Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy. Study Design: Analytical cross-Sectional Study. Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021. Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale <0.05 was considered statistically significant. Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47. Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients.
Objective: To determine the spectrum of arrhythmias during initial 48 hours of AMI and their impact on the in-hospital outcome. Study Design: Analytical Cross-sectional study. Place and Duration of Study: This study was conducted at a Tertiary Cardiac Center of Rawalpindi Pakistan from Jun 2021 till Jan 2022. Methodology: A total of (n=150) patients of Acute Myocardial Infarction (AMI) undergoing immediate or early revascularization and meeting the inclusion and exclusion criteria were included in the study. They were monitored for arrhythmias during initial 48 hours of hospitalization and their in-hospital outcomes were noted on a predesigned Performa.Chi square test applied for arrhythmia association with adverse outcome at 95% confidence interval and 5% margin of error. Results: This study comprised (n=117; 78%) males and (n=33; 22%) females. Mean age was 62.9 years. ST elevation MI(STEMI) constituted (n=127; 84.7%) and Non-ST Elevation MI (NSTEMI) (n=23;15.3%) of total patients. Arrhythmias documented in overall (n=122;81.3%) patients, 81.8% (n=104) in STEMI and (n=18; 77.2%) in NSTEMI. Sinus tachycardia(n=52;34.7%) was most common rhythm followed by accelerated idioventricular rhythm (n=20;13.4%) and sinus bradycardia12.7% (n=19). In-hospital mortality was (n=25;16.7%) with p-value=0.009, mostly in patients with ventricular tachycardia/ventricular fibrillation, atrial fibrillationand complete heart block. Other outcomes included (n=23;14.7%) acute left ventricular failure, (n=9; 6%) cardiogenic shock (n=5;3.3%) acute stent thrombosis, (n=2; 1.3%) cerebrovascular accident (CVA)and (n=31; 20.7%) prolonged hospitalization (p-value 0.05). Conclusion: Arrhythmias are common in acute myocardial infarction during initial 48 hours of presentation with sinus tachycardia being most common followed by accelerated idioventricular rhythm and sinus bradycardia. Arrhythmias are associated with increased in-hospital mortality and adverse outcome.
Objective: Prospective To determine the various risk factors and exposures for spread of Corona Virus Disease 2019 (COVID19) among health care workers working at Combined Military Hospital Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from Apr to Jul 2020. Methodology: A total of 134 health care workers who were infected with COVID-19, were included in study. A structured questionnaire was attained after informed consent and approval from hospital ethical committee. Data was analyzed using SPSS-19 statistical software. Results: Overall, 134 of 2591 Health care workers (Health care workers) in Combined Military Hospital Rawalpindi tested positive for COVID-19 during the study period. The infection rate was 5.17%. Among them 25 (18.7%) were women and 109 (81.3%) were men. There was not statistical difference in infection rate between male and female health care workers p=0.156). The infection rate in clinical category was significantly higher than non-clinical category (p<0.001. The infection rate in nursing assistants was significantly higher than the doctors (p=0.021). Personal protective equipment was optimally provided to health care workers except for goggles and face shields whose provision and use were both lacking. Conclusion: Health care workers are at high risk of developing COVID-19. There is need for extensive training, easy availability of personal protective equipment and strict compliance to infection control policies.
Objective: To analyse the prevalence of myths related to trial of labour after caesarian section (tolac) and vaginal birth after caesarian section (VBAC). Study Design: Cross-sectional Knowledge, Attitude and Practice study. Setting: PNS Shifa Hospital Karachi; A Tertiary Care Centre. Period: January 2020 to June 2020. Material & Methods: A questionnaire was designed including demographic details; age, education level, socioeconomic status and whether or not patient has received counselling about (VBAC) from obstetrician and answers to fifteen close ended questions related to prevalence of myths concerning trial of labour after c section(TOLAC) and vaginal birth after c section (VBAC). Every question had three possible answers: Yes (myth), No (correct answer) and don’t know (unsure). SPSS 22 was used for data analysis. Results: Of the 1000 forms, 850 were completed and returned. The mean age of study population was 34.22±11. 63 years. 480 participants (56.48 %) gave more than 50% yes answers and 370 participants (43.52%) gave more than 50 % no answers. There was significant inversely proportional impact of education (p<0.001) and socioeconomic class (p<0.002) and attendance of antenatal counselling on VBAC by obstetrician on prevalence of myths (p<0.001). The effect of age on the prevalence of myths was not significant (p<0.017). Conclusion: Our study delineated the fact that while considering vaginal birth after c section, myths and misconceptions overshadowed medical evidence in guiding patient’s decisions.
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