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  • 1
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    FREQUENCY OF UNIDENTIFIED DIABETES MELLITUS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
    Army Medical College ; 2021
    In:  Pakistan Armed Forces Medical Journal Vol. 70, No. Suppl-4 ( 2021-01-05), p. S731-36
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 70, No. Suppl-4 ( 2021-01-05), p. S731-36
    Abstract: Objective: To determine the frequency of unidentified Diabetes Mellitus in Acute Myocardial Infarction. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Army Cardiac Centre Lahore, Lahore, from Jan 2020 to Feb 2020. Methodology: Patients (male and females) with acute myocardial infarction both ST Elevation MI and non-ST Elevation MI presenting to cardiac centre were included through consecutive non probability sampling technique. Patients with gestation diabetes mellitus and diabetes type I were excluded. Data was collected through detailed questionnaire covering the necessary variables. Distribution of unrecognized diabetes in these patients were determined through Blood Sugar Fasting and HBA1c levels undersigned by the classified Pathologist. Results: Over the study period, a total of 150 patients were included. 68.6% were males with 40.6% patients suffering from STEMI and 28% with NSTEMI. Among 31.2% females, 12.6% patients had STEMI and 18.6% had NSTEMI. Out of total patients, 40% were known case of diabetes, 26.6% were newly diagnosed diabetics, normoglycemic were 23.3% and impaired fasting blood glucose levels was present in 10% patients. Total 40 (26.6%) patients were those who were first diagnosed diabetes during admission for acute MI management. In unidentified diabetic group STEMI was more common than NSTEMI with male predominance. Conclusion: There is a high frequency of unrecognized diabetes mellitus in patients with acute Myocardial infarction in our population. Therefore, in high risk patients for ischemic heart disease, screening for diabetes is routinely suggested to take timely preventive efforts and avoid complications.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v70iSuppl-4.6014
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2021
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  • 2
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    Mitral Annular Disjunction in Mitral Leaflet Prolapse: Prevalence, Clinical Profile and Echocardiographic Features at Tertiary Cardiac Care Centre, Rawalpindi
    Army Medical College ; 2022
    In:  Pakistan Armed Forces Medical Journal Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S450-54
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S450-54
    Abstract: Objective: To determine the prevalence of Echocardiographically-recognizable Mitral Annular Disjunction in patients of Myxomatous Mitral Valve Disease/Mitral Leaflet Prolapse. Study design: Analytical Cross sectional . Place & Duration of study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD),Rawalpindi Pakistan from Jul 2021 to Sep 2021. Methodology: A total (n=45) diagnosed patients of Myxomatous Mitral Valve disease, were included through non-probability consecutive sampling. Mitral Annular Disjunction (MAD) was assessed by 2D TTE imaging as the distance between the point of insertion of the posterior leaflet into the left atrial wall (upper boundary of the disjunction) and the link between the left atrium and the left ventricle myocardium (lower border of the disjunction)at end-systole in parasternal long axis view. A distance equal to or greater than 2mm was used as a threshold for diagnosing the presence of MAD. The data analysis was done with the help of computer software programme SPSS version 24. Results: Total number of patients were 45 patients with males being 32 (71.11%) while females being 13 (28.88%), with a mean age of 30.24 + 5.21 years. MAD was present in 26 (57.8%) of the patients with mean length of 2.88mm + 2.77 mm. Patients with MAD had more chest pain, palpitations and dyspnoea than those without MAD. Mitral regurgitation was more severe in patients with MAD than without. The MAD severity correlated with the presence of Non Sustained Ventricular Tachycardia. Conclusion: MAD is not an uncommon finding in patients having myxomatous mitral valve disease/mitral valve prolapse........
