Clinical presentations of nephrotic syndrome in patients of a tertiary care hospital at Peshawar.

BACKGROUND: Nephrotic syndrome (NS) is manifested by presence of pitting oedema, profound proteinuria in excess of 3.5 g/day, serum albumin levels of less than 3.0 g/dL and hypercholesterolemia. This study was conducted to determine the frequency and clinical presentation of nephrotic syndrome in patients coming to a tertiary care hospital. METHODS: This cross-sectional study was done from March to November, 2012 (for 9 months). Patients with complaints of peri-orbital or generalized swelling, and proteinuria on urine examination were included in the study through emergency or outpatient department. RESULTS: Out of 360 suspected cases, nephrotic syndrome was found with a frequency of 67.05%. Among these patients, 69.55% were male and 30.45% female. Majority (65.85%) were between 41-60 years with mean age of 40.36 +/- 15.93 years. All (100%) patients had oedema, 43.20% had oliguria, 17.28% presented with abdominal tenderness, 15.22% patients had fever, 13.16% showed hematuria, 10.28% patients had uraemia and 2.5% of the patients had thrombosis. The majority of patients (56.80%) were diabetic, and 43.20% patients had hypertension. In 23.86% patient's high blood urea alone was recorded and 17.28% showed high serum creatinine along with raised blood urea. Rest of patients had normal renal function at the time of presentation. CONCLUSION: Frequency of nephrotic syndrome was 67.05%. Among these majorities were males. Oedema was the commonest presenting complaint while oliguria, abdominal tenderness, fever, hematuria, uraemia and thrombosis were found in descending orders. Diabetes mellitus was leading cause in majority of patients, followed by hypertension, high blood urea, and high serum creatinine.

Predicting clinical outcome in diabetics vs. non diabetics with acute myocardial infarction after thrombolysis, using ECG as a tool.

OBJECTIVES: To compare, the post Myocardial Infarction in-patient outcome after thrombolytic therapy in diabetics and non diabetics, in a South Asian population. METHODS: This was a prospective cross sectional study done at the Punjab Institute of Cardiology, Lahore from January to July 2009. Consecutive patients with ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent for thrombolysis. ECG was taken at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups: (A) Non Diabetics, (B) Diabetics. This cohort was followed up through the in hospital stay for major complications which were recurrent ischaemic chest pain, heart failure, arrhythmias and death. RESULTS: A total of 182 patients were included in the study, 146 males and 36 females. In non diabetic group, ST segment resolution occurred in 74 (84%) out of 88 patients and in diabetics, 13 (13.8%) out of 94 patients. In non diabetics, complications developed in 29 (32.9%) out of 88 patients and in diabetics, 75 (79.8%) out of 94 patients (p < 0.001). Diabetes with incorporate ST resolution compared to complete resolution were found to have more in hospital complications such as: recurrent chest pain (71.6% vs 23%, p < 0.0001), heart failure (39.5% vs 15.3%, p = 0.0007), arrhythmias (59.2% vs 15.3%, p < 0.0001), mortality (7.4% vs 0%, p = 0.0082). A similar trend was observed in non diabetics: recurrent chest pain (57.1% vs 17.5%, p < 0.0001), heart failure (42.8% vs 14.8%, p = 0.0002) and arrhythmias (50% vs 12.1%, p < 0.0001). Significant interaction was seen between diabetic status and ST segment resolution with respect to clinical outcome (recurrent chest pain p < 0.0001, heart failure p = 0.025, arrhythmias p < 0.0001, and death p = 0.014). CONCLUSION: Diabetics with Acute Myocardial Infarction (AMI) encounter more adverse clinical outcome as predicted by incomplete ST resolution after thromboysis.

Abnormal ankle brachial index and the presence of significant coronary artery disease.

OBJECTIVE: To determine the association between an abnormal ankle brachial index (ABI) and the presence of significant coronary artery disease (CAD) on coronary angiography. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: The study was carried out at Sheikh Zayed Hospital, Lahore, from July to October 2007. METHODOLOGY: A series of 41 patients undergoing coronary angiography in Sheikh Zayed Hospital were selected and their ABI were calculated before the diagnostic coronary angiography. ABI calculations and coronary angiography reporting were done by separate individuals and data was analysed using SPSS 12.0. All patients undergoing diagnostic coronary angiography were included in the study except for those having peripheral arterial disease documented by lower extremity revascularization, lower extremity ulceration and lower extremity amputation. Proportion were compared using chi-square test with significance at p < 0.05. RESULTS: Out of the 41 patients 31 male (76%) and 10 female (24%), 3 patients (7.31%) had ABI < 0.9 and all 3 had triple vessel disease. Ten patients (24%) had ABI 0.91-0.99 and 2 (20%) of them had single vessel disease. Two (20%) had double vessel disease and 6 (60%) had triple vessel disease. Twenty four patients (58%) had ABI of 1.00-1.28 and 8 (33%) of these had single vessel disease, 3 (12%) had double vessel disease and 13 (55%) had triple vessel disease, while 4 patients had normal coronaries. A total of 22 patients were found to have triple vessel disease and only 3 (13.6%) of these 22 patients had an ABI < 0.9 which is statistically not significant (p=0.07). CONCLUSION: This study was not able to establish a direct association between ABI and significant CAD as only 3 patients out of 22 with triple vessel disease had an ABI < 0.9. However, an approximately log linear relationship was noted between ABI and CAD risk which means that not only the average CAD risk increased exponentially at values < 1.0 but also that the CAD risk continued to decline as ABI values increased above 1.0.

Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease.

BACKGROUND: A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute interior wall myocardial infarction (MI) cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermole, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery (RCA) in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross sectional study carried out at the department of cardiology and cardiac catheterization at Jiinnah Hospital, Lahore from April 2008 to September 2008. METHODS: A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. RESULTS: Out of 60 patients, 29 (48.4%) had the culprit lesion in proximal, 23 (38.5%) in mid and 8 (13.4%) in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. CONCLUSION: This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion.