Interpretation of Electrocardiogram and Emergency Management of Myocardial Infarction: A Survey among Doctors

2020 ◽  
Author(s):  
Farah Ahmad
Keyword(s):  
Myocardial Infarction ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Ethical Review ◽  
P Value ◽  
Acute Management ◽  
Inverse Results ◽  
Ecg Interpretation ◽  
Emergency Doctors

Background: A virtuous understanding of Electrocardiogram is an indispensable ability and essential skill required in doctors. This study assessed the understanding of the electrocardiogram and acute management of myocardial infarction among emergency doctors, general practitioners, medical officers, house officers and postgraduate students. Methods: A cross sectional survey was conducted for 7 months on n=312 doctors working in tertiary care public and private hospitals and as General practitioners in Karachi, Pakistan. Convenience sampling technique was used. Participants were asked to interpret a 12 lead electrocardiogram attached to questionnaire and write down their findings and diagnoses. They were then asked about its acute management. ANOVA and Chi square was applied for making inferences from the acquired data. p value of less than 0.05 was taken as significant. Approval was taken from the Ethical Review board. Results: Knowledge was assessed on basis of designation, 84.6% of the emergency doctors correctly interpreted the ECG while 75.4% of general physicians read it correctly. House officers and medical officers had the lowest scores in ECG interpretation. Years of experience demonstrated inverse results with >5 years experience at the lowest scores for interpretation of ECG and MI management. Interpretation scores of ECG were significantly high (p value 0.03) in participants who attended workshops compared to those who didn’t. Conclusion: Emergency doctors had better scores when it comes to ECG interpretation and management of MI. Frequent workshops and cardiology rotations should be mandatory for health care professionals to improve essential skill and knowledge of acute management of myocardial infarction.

scholarly journals ACUTE MYOCARDIAL INFARCTION;

2013 ◽  
Vol 20 (03) ◽  
pp. 332-340
Author(s):  
ATIF SITWAT HAYAT ◽  
MUHAMMAD ADNAN BAWANY ◽  
JAWAD AHMED QADRI ◽  
Kiran Khalil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tertiary Care ◽  
Anterior Wall ◽  
P Value ◽  
Inferior Wall ◽  
Care Hospital ◽  
Significant Difference

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.

scholarly journals CHARACTERISTICS AND OUTCOMES OF ROTATIONAL ATHERECTOMY IN A TERTIARY CARE CARDIOLOGY FACILITY IN PAKISTAN

2021 ◽  
Vol 54 (3) ◽  
pp. 214-218
Author(s):  
Bilal Kabeer Khan ◽  
Osman Faheem ◽  
Muhammad Nasir Rahman
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Tertiary Care ◽  
Rotational Atherectomy ◽  
Ethical Review ◽  
Major Adverse Cardiovascular Events ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Procedural Success ◽  
Almost All

Objectives: To retrospectively review the short term outcomes of rotational atherectomy in a high CathPCI Risk and high Syntax Population. Methodology: A total of 51 patients who underwent RA between 1st June 2017 and 31st April 2019 were retrospectively reviewed after approval from ethical review committee. Clinical follow up was obtained for procedural success and major adverse cardiovascular events (MACE) at 3 months. Results: Patients who underwent RA were high risk with a mean Syntax score 32.7±5.9 and mean NCDR CathPCI risk score of 51.1±13. The mean age of the patients were 70 years, majority were males (81%), type 2 diabetics (78%) with chronic kidney disease (52.7%), Non-ST elevated myocardial infarction (NSTEMI) (35%) and Syntax Score>32 (64.8%). Out of 37 individuals, procedural success was reported in all subjects except one in the high risk syntax group. At three months, MACE was reported in 4 patients. Out of these four, one was intra-procedural death, three had repeat myocardial infarction. Out of these three, two declined repeat revascularization and were managed medically. One patient died during admission despite repeat revascularization. Almost all MACE reported, occurred in patients with Syntax>32. Conclusion: Despite high risk Syntax and CathPCI scores, RA led to high immediate procedural success for PCI in calcified lesions at our hospital with infrequent MACE.

