IntroductionEnvironmental triggers of acute myocardial infarction (AMI) have gained mounting evidence from various geographies of the world. However, due to geographic variations in seasonal temperature and other metrological parameters, it is difficult to generalize the findings in one population to another population with different climatic conditions. Therefore, the aim of this study was to assess the relationship between meteorological parameters and the number of primary percutaneous coronary intervention (PCI) procedures for AMI at a tertiary care cardiac hospital in Karachi, Pakistan.MethodsFor this cross-sectional study, data was obtained on the number of primary PCI procedures conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan during 1st June 2016 to 31st May 2018. Daily meteorological data of the Karachi region for the same period was obtained from the Pakistan Meteorological Department. It consists of temperature, atmospheric pressure, and relative humidity. Based on the weather conditions of Karachi, the data was divided into two seasons; summer (April to October) and winter (November to March). Multiple linear regression analysis was performed taken the number of primary PCI performed as regressand and time trend, average temperature, temperature variation, and relative humidity as regressors.ResultsA total of 115,494 hospital admissions were recorded during the study period out of which rate of primary PCI was 10.5% (12,107). A negative relationship between average temperature and number of primary PCI was observed with standardized regression coefficients of -0.13 (p < 0.001) on the overall regression model. A similar significant negative relationship of average temperature was observed on the regression model for the cold season with standardized regression coefficients of -0.17 (p < 0.001). While no such relationship was observed for the warm season.ConclusionThe average daily temperature was found to be negatively related to the number of primary PCI. Subgroup analysis revealed that the average daily temperature had a significant negative relationship with the number of primary PCI in the cold season; however, no such impact was observed in the warm season.
Background Accurate management of non-ST elevation myocardial infarction (NSTEMI) patients can be achieved by stratifying risks as early as possible on hospital admission. Previously, the Thrombolysis in Myocardial Infarction (TIMI) risk score has been validated and used on patients presenting with NSTEMI or unstable angina (UA) in developed countries. The aim of this study was to assess the validity of the TIMI risk score in patients presenting with NSTEMI in Pakistan. Methods This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. The receiver operating characteristic (ROC) curve analysis was performed, and area under the curve (AUC) along with 95% confidence interval (CI) was reported. Univariate and multivariate logistic regression analysis was performed and odds ratio (OR) along with 95% CI was reported. Results This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. Validity of TIMI score in predicting hospital mortality 14 days after the diagnosis of NSTEMI in a population in Pakistan was assessed by ROC curve and logistic regression analysis. The AUC of the TIMI score for predicting 14-day outcome was 0.788 [95% CI: 0.689-0.887], with optimal cutoff of ≥4 with sensitivity of 77.78%. On multivariate analysis, cardiac arrest at presentation and the TIMI risk score were found to be independent predictors of 14-day mortality with adjusted ORs of 136.49 [10.23-1821.27] and 2.67 [1.09-6.57], respectively. Conclusions The TIMI risk score is a useful and simple score for the stratification of patients with high risk of 14-day mortality with reasonably acceptable discriminating ability in patients with NSTEMI acute coronary syndrome.
Background: In this questionnaire based cross sectional survey, the researchers aimed to identify the sociodemographic predictors of knowledge regarding puberty and menstruation among females of reproductive age visiting a public healthcare institute. Methods: Using non-probability sampling, a self-designed, pretested and validated interviewer administered questionnaire in Urdu language was used to collect data from females of reproductive age (18-55 years) visiting the Gynecology outpatient department of tertiary care hospital in Rawalpindi, Pakistan from November 2019 to March 2020. Results: Descriptive and inferential analysis using SPSS v. 21.0 revealed that 288 female participants with mean age 30.30±8.98 years participated in the study, out of which 48.6% of the participants had adequate knowledge regarding puberty and menstruation. The knowledge score was significantly higher among married females (67.7%), those living in urban areas (68.3%), having nuclear families (63.2%), and females with more than 12 years of education (69.9%), employed females (92.2%) and those with higher family income (83.3%). Binary logistic regression showed women living in urban setting were 4.01 times more likely to have good knowledge about puberty (OR 4.01, 95% CI 2.03-8.10, p<0.001) and menstruation and working women were 16.5 times more likely to have adequate knowledge (OR 16.5, 95% CI 1.5-181.7, p 0.022). Conclusion: The inadequate knowledge of females may be attributed to misconceptions regarding menstruation due to poor access to health-related education and a culture of silence around sexual and reproductive health issues. Systemic integration of adequate menstrual socialization at homes and in schools can change the discourse around sexual and reproductive health in the societal landscape. Future studies may explore health-information seeking practices of females from diverse socio-demographics to identify the sources and types of knowledge that they seek on female reproductive health issues.
Objective: Hospitalized patients can pick infections from healthcare facilities which may lead to extended hospital stay, increased morbidity and mortality of hospitalized patients and economic burden on health care. Active surveillance of HAIs that is continuous and prospective in nature has been accepted as a gold standard approach in preventing and controlling healthcare associated infections. To estimate the prevalence HAIs and their types in a tertiary care cardiac center and to identify associated risk factors. Methodology: Nine prospective point prevalence surveys were conducted on three separate days in three consecutive weeks for three months. A data collectors team comprising of two research officers and an infection control nurse, visited the enrolled patients and patient’s history, demographics, physical examination, laboratory findings and other details were reviewed from patient files and recorded on study questionnaire. Results: A total of 559 patients were enrolled in the study. The prevalence of HAIs was 6.4%, which means 36 HAIs were identified in 559 patients. Univariate analysis showed a significant association between HAI and being in ICU/CCU ward (OR 3.4, 95% CI 1.5-7.4) longer duration of hospital stay (OR 3.0, 95% CI 1.5-6.0, P=0.001), exposure to urinary catheter, use of antimicrobials (OR 2.8, 95% CI 1.3-6.1, P=0.006), and diabetes (OR 2.5, 95% CI 1.2-5.2, P=0.008). Conclusion: Healthcare associated infection is a major public health problem and rate of HAIs in the selected centers was found to be 6.4%. Present survey provided baseline evidence for further surveillance and multifaceted infection.
Purpose: To compare the safety and efficacy of Accelerated Corneal Cross Linking (AXL) protocols ,9mW/cm2 for 10 min with 18mW/cm2 for 5 min in terms of refractive and topographic keratometric indices in patients with progressive keratoconus over 3, 6, 12 and 18 months follow-up. Study Design: Quasi experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Nov 2016 to Jun 2018. Material and Methods: Sixty eyes, 30 in each group, of 55 consecutive patients diagnosed with progressive keratoconus were enrolled through convenience sampling and were subjected to AXL with irradiance protocols of 18 watt/cm2 for 5 minutes in group 1 and 9mwatt/cm2 for 10 minutes in group 2. All patients underwent a comprehensive ophthalmic examination at baseline and postoperative follow up visits at 3, 6, 12 and 18 months. Primary outcome parameter was disease stability defined as increase in maximum keratometry over baseline K max of no more than 1 diopter at 1 year after AXL. Statistical analysis of data was performed with IBM SPSS software (version 20.0 SPSS). P value of < 0.05 was considered as statistically significant. Results: Disease stability was 96 % in each group. At the final time point of 18 months, group 2 (AXL 9mmwatt/cm2 for 10 min) was superior as compared to group 1 (AXL 18mmwatt/cm2 for 5 min) in terms of flattening of steep and sim K (p = 0.007, 0.023 respectively). Conclusion: The two AXL protocols are safe and appear to show comparable efficacy in disease stability. They can be used alternatively in the treatment of progressive keratoconus.
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