Cardiovascular diseases are among the top leading causes of death worldwide. Most of the time, the patients present with no symptoms, or some symptoms resemble other diseases. This makes most cases challenging for physicians and healthcare workers to diagnose. Besides this, most of the time, not diagnosing the patient on time or delay in the start of intervention is the main cause of death in cardiovascular diseases. Proper history and examination can play a crucial role in this part. History taken in properly can help in reaching the diagnosis. Apart from this, it also helps in the start of empirical therapy. This is where most clinicians are lacking. Waiting for the labs is still time-wasting in other health issues, but it can be killing in cardiac patients. Thus the cardiologist needs to start with a good history and then go on with examinations. Then confirm their findings with the proper labs. This narrows down the diagnosis and saves a lot of time. History-taking is the most important clinical step in the management of patients. But most of the time, it is underrated, and most clinicians rely on labs rather than these basic skills. This article thus reviews the importance of history-taking in diagnosing patients with cardiovascular diseases. Besides this, it also addresses how a good history should be taken to narrow down the diagnosis and reach the proper diagnosis within time to save a patient's life.
Background: This study is based on management issues within the healthcare sector in Karachi. Specifically, it is focused on managing conflicts in the operation rooms, whereby team performance of Operation Theatre staff directly impacts patients' speedy recovery. Methodology: A quantitative survey was conducted involving the surgeons and Operation Theatre staff in Karachi's community hospitals. A closed-ended questionnaire was used in this study, and the questions mainly focused on the conflicts and management of doctors and staff in the operation theatre. Only those doctors and staff members included in the study who is currently working in the operation theatre division of the hospital. a Pearson correlation analysis was performed to assess the relationships between the factors affecting conflicts in the hospital's operating room. Results: The results indicated that the extent of conflict management is high. Factors include communication, leadership, training, adequate compensation, and role identification as perceived by employees. After performing OLS regression tests, the study found that the variable of miscommunication, the communication gap, plays a crucial role in accelerating disagreements of conflicts in Operation Theatre. Conclusion: A significant positive association between the factors and conflict management is observed. It suggests that operation theatre-related factors are improving with better conflict management practices.
Background Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients. Methods Data of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve. Results Mean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1–5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%). Conclusion High in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.
Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. (American Heart Association) AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation (IMR). Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography (TEE). Result Total number of patients included in study was222, out of those 153 (69.9%) patients underwent conventional approach and 69 (31.1) patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach. Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well.
Middle-aged male known case of hypothyroidism presented with shortness of breath and hypoxia. Echo showed large RA myxoma with ASD causing right to left shunt.
Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis. Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome. Results Mean age of the patients was 38.14 ±7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 (65.5%) patients. Stratification of age group shows, that 40 (66.7%) patients in age group ≤ 40 years had raised urinary trypsinogen-2. Stratification of gender showed significant association with raised urinary trypsinogen-2 level (p-value 0.010). Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high.
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