Factors Predisposing to Rhegmatogenous Retinal Detachment in a Tertiary Care Hospital of Pakistan

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Sahira Wasim ◽  
Imran Ghayoor ◽  
Munira Shakir ◽  
Ronak Afza ◽  
Waqas Ali
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Tertiary Care ◽  
Ethical Review ◽  
P Value ◽  
Care Hospital ◽  
Individual Factor ◽  
Cross Sectional ◽  
Intraocular Surgery ◽  
Lattice Degeneration

Purpose:  To find out the factors predisposing to rhegmatogenous retinal detachment. Study Design:  Descriptive cross sectional study. Place and Duration of Study:  Liaquat National Hospital, Karachi, from October 2017 to April 2018. Methods:  After approval from ethical review committee 117 patients presenting with Rhegmatogenous retinal detachment (RRD) were included in the study. A detailed history was taken including previous surgery and trauma. Complete ocular examination was performed including dilated fundus examination. Data was analyzed using SPSS version 21. Mean and standard deviation were computed for quantitative variable i.e. age and frequency. Percentages were calculated for qualitative variables i.e. gender, eye involved, lattice degeneration, trauma and intraocular surgery. Stratification was done with regards to age, gender, eye involved to see the effect of these modifiers on individual factor (lattice degeneration, trauma, intraocular surgery) by using chi square test and considering p value ≤ 0.05 as significant. Results:  There were 117 patients including 91 males and 26 females. Sixty four were right eyes and fifty three were left eyes. Mean age was 37.30 ± 8.97 years. Lattice Degeneration was observed in 29.1% patents, Trauma was 37.6% and intraocular surgery was observed in 33.3% patients. There was a significant association of age with trauma (p = 0.045) and intraocular surgery (p = 0.001), which had statistically significant association with RRD. Conclusion:  Intraocular surgery, trauma were significantly associated with age and RRD. However, although lattice degeneration is an established risk factors for Rhegmatogenous retinal detachment it was not associated with increased age. Key Words:  Rhegmatogenous Retinal Detachment, Lattice Degeneration, Trauma, Intraocular Surgery.

scholarly journals Histopathology diagnosis in women who underwent a hysterectomy for a benign condition.

2020 ◽  
Vol 27 (04) ◽  
pp. 721-724
Author(s):  
Night Afridi ◽  
Amna Fareed ◽  
Saira Nazeer ◽  
Saifullah Khan ◽  
Shah Gul Khan
Keyword(s):  
Histopathological Examination ◽  
Tertiary Care ◽  
Study Data ◽  
Histopathological Finding ◽  
Ethical Review ◽  
P Value ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Benign Condition ◽  
Gynecology And Obstetrics

Objectives: To determine frequency of histopathological diagnosis in women who underwent hysterectomy for benign condition in tertiary care hospital. Study Design: Retrospective study. Setting: Department of Gynecology and Obstetrics, CMH Nowshera. Period: 6 months (July 2018 December 2019). Material & Methods: Data of all hysterectomies underwent in last 3 years was reviewed. Ethical approval was taken from ethical review board. Patients undergone hysterectomy with benign condition were included in study. Data was analyzed using SPSS version 24. Chi-square and correlation test was performed. P value ≤0.05 was considered significant. Results: Total 430 cases were included in study. Mean age of women was 37.1 years± 8.2 SD. Most common complaints was irregular bleeding 123(28.6%) following dysmenorrhea 78(18.1%). Most common histopathological finding was adenomyosis 214(49.8%), following leiomyoma 66(15.3%). Histopathological findings were significantly associated parity (p=0.000), type of hysterectomy (p=0.000), marital status (p=0.000) and occupation (p=0.000). Significant correlation between clinical diagnosis and histopathological finding was found (r= 0.7, p=0.00). Conclusion: Hysterectomy is most common surgical modality in gynecology. Adenomyosis is most common histopathological finding in patients undergone hysterectomy for benign condition. All hysterectomy specimens should be subjected to pre-operative and post-operative histopathological examination for accurate diagnosis and management in benign conditions.

scholarly journals ST ELEVATION MYOCARDIAL INFARCTION

2015 ◽  
Vol 22 (05) ◽  
pp. 536-540
Author(s):  
Syed Fasih Ahmed Hashmi ◽  
Mashooq Ali Dasti ◽  
Nisar Ahmed Shah ◽  
Syed Saad Hussain ◽  
Munaza Gohar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Care Hospital ◽  
Female Population ◽  
St Elevation

