Introduction of Small Stitch Small Bite technique: a retrospective long-term follow-up.

PURPOSE: Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to explore the impact of a structured introduction of guidelines for abdominal wall closure on the rates of incisional hernia and wound dehiscence. METHODS: All procedures performed via a midline incision in 2010-2011 and 2016-2017 at Capio St Göran's Hospital were identified and assessed for complications and risk factors. RESULTS: Six hundred two procedures were registered in 2010-2011, and 518 in 2016-2017. Four years after the implementation of new guidelines, 93% of procedures were performed using the standardized technique. There was no significant difference in the incidence of incisional hernia or wound dehiscence between the groups. In multivariate Cox proportional hazard analysis, BMI > 25, wound dehiscence, and postoperative wound infection were found to be independent risk factors for incisional hernia (all p < 0.05). In multivariate logistic regression analysis, male gender and chronic obstructive pulmonary disease were risk factors for wound dehiscence (both p < 0.05). CONCLUSIONS: The present study failed to show a significant improvement in rates of incisional hernia and wound dehiscence after the introduction of Small Stitch Small Bites. When introducing a new standardized technique for closing the abdomen, education and structural implementation of guidelines may have an impact in the long run. The risk factors identified should be taken into consideration when closing a midline incision to identify patients with high risk.

Facile hydrothermal synthesis of BiVO4 nanomaterials for degradation of industrial waste.

Bismuth Vanadate (BiVO4) has been synthesized using simple hydrothermal technique while varying the pH of concentrated H2SO4. With the increase of pH values (from 06 to 10), the morphology of the synthesized material tuned in the form of nano-spheres and cubes in the range from 50 to 60 nm. The lateral affect tuned the bandgap of BiVO4 from 2.47 eV to 2.50 eV which is significant in the context of present study. It is worth mentioning that desirous bandgap corresponds to the visible spectrum of the solar light being abundantly available and finds many applications in real life. The synthesized nanomaterial BiVO4 has been characterized through UV-Vis spectroscopy, X-ray diffraction, Scanning electron microscope and energy-dispersive X-ray (EDX) spectroscopy. The synthesized BiVO4 has been tested as photocatalyst for degradation of industrial pollutant from Leather Field Industry. Said catalyst (BiVO4) successfully degraded the industrial pollutant after 3 h under solar light irradiation. Therefore, the BiVO4 can be regarded as potential photocatalyst for degradation of industrial waste which is highly needed.

Serum high sensitivity C-reactive protein levels and the severity of coronary atherosclerosis assessed by angiographic gensini score.

OBJECTIVE: To assess the relationship between plasma high sensitivity C-reactive protein levels with severity of coronary atherosclerosis. MATERIALS AND METHODS: The study included 80 patients subjected to coronary angiography. The extent of Coronary Artery Disease (CAD) was assessed using Gensini score. Patients were divided into three risk groups according to hs-CRP levels (< 1 mg/L--as low risk, 1-3 mg/L--as average risk and >3 mg/L--as high risk). Mean Angiographic Gensini scores were compared among the risk groups. Correlation between serum hs-CRP levels and angiographic Gensini scores was also assessed. RESULTS: The 26 (32.5%) patients belonging to hs-CRP low-risk group had a mean angiographic Gensini score of 11.8 +/- 5.8, 18 (22.5%) belonging to moderate-risk group had a mean score of 28.9 +/- 7.9 and 36 (45%) belonging to high- risk group had a mean score of 78.7 +/- 41.0. By applying ANOVA the mean angiographic Gensini scores showed increasing trend from lower to higher hs-CRP risk groups (p < 0.001). Serum hs-CRP levels showed significant correlation with respective angiographic Gensini scores by Pearson's correlation (p < 0.001). CONCLUSION: Serum hs-CRP levels show significant correlation with the severity of Coronary Artery Disease as assessed by angiographic Gensini score.

Permanent pacemaker implantation associated tricuspid regurgitation.

OBJECTIVE: To determine the prevalence of tricuspid regurgitation in patients with dual-chamber permanent pacemaker implantation. METHODS: This study included 153 patients undergoing permanent pacemaker implantation. All eligible candidates had baseline transthoracic echocardiography to rule out preexisting tricuspid regurgitation. Echocardiography across the tricuspid valve was repeated one month after permanent pacemaker implantation, and the frequency of significant tricuspid regurgitation was determined. The associations of potential effect modifiers (age, sex, height, body mass index categories, diabetes, and hypertension) with tricuspid regurgitation were assessed individually using simple and multivariable logistic regression models. RESULTS: After dual-chamber permanent pacemaker implantation, significant tricuspid regurgitation was present in 22 (15.8%) patients. Tricuspid regurgitation was significantly associated with body mass index >30 kg·m-2 (odds ratio = 32.84, 95% confidence interval: 1.26-853.82, p = 0.04). CONCLUSION: Significant tricuspid regurgitation was present in substantial number of patients after dual-chamber pacemaker implantation and was independently associated with body mass index >30 kg·m-2.

Frequency of risk factors in patients of acute coronary syndrome due to coronary ectasia.

BACKGROUND: Coronary artery ectasia is a relatively common entity characterized by inappropriate dilatation of the coronary vasculature. In some cases of acute coronary syndrome without obstructive coronary lesions, coronary ectasia is the sole cause. The exact mechanism of its development is unknown but evidence suggests a combination of genetic predisposition, common risk factors for coronary artery disease, and abnormal vessel wall metabolism. As there are few data regarding the pattern of coronary risk factors in patients with coronary ectasia, the objective of the study was to determine the frequency and distribution of coronary risk factors in patients with acute coronary syndrome solely due to coronary ectasia. METHODS: The study included 155 patients over a period of 6 months, with coronary angiographic evidence of coronary ectasia as the sole cause of acute coronary syndrome. There were 79 (51%) men and 76 (49%) women with a mean age 51.92 ± 7.83 years; 73 (47.10%) were aged 20-50 years and 82 (52.90%) were 51-80 years of age. The frequencies of coronary risk factors were stratified according to sex and the two age groups. RESULTS: Seventy-one patients (45.80%) had diabetes mellitus, 83 (53.54%) had hypertension, 55 (35.48%) were smokers, 46 (29.68%) had dyslipidemia, and 47 (30.3%) were obese. CONCLUSION: Hypertension is the leading coronary risk factors in patients with acute coronary syndrome solely due to coronary ectasia, followed by diabetes mellitus and smoking.

In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score.

BACKGROUND: Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. OBJECTIVES: To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. METHODS: The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low-risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. RESULTS: Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p = 0.001). CONCLUSION: TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI.

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.

Parachute-Like Mitral Valve Tuberculoma: A Rare Presentation.

There have been anecdotal reports of tuberculous cardiac involvement, mainly in cases of military tuberculosis or immune deficient individuals. The spectrum of clinical presentations of tuberculous cardiac involvements includes incidental detection of single and multiple well-circumscribed tuberculomas, symptomatic obstructive lesions, AV conduction abnormalities, and even sudden death. We present a case of cardiac tuberculoma in an immune-competent person who presented with worsening dyspnea. The unique morphology of this mass posed an imaging challenge that required 4-dimensional (4D) echocardiography and cardiac magnetic resonance (CMR) detail to differentiate the mass from an anterior mitral leaflet (AML) aneurysm. Histological examination after surgical resection confirmed its tuberculous etiology.