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v72iSUPPL-3.9532
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2022
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  • 3
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    Frequency of In-Stent Restenosis among Different 2nd/3rd Drug Eluting Stents in Patients Presenting with ACS/Angina at Trtiary Cradiac Care Centre
    Army Medical College ; 2022
    In:  Pakistan Armed Forces Medical Journal Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S496-500
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S496-500
    Abstract: Objective: Primary objective was to determine the frequency of in-stent restenosis (ISR) among second/third generation drug eluting stents (DES), diagnosed angiographically in cardiac catheterization laboratory either in emergency settings or elective stage procedure and to determine the risk factors precipitating ISR. Study Design: Analytical Cross-sectional study. Place and Duration of the study: Tertiary Cardiac Care Center of Rawalpindi Pakistan, from Nov 2021 to Apr 2022. Methodology: After hospital ethical committee approval, medical data of consecutive patients were analyzed. Clinical and bio data were obtained followed by admission. Risk factors for atherosclerosis obtained along with baseline investigations and echocardiogram obtained to calculate ejection fraction. Classified interventional cardiologists analyzed angiographic images and confirmed the presence of ISR. Details of previous angioplasty and type of stent were documented. Results: Out of total 137 patients, 98(72%) were males and 39(28%) females. 94(68%) patients were diabetic, 102(72%) were hypertensive, 72(52%) had dyslipidemia, 56(40%) were smokers, and 32(23.35%) strong family history of CHD. After coronary angiography we found that frequency of ISR was 32(23%) in patients who had Xlimus sirolimus stent, 34(24.8%) patients had Xience (everolimus eluting stent), 33(24%) had Ultimaster (sirolimus eluting stent), 38(27%) had Biomatrix stent with p-value=0.25. Conclusion: The clinical presentation of ISR is usually with angina in all new generation DES. There was no statistically significant difference in terms of ISR among second/3rd generation DES. DES ISR not only depends upon the type of DES used but also depends upon multiple patient ...
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v72iSUPPL-3.9541
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2022
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  • 4
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    RISK OF DEVELOPMENT OF HYPERTENSION AFTER DONOR NEPHRECTOMY
    Army Medical College ; 2021
    In:  Pakistan Armed Forces Medical Journal Vol. 71, No. 2 ( 2021-04-29), p. 588-92
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 71, No. 2 ( 2021-04-29), p. 588-92
    Abstract: Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v71i2.4382
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2021
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  • 5
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    Diffused Myocardial Inflammation in COVID-19 Associated Myocarditis Detected by Cardiac Magnetic Resonance Imaging in Post-COVID Patients
    Army Medical College ; 2022
    In:  Pakistan Armed Forces Medical Journal Vol. 72, No. SUPPL-3 ( 2022-11-21), p. S418-22
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 72, No. SUPPL-3 ( 2022-11-21), p. S418-22
    Abstract: Objective: To determine the frequency of myocarditis in patients recovered from COVID-19 infection. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Cardiac Magnetic Resonance Imaging Department, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi Pakistan from Jul 2020 till Apr 2022. Methodology: All patients who underwent Cardiac Magnetic Resonance Imaging after recovery from COVID-19 were enrolled. Non-probability consecutive sampling technique was used for sample selection and was calculated on the basis of Gpower. Data of patients fulfilling the inclusion criteria was selected. All PCR positive cases of COVID-19 who recovered from COVID-19 and completed their 12 days of isolation not exceeding 60 days of 1st Polymerase chain reaction positive, and who have any symptoms of shortness of breath, fatigue and chest pain with reduced left ventricular ejection fraction (LVEF) on 2Dechocardiogram were included in the study. Data was recorded, stored, and analyzed by using SPSS version-21. Quantitative data was reported as Mean±SD. Categorical variables were reported as frequency and percentage. To determine theassociation between different variables Chi square test was used. Results: Total 83 patients were included in this study who recovered from COVID-19 and underwent Cardiovascular magnetic resonance. Mean age of the patients was 39.17±12.9 years. 67(80.72%) were male while 16(19.28%) were females.50(60%) had myocarditis after recovery from COVID-19. This study showed statistically significant association of all the Cardiovascular magnetic resonance imaging findings with Myocarditis (p 〈 0.05) at 95% confidence interval and 5% margin of error. Conclusion: Early detection of COVID-19 related myocarditis will help in better management of patient. In such patients,cardiac Magnetic Resonance Imaging is the modality of choice, since it allows for noninvasive assessment of myocardial edema and fibrosis, as well as therapeutic guidance and improved patient outcomes.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v72iSUPPL-3.9524
