scholarly journals Clinical Outcomes and Prevalence of Intravascular Ultrasound Use at a Tertiary Care Hospital in a South Asian Country

2021 ◽  
Vol 11 ◽  
pp. 42
Author(s):  
Nasir Rahman ◽  
Ihsan Ullah ◽  
Ghufran Adnan ◽  
Maria Ali Khan ◽  
Awais Farhad ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intravascular Ultrasound ◽  
South Asian ◽  
Tertiary Care ◽  
Asian Country ◽  
Artery Dissection ◽  
Care Hospital ◽  
Coronary Artery Dissection ◽  
Luminal Diameter ◽  
South Asian Country

Objectives: Intravascular ultrasound (IVUS) plays a pivotal role in the current era of coronary interventions. We aimed to determine the prevalence of IVUS use and clinical outcomes of IVUS-guided percutaneous treatment of coronary arteries lesions in a South Asian country. Material and Methods: It is a retrospective observational study, a total of 134 consecutive patients having done IVUS, was enrolled from January 2013 to March 2020 at a single center. Results: Out of 134 patients, 97 (72.4%) were male with a mean age of 63.1 ± 12.9 years. The prevalence of IVUS in our center was 3.0%. The most frequent comorbidity observed was dyslipidemia, n = 111 (82.8%). Non-ST-elevation myocardial infarction, n = 50 (37.3%), was the common mode of presentation. On coronary angiogram, the left main (LM) disease was found in n = 46 (34.3%), however, single-vessel disease, n = 51 (38.1%), was most commonly noted. IVUS utilization was higher in the left anterior descending, n = 94 (70.1%), followed by LM, n = 46 (34.3%). The LM mean minimal luminal area was 6.0 ± 2.6 mm2 and minimal luminal diameter was 4.53 mm ± 0.6 (mean). The coronary artery dissection was noted in n = 15 (11.2%). The mean duration of follow-up in our study was 40.3 ± 30.1 months. Major adverse cardiac events (MACEs) were recorded in n = 13 (9.7%), which included heart failure, n = 4 (3%). Cardiovascular death and target vessel revascularization occurred in n = 3 (2.2%). Conclusion: IVUS results in a significant decrease in MACE. Our data might support the broader use of IVUS in both developed and in our part of the world.

scholarly journals A retrospective review of antiphospholipid syndrome from a South Asian country

2021 ◽  
Author(s):  
Muhammad Zain Mushtaq ◽  
Syed Ahsan Ali ◽  
Zaibunnisa Sattar ◽  
Saad Bin Zafar Mahmood ◽  
Tazein Amber ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
South Asian ◽  
Antiphospholipid Syndrome ◽  
Tertiary Care ◽  
Asian Country ◽  
Immunoglobulin M ◽  
Antiphospholipid Antibody ◽  
Care Hospital ◽  
South Asian Country ◽  
Wide Range

Objectives: This study aims to investigate clinical presentations, antiphospholipid antibody patterns and their levels, therapeutic regimens, and outcomes in patients with antiphospholipid syndrome (APS) admitted to a tertiary care hospital of a South Asian country. Patients and methods: Between January 2009 and December 2019, a total of 216 patients with APS (8 males, 208 females; median age: 35.7±6.9 years; range, 20 to 76 years) who either fulfilled the modified Sydney criteria or those who satisfied only clinical criteria along with positive antiphospholipid antibody on at least one occasion (probable APS) were retrospectively analyzed. Results: The majority of the patients (n=183, 84.7%) had obstetric complications, followed by venous thrombosis in 23 (10.8%) patients. Recurrent early abortions in 126 (58.6%) and deep venous thrombosis in 16 (7.4%) patients were the most prevalent obstetrical and venous events, respectively, whereas limb gangrene in seven (3.3%) and ischemic stroke in seven (3.3%) were the most common arterial events. A total of 190 (88%) patients had primary APS, while 26 (12%) had secondary APS. Systemic lupus erythematosus was the frequent association with secondary APS found in 19 (73%) patients. Immunoglobulin M (IgM) anticardiolipin antibody was present in 173 (65.0%) patients, being the most commonly reported antibody. Probable catastrophic APS was found in four (1.9%) patients. Majority of the patients (n=190, 87.9%) were treated with a combination of acetylsalicylic acid and low-molecular-weight heparin. Single mortality was observed in our study population due to complications related to catastrophic APS. Conclusion: Antiphospholipid syndrome has a wide range of thrombotic and obstetrical manifestations with important variations in different regions of the world. There is a significant morbidity and mortality related to APS, despite treatment with anticoagulation and; therefore, describing prognostic markers and optimal therapeutic interventions is pivotal to prevent complications.

scholarly journals Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Ata Bajwa ◽  
Udit Bhatnagar ◽  
Amit Sharma ◽  
Hani El-Halawany ◽  
Randall C. Thompson
Keyword(s):  
Coronary Artery ◽  
Fibromuscular Dysplasia ◽  
Life Support ◽  
Tertiary Care ◽  
Sudden Cardiac Arrest ◽  
Stable Condition ◽  
Ventricular Rate ◽  
Artery Dissection ◽  
Care Hospital ◽  
Coronary Artery Dissection

A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS) was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA). A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS) was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall.

Ayodhya Dispute and Responses of India’s Islamic Neighbors and Hindu Nationalism in India

2021 ◽  
Vol 7 (2) ◽  
pp. 223-236
Keyword(s):  
South Asian ◽  
Civil Disobedience ◽  
Asian Country ◽  
Hindu Nationalism ◽  
Mahatma Gandhi ◽  
South Asian Country ◽  
National Congress ◽  
Independence Movements ◽  
Indian National Congress

India has been noted for its independence movements including the non-cooperation and civil disobedience movements under the leadership of the Indian National Congress in general and Mahatma Gandhi in particular. However, in this South Asian country, there is another kind of nationalism that roots in Hinduism. The objective of the article is to explain the nature of Hindu nationalism in India. To gain this aim, the author is going to implement three tasks including giving a brief overview of the Ayodhya dispute; reporting the reactions from India’s neighbors to the Ayodhya issue; and explaining the relations among the Ayodhya related legal fights and responses from Pakistan and Bangladesh, as well as Hindu nationalism. As a result, the study is helpful to comprehend the politics of India and its nationalism. Received 25th September 2020; Revised 2nd January 2021; Accepted 20th February 2021

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 20-25
Author(s):  
OVAIS ULLAH SHIRAZI ◽  
NORNY SYAFINAZ AB RAHMAN ◽  
CHE SURAYA ZIN ◽  
HANNAH MD MAHIR ◽  
SYAMHANIN ADNAN
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Ward ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Slope Change ◽  
The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

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