OBJECTIVE: To evaluate the frequency of hyponatremia and its prognosticimportance in ST elevation myocardial infarction. Period: Six months. Design: Case series.Setting: Tertiary care hospital Hyderabad. Methods: All the cases with ST elevation myocardialinfarction admitted in the CCU were recruited and evaluate for serum sodium level at admissionand then at 24, 48 and 72 hours. The data was analyzed in SPSS 16 and the frequency andpercentage was calculated. Results: One hundred patients with acute myocardial infarctionwere recruited and assessed for sodium level. The mean age ±SD of whole population was57.52±9.51 whereas in male and female population it was 58.72±7.53 and 53.84±7.93respectively. The sodium level was 130.21±3.42 and 127.41±4.21 in male and femalepopulation. The p-value was statistically significant (<0.01) in context to age and sex whereasthe age in context to hyponatremia is non significant (p=0.77). The hyponatremia and itsseverity was statistically significant in context to sex (p=0.04) and duration of the myocardialinfarction (p=0.03). The serum sodium level in context to duration of MI was also significant(p=0.03) whereas the mortality at the end of 30 days was 11% of which 02 patients had normalsodium level while the 09 had low sodium level (hyponatremia). Conclusion: Hyponatremia inpatients with acute STEMI is a important predictor of thirty days mortality.

scholarly journals Percutaneous Coronary Interventions in Elderly Patients: Experience from a Tertiary Care Center from Developing Country

2021 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Elderly Patients ◽  
Heart Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
Young Patients ◽  
Vascular Complications ◽  
P Value ◽  
Percutaneous Coronary

Objective of the study: To assess the outcome of Percutaneous coronary intervention in elderly in terms of success and complications. Methods: Retrospective data review of 887 consecutive cases of percutaneous interventions done at Karachi institute of heart diseases from 2015-2020. We divided the patients in three age groups younger (<65 years, n=592); older (65 to 75 years, n=201); and elderly (>=75 years, n=94). Immediate and six months outcomes of in hospital vascular complications, death, myocardial infarction, repeat target lesion revascularization and stroke were compared between these groups. Result: The vascular complications was in three groups (relative risk 3.2% vs 2.9% vs 4.3% with p=0.56) respectively. The relative risk of periprocedural Myocardial infarction in elderly/older patients was not higher than young patients with (OR of 0.6 with 95% CI 0.3 vs 1.4 with P=0.35), so was the need of repeat target revascularization with (OR of 0.3 95% CI 0.2 vs -1.6 with P=0.85), the risk of stroke following procedure was minimal (OR of 0.7 95% CI 0.4 vs 1.6 P=0.4). The in-hospital mortality was higher in elderly with (OR with 95% CI 1.0 vs 2.0 vs 3.4 P=0.03) in three groups. The six months outcomes of myocardial infarction in elderly were also not higher than younger pts (OR 0.7 vs 0.4 P=0.58). so was the need for repeat target revascularization (OR 0.5 vs 0.3 P=0.6). The six-month mortality in three groups was high in elderly (OR with 95% CI 1.5% vs 3.4% vs 4% with P value of 0.04). Conclusion: The procedure success in elderly patients was similar to younger patients, but in hospital and six months mortality was higher in elderlies.

scholarly journals Knowledge, attitude and practice regarding COVID-19 among doctors and nurses at a tertiary care maternity hospital in Nepal

2020 ◽  
Vol 7 (2) ◽  
pp. 23-31
Author(s):  
Shaheen Naaz Ansari ◽  
Imran Ansari ◽  
Meena Jha ◽  
Rakshya Upreti
Keyword(s):  
Health Care Professionals ◽  
Good Practice ◽  
Tertiary Care ◽  
P Value ◽  
Attitude Score ◽  
Attitude And Practice ◽  
Validated Questionnaire ◽  
Significant Difference ◽  
Knowledge Attitude And Practice ◽  
Doctors And Nurses

Introduction: Knowledge, attitude, and practice (KAP) survey provides a suitable format to evaluate existing programs and to identify effective strategies for behavior change in society. This study aimed to investigate and compare KAP concerning COVID-19 among Health Care Professionals (HCPs) at Paropakar Maternity and Women’s Hospital (PMWH). Method: This was a cross sectional descriptive study conducted in HCPs (doctors and nurses) of PMWH, Nepal, from May to June 2020. A pre-validated questionnaire was used to access the objectives where knowledge and attitude score was 10 each and practice score was 20. Collected data was entered in Microsoft excel spreadsheet and analyzed using IBM SPSS software and p-value < 0.05 was taken as statistically significant. Result: A total of 168 doctors and nurses responded to the survey, of which 112 (66.6%) were in 25-34 years of age group, 87.5% females, and 61.9% nurses. Mean score for knowledge, attitude and practice score was 5.8 (out of 10), 8.1 (out of 10) and 17.4 (out of 20) respectively. The score was significantly different among doctors and nurses in ‘knowledge’ (p=0.000) and ‘attitude’ categories (p = 0.006). There was no significant difference in ‘practice’ scores (p = 0.664). Conclusion: Doctors and nurses of PMWH have positive attitude and good practice towards COVID-19. This characteristic can prove handy in bringing about useful behavioural changes and promoting safe practices while managing maternity patients in this hospital.