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2022
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  • 6
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    MINIMAL INVASIVE PARATHYROIDECTOMY IN A PATIENT OF PARATHYROID ADENOMA - A CASE STUDY
    Army Medical College ; 2020
    In:  Pakistan Armed Forces Medical Journal Vol. 70, No. 6 ( 2020-12-16), p. 1941-43
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 70, No. 6 ( 2020-12-16), p. 1941-43
    Abstract: Frequently, the kidney stones are treated without determining the root cause of kidney stones which leads to recurrence of the kidney stones. This is a case report of a forty nine years old male who developed nephrolithiasis secondary to parathyroid adenoma. This tumor was removed through a modern and an efficient technique called minimal invasive parathyroidectomy which proved to be more efficient and safe compared to the old techniques.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v70i6.5884
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2020
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  • 7
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    OUTCOMES OF TRANSRADIAL APPROACH IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
    Army Medical College ; 2021
    In:  Pakistan Armed Forces Medical Journal Vol. 70, No. Suppl-4 ( 2021-01-05), p. S745-51
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 70, No. Suppl-4 ( 2021-01-05), p. S745-51
    Abstract: Objective: An experience to evaluate the outcomes, feasibility, effectiveness and safety of transradial approach practice in patients undergoing primary percutaneous coronary intervention for acute ST elevation Myocardial infarction in Army Cardiac Centre. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Army Cardiac Centre, Lahore, from Jan 2020 to Mar 2020. Methodology: All patients undergoing primary percutaneous coronary intervention via transradial approach for acute ST elevation Myocardial infarction were included. Informed consent was taken signed. Demographic characteristics, risk factors, time variables like arterial access time, door to balloon time and procedural success was determined. Results: Out of enrolled patients in study, frequency of males and females were 49 (82%) and 9 (18%) respectively. The mean age was 57 ± 10.86 years ranging from 30 to 75 years. On admission, 25 (50%) were hypertensives, 20 (40%) had diabetes and 18 (36%) were smokers. The initial choice for primary percutaneous coronary intervention was transradial approach in all patients, right side 49 (98%) and left side 1 (2%). Due to failure to achieve radial access transfemoral and homolateral ulnar approach was adopted 2 (4%) and 1 (2%) respectively leading to 96% success and 4% failure for transradial access. The main infarcted artery was LAD 31 (62%) followed RCA 15 (30%) Time to arterial access time was 2 mins, door to balloon 34 mins. Eighty percent complication free transradial approach was achieved, 8 (16%) patients had pain and 2 (4%) developed hematoma. Conclusion: Our results proved Transradial approach for primary PCI as a safe, feasible and cost effective procedure.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v70iSuppl-4.6017
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2021
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  • 8
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    Comparison of Left Ventricular Ejection Fraction in Heart Failure Patients on Echocardiography, Cardiac Magnetic Resonance Imaging and Single Photon Emission Computed Tomography
    Army Medical College ; 2022
    In:  Pakistan Armed Forces Medical Journal Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S461-66
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 72, No. SUPPL-3 ( 2022-11-22), p. S461-66
    Abstract: Objective: To compare the left ventricular ejection fraction on echocardiograph, cardiac magnetic resonance imaging and single-photon emission computed tomography scan in heart failure patients. Study Design: This was a prospective cross-sectional study. Place and Duration of Study: Tertiary Cardiac Care Center of Rawalpindi, Pakistan, from Nov 2021 to Apr 2022. Methodology: This was a prospective cross-sectional study conducted from November 2021 to April 2022 at a tertiary cardiac care center of Rawalpindi. Thirty (n=30) heart failure patients of either gender with reduced ejection fraction were selected by consecutive sampling technique and were analyzed to quantify their left ventricular ejection fraction (LVEF) using Echo, CMR and SPECT scan. All three modalities were used to measure LVEF in these patients and were compared accordingly. Results: The LVEF measured by Cardiac Magnetic Resonance Imaging, Single Photon Emission Computed Tomography Scan and Echocardiography was in the range of 15% to 67%. The mean LVEF was 37.2±14.2 by CMR, 37.17±14.1 by SPECT and 38±12.3 by Echo. The mean LVEF determined by SPECT was slightly lower while that determined by Echocardiography was slightly higher. The measured p-value of LVEF by the three modalities, however, indicated statistically difference (p-value 〈 0.05). Conclusion: Although the literature shows diversity in results of these modalities, CMR is considered the standard reference for assessment of LVEF when interpreted by an expert observer. We in our study found that all three modalities are complimentary to each other and can be used interchangeably depending upon the availability of the equipment and reporting expertise of the observers.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v72iSUPPL-3.9534
