Comparing the sodium excreting efficacy of furosemide and indapamide combination against furosemide and metolazone combination in congestive heart failure patients: A randomized control trial.

OBJECTIVE: To compare efficacy and safety of indapamide-furosemide combination against metolazone-furosemide combination in refractory heart failure patients. METHODS: The randomised controlled trial was conducted at Rehman Medical Institute, Peshawar, Pakistan, from January 1 to June 30, 2018, and comprised refractory heart failure patients who were randomised into two groups using lottery method Group 1 received intravenous furosemide 40mg Q12hr with metolazone 5mg Q24hr, while group 2 received intravenous furosemide 40mg Q12hr with indapamide 2.5mg Q24hr. Both groups were assessed for urinary sodium excretion, total urine output and decrease in weight on day one, day three and day five of admission. SPSS 22 was used for data analysis. RESULTS: Of the 150 patients, there were 75(50%) in each of the two groups. Mean age in group 1 was 64.8}11.2 years, while it was 66.3}12.9 years in group 2. Both groups showed increased urinary sodium excretion and total urine output (p>0.05). Hypokalaemia was the most common adverse event 66%. Mean hospital stay was not significantly different between the groups (p>0.05). CONCLUSIONS: There was no significant differences between adverse events and efficacy between patients receiving either indapamide-furosemide combination or metolazone-furosemide combination.

Risk Factor for Cardiac Permanent Pacemaker Infection.

BACKGROUND: Cardiac pacemaker infections have increased globally due to increase in demand and lack of adequate knowledge about its significantly contributing risk factors. This study was therefore aimed to determine the prevailing causative microbes and risk factors of both single and dual chamber permanent pacemaker infections. METHODS: This was a retrospective case control study. Cases were selected as culture positive swab, Temporary pacemaker wire or catheter were matched with three controls for each variable using chi square test. Multivariate regression analysis was done to determine risk factors. RESULTS: Among 47 cases, 23.4% cases were infected by methicillin resistant staph aureus, 14.9% by methicilin susceptible Staphylococcus aureus, 10.6% by pseudomonas, 8.5% by escherichia coli and 6.4% by klebsiella. Temporary pacemaker/Central line placed >24 hours ago before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and non-absorbable stitches had statistically significant association with permanent pacemaker infection using multivariate regression model analysis. Chronic obstructive pulmonary disease and non-absorbable stitches had a non-significant association. CONCLUSIONS: Temporary pacemaker/Central line placed >24hours before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and use of non-absorbable stitches are risk factors for permanent pacemaker infection. Staph aureus is the most prevalent microorganism causing infection.

Asymptomatic Pneumopericardium with Atrial Fibrillation after Pericardiocentesis: A Case Report.

Air inside the pericardial cavity is called "pneumopericardium", which is a rare complication of pericardiocentesis. Pneumopericardium may resolve spontaneously or can complicate into tension pericardium, requiring urgent aspiration. We herein describe a 55-year-old man with pericardial effusion who underwent pericardiocentesis. The patient was completely asymptomatic after the procedure. Chest radiograph and computed tomography scan accidentally detected pneumopericardium, which was subsequently complicated by atrial fibrillation and necessitated pharmacological cardioversion. We found no case of asymptomatic pneumopericardium complicated by atrial fibrillation after pericardiocentesis in our literature review. Clinicians and cardiologists should do a post pericardiocentesis chest X-ray to diagnose pneumopericardium and prevent the catastrophic complications of tension pneumopericardium.

Correlation of hyper-homocysteinemia with coronary artery disease in absence of conventional risk factors among young adults.

OBJECTIVE: Coronary artery disease is major cause of mortality and morbidity. Homocysteine has long been postulated as an underlying factor for atherosclerosis leading to coronary artery disease, yet its role in young patients is uncertain. This study was aimed to analyze the correlation between plasma homocysteine and coronary artery disease among young adults in the absence of conventional risk factors. METHODS: It was a case-control study carried out at Rehman Medical Institute, Peshawar, Pakistan from October 1, 2016, to September 30, 2017. Universal sampling technique was adopted and 158 participants were included. A total of 30 participants were in the control group and 128 were in the patient group, who had moderate to severe stenosis in either single or multiple major coronary arteries on coronary angiography and aged <40 years. RESULTS: Cases and controls had similar characteristics but differed significantly in serum homocysteine concentration. In the control group, the mean plasma homocysteine concentration of 6.3 (±2.05) µmol/L and in the patient group a mean plasma homocysteine concentration of 44.5 (±14.01) µmol/L was observed. All the patients with moderate to severe stenosis in single or major coronary arteries had raised plasma homocysteine concentrations. Among 128 patients, 15 (11.7%) had moderate increase, 109 (85.2%) had intermediate increase, and four (3.1%) had severe increase in plasma homocysteine levels. Single vessel coronary artery disease was observed in 118 (92.2%) patients, whereas 10 (7.8%) had more than one major coronary artery involvement. CONCLUSION: Hyper-homocysteinemia has positive correlation with coronary artery disease among young adults in the absence of conventional risk factors.