role of trans-radial band protocols in radial artery occlusion: Randomized trial.

BACKGROUND: Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital's radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications. METHODS: This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The secondary outcomes included hematoma and bleeding after radial band removal. RESULTS: The mean age of the participants in the trial was 58.3 ± 11.5 years, while 63% of them were men. Participants in both the groups had similar baseline characteristics. Radial artery occlusion was not significantly different between protocol A and protocol B (10% vs. 14%, p = 0.49, respectively). Similarly, hematoma and bleeding after trans-radial band removal showed no statistical difference between the groups. CONCLUSION: Trans-radial band deflation practice at our institution was non-inferior to Cohen and Alfonso's protocol in the incidence of radial artery occlusion after coronary angiography. TRIAL REGISTRATION NUMBER: This trial is registered at clinicaltrials.gov (https://clinicaltrials.gov) with registration number NCT03298126.

Validation of the Recent Life Changes Questionnaire (RLCQ) for stress measurement among adults residing in urban communities in Pakistan.

BACKGROUND: Recent Life Changes Questionnaire (RLCQ) developed by Richard Rahe has enabled quantification of stress by analyzing life events. The overall aim of the study was to create a reliable version of the Rahe's RLCQ for measuring stress in individuals living in developing countries and assess its validity. This paper discusses criterion validation of the adapted RLCQ in urban communities in Pakistan. METHODS: This is a criterion validation study. Four urban communities of Karachi, Pakistan were selected for the study in which households were randomly chosen. Two data collectors were assigned to administer the adapted RLCQ to eligible participants after obtaining written informed consent. Following this interaction, two psychologists interviewed the same participants with a diagnostic gold standard of Mini International Neuropsychiatric Interview (MINI) which is utilized in usual practice within Pakistan to confirm the presence of stress related mental disorders such as Depression, Anxiety, Dysthymia, Suicide, Phobia, OCD, Panic Disorder, PTSD, Drug abuse and dependence, Alcohol abuse and dependence, Eating Disorders and Antisocial Personality Disorder to validate the accuracy of the adapted RLCQ. We generated the ROC curves for the adapted RLCQ with suggested cut-offs, and analyzed the sensitivity and specificity of the adapted RLCQ. RESULTS: The area under the receiver operating characteristic curve (ROC) of common mental disorders such as depression and anxiety was 0.64, where sensitivity was 66%, specificity was 56% and the corresponding cut off from the adapted RLCQ was 750. Individuals scoring ≥750 were classified as high stress and vice versa. In contrast, the area under the ROC curve for serious mental disorder and adverse outcomes such as suicide, bipolar and dysthymia was 0.75, where sensitivity was 72% and specificity was 60% at the cut off of 800 on the adapted RLCQ. Individuals scoring ≥800 were classified as high stress and vice versa. The rate of agreement between the two psychologists was 94.32% (Kappa = 0.84). CONCLUSION: The adapted and validated RLCQ characterizes common mental disorders such as depression and anxiety with moderate accuracy and severe mental disorders such as suicide, bipolar and dysthymia with high accuracy. TRIAL REGISTRATION: Clinicaltrials.gov NCT02356263 . Registered January 28, 2015. (Observational Study Only).

Significance of Hyponatremia as an Independent Factor in Predicting Short-term Mortality in Patients with Hemorrhagic Stroke.

Introduction Hyponatremia is the most common electrolyte imbalance in patients with acute cerebrovascular insults. In patients with acute non-traumatic hemorrhagic stroke, the role of hyponatremia as a negative prognostic indicator has been controversial. The aim of this study is to evaluate the frequency of hyponatremia in patients with hemorrhagic stroke and determine its impact on their in-hospital disease outcome. Methods This was a prospective observational study, which included all patients with non-traumatic hemorrhagic stroke. Serum sodium concentration <135 mmol/L was labeled as hyponatremia. The etiology of hyponatremia was determined as syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS). The outcome was categorized as "complete recovery," "motor/sensory deficit but not wheelchair/bed bound," "wheelchair/bed bound," and "in-hospital mortality." SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, US) was used to analyze the data. Results Out of 234 patients of hemorrhagic stroke, 45.3% (n=106) were hyponatremic, 58.5% had SIADH and 41.5% had CSWS. The overall mortality rate of hemorrhagic stroke was 16.2%. The mortality rate was 36.5% in the SIADH group, 50% in the CSWS group, and 13.1% in the normonatremic group (p<0.00001). The mean hospital stay in the SIADH group was 7.04 ± 2.57, in the CSWS group, it was 6.50 ± 1.55, and in the normonatremic group, it was 3.88 ± 2.74 (p=0.000). Conclusion Hyponatremia is an independent predictor of short-term mortality in patients with acute hemorrhagic stroke.

Effects of Metformin on Symptoms of Polycystic Ovarian Syndrome Among Women of Reproductive Age.

Background Metformin is a highly preferred drug that is used to treat the symptoms of polycystic ovarian syndrome among women. Pakistan is facing a continuous rise in the prevalence of polycystic ovarian syndrome. Therefore, the determination of the effectiveness of the drug in this condition is considered ideal as per the presenting situation. Objective The aim of the study was to determine the effects of metformin in patients with polycystic ovarian syndrome. Methods This cross-sectional study has investigated the influence of metformin on the ability to conceive, body weight, mood swings, energy levels, menstrual irregularities, and acne and hirsutism. As per the inclusion criteria, 100 women were evaluated from the outpatient clinics of Jinnah Postgraduate Medical Centre and Civil Centre, Karachi, from November 2016 to January 2017. A structured, pre-tested questionnaire was used for data collection. Results The study group had a mean age of 27.2 ± 4.75 years. Outcomes reported by study participants suggested a significant influence of metformin on menstrual irregularities (p 0.046), acne and hirsutism (p<0.001), mood swings (p<0.001), and daily energy levels (p<0.001). Findings further proposed that metformin does not produce a significant impact on the ability to conceive (p 0.096) and in the change in body weight (p 0.073) of the patients. Conclusion Metformin has been realized to have a significant role in dealing with the symptoms of polycystic ovarian syndrome. It is recommended to conduct more in-depth and longitudinal research on the long-term effects of the drug and compliance among these women.