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2022
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  • 9
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    Prevalence of Acute Gastro Intestinal Tract Bleeding in Patients Undergoing Primary Percutaneous Coronary Intervention After Acute Myocardial Infarction
    Army Medical College ; 2022
    In:  Pakistan Armed Forces Medical Journal Vol. 72, No. SUPPL-3 ( 2022-11-21), p. S412-17
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 72, No. SUPPL-3 ( 2022-11-21), p. S412-17
    Abstract: Objective: To determine the prevalence of acute gastro-intestinal tract bleeding and the factors associated with it in patients undergoing Primary PCI after acute myocardial infarction. Study Design: Analytical Cross sectional study. Place and Duration of Study: Department of Interventional Cardiology, Tertiary Cardiac Care Center, Rawalpindi Pakistan, from May 2021 to April 2022. Methodology: Five hundred patients (n =500) between 30-80 years of age, presented at the emergency of Tertiary cardiac care center, Rawalpindi and diagnosed with Acute Myocardial Infarction were planned to undergo the Primary Percutaneous Coronary Intervention (PCI) procedure. After the procedure, patients were evaluated for acute gastro-intestinal tract bleeding within first 48 hrs. Blood samples were taken before and after 24 hrs and 72 hrs of primary PCI. The blood hemoglobin level was assessed and fall in its level was noted. SPSS 26 was used to enter and analyze the collected data. Results: Out of n=500 patients enrolled in the study, 440(88%) were males and 60(12%) were females. The mean age of patients was 64.27 ± 6.47 years. The mean time from symptoms onset to primary PCI was 9.74±5.15 hrs. The mean duration of the procedure was 34.99 ± 6.01 mins. After the procedure, 23(4.60%) patients had developed the acute gastro-intestinal tract bleeding. In patients who developed acute gastro-intestinal bleeding, mean blood hemoglobin level before the procedure was 11.95 ± 1.05 g/dl, which was reduced to 8.46 ± 0.51 g/dl after the procedure. In patients who did not develop it, the mean blood hemoglobin level before the procedure was 11.94±1.03 g/dl, which was reduced to 11.80 ± 1.04 g/dl after the procedure. The blood hemoglobin level after the procedure was significantly less in patients who suffered from acute gastro-intestinal tract bleeding. Conclusion: The research study concluded that the frequency of acute gastro-intestinal tract bleeding in patients after primary PCI for acute myocardial infarction was very low but on the other hand marked reduction in blood hemoglobin level was observed, which can lead to many adverse sequelae.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v72iSUPPL-3.9523
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2022
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  • 10
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    OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION ARRIVING IN ARMY CARDIAC CENTER LAHORE
    Army Medical College ; 2021
    In:  Pakistan Armed Forces Medical Journal Vol. 70, No. Suppl-4 ( 2021-01-05), p. S781-86
    Details
    In: Pakistan Armed Forces Medical Journal, Army Medical College, Vol. 70, No. Suppl-4 ( 2021-01-05), p. S781-86
    Abstract: Objective: To evaluate the feasibility and outcomes of primary percutaneous coronary intervention (PCI) as a mode of treatment in acute ST segment elevation myocardial infarction (STEMI). Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was conducted in Army Cardiac Center Lahore, from Nov 2019 to Feb 2020. Methodology: All patients diagnosed as acute ST-segment elevation myocardial infarction during the study period were offered primary percutaneous coronary intervention among treatment options. Patients who chose primary percutaneous coronary intervention were included in the study. Informed consent was taken. Patient demographics, risk factors, time variables, procedural characteristics and in-hospital adverse events were evaluated. Results: On admission, Out of 50, 30 (60%) of the patients were current smokers, 25 (50%) were hypertensive, 22 (44%) were diabetic, and 1 (2%) had cardiogenic shock. The mean time from symptom onset to hospital arrival was 5 hours and the mean door-to-balloon time was 34 minutes. Culprit coronary artery was the left anterior descending artery (LAD) in 56% cases and multi-vessel disease was present in 38% cases. Primary percutaneous coronary intervention involved balloon dilatation (2%) and stent implantation (98%). The incidence of postprocedural angiographic no-reflow was 0%. All-cause mortality was 1%. Conclusion: This study has shown efficiency, feasibility and safety in performing of primary percutaneous coronary intervention with excellent outcomes in Army Cardiac Center Lahore. In order to further improve its outcomes, our goal should be to decrease reperfusion time which can be achieved by reducing patient delay, increasing public awareness and improving the management of first medical contact.
    Type of Medium: Online Resource
    ISSN: 2411-8842 , 0030-9648
    URL: Article
    DOI: 10.51253/pafmj.v70iSuppl-4.6024
    Language: Unknown
    Publisher: Army Medical College
    Publication Date: 2021
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