scholarly journals Awareness About Ebola Virus Disease Among the Health Care Professionals in Karachi, Pakistan

2018 ◽  
Vol 55 (2) ◽  
pp. 102-107
Author(s):  
Kashif Ali ◽  
Syed Omair Adil ◽  
Subhana Akber ◽  
Shakir Khan ◽  
Nand Lal ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Ebola Virus ◽  
Virus Disease ◽  
Tertiary Care ◽  
Ebola Virus Disease ◽  
P Value ◽  
Care Hospital ◽  
Awareness Campaigns ◽  
Study Participants

Background: Ebola virus disease is an acute and life-threatening illness, which, if untreated, is fatal. It was first discovered in 1976, which aware the world with sporadic outbreaks of Ebola in some parts of Africa. According to Centers for Disease Control and Prevention (CDC), the natural reservoir for Ebola virus remains unknown; however, it is yet to be affirmed that the natural habitat is animal-borne where bats are most likely to carry over this virus. Therefore, the aim of this study was to estimate awareness of health care professionals as they serve as the integral part of our health care system. Methods: A cross-sectional survey was conducted among 149 health care workers (HCWs) in Civil Hospital of Karachi from June 2015 to August 2015. The study participants were randomly selected individuals who were students of and/or were working in the university’s affiliated tertiary care hospital in Karachi, Pakistan. Results: Baseline characteristics of the study participants are shown in Table 1. Median age of the participants is 21 (range: 17-24) years. Female preponderance was found to be higher (104; 69.8%) as compared with the males (45; 30.2%). Discipline of majority of the study participants was medical technology (80; 53.7%), followed by nurses (38; 25.5%) and doctors (31; 20.8%). Majority of the study respondents were undergraduate medical students (60; 75%) as compared with medical technologist and the nurses (17; 24.6%) with a P value < .001 as shown in Figure 1. The mean for correct responses was 8.43 ± 4.08 (range: 3-17). Appropriate knowledge was observed in 84 (56.4%) responders and inappropriate knowledge was observed in 65 (43.6%) of the study respondents. Conclusion: Our study concludes that there is an unsatisfactory knowledge about Ebola virus disease among health care professionals. Moreover, public health authorities should signify the importance of prevention against Ebola virus disease not only among the health care professionals but also into the communities through mass media and awareness campaigns which can thus halt the panic and incidence of Ebola virus outbreaks in coming decades.

scholarly journals Are there gender differences in acute management and secondary prevention of acute coronary syndromes in Barbados? A cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025977 ◽  
Author(s):  
Natasha Sobers ◽  
Angela M C Rose ◽  
T Alafia Samuels ◽  
Julia Critchley ◽  
Melissa Abed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Gender Differences ◽  
Acute Coronary Syndromes ◽  
Tertiary Care ◽  
Case Fatality ◽  
Acute Management ◽  
Chronic Angina ◽  
Prescription Rates ◽  
Coronary Syndromes ◽  
To Receive

ObjectivesIn Barbados, high case fatality rates have been reported after myocardial infarction (MI) with higher rates in women than men. To explore this inequality, we examined documented pharmacological interventions for ST-segment elevated myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable and chronic angina in women and men.DesignProspective cohort registry data for STEMI and NSTEMI and retrospective chart review for unstable and chronic angina.SettingTertiary care (acute coronary syndromes) and primary care (chronic angina) centres in Barbados.ParticipantsFor the years 2009–2016, a total of 1018 patients with STEMI or NSTEMI were identified via the prospective study. For unstable and chronic angina, 136 and 272 notes were reviewed respectively for the years 2010–2014.Outcome measuresThe proportions of patients prescribed recommended medication during the first 24 hours after an acute event, at discharge and for chronic care were calculated. Prescribed proportions were analysed by gender after adjustment for age.ResultsBetween 2009 and 2016, for the acute management of patients with NSTEMI and STEMI, only two (aspirin and clopidogrel) of six drugs had documented prescription rates of 80% or more. Patients with STEMI (n=552) had higher prescription rates than NSTEMI (n=466), with gender differences being more pronounced in the former. Among patients with STEMI, after adjustment for age, diabetes, hypertension and smoking, men were more likely to receive fibrinolytics acutely, OR 2.28 (95% CI 1.24 to 4.21). Compared with men, a higher proportion of women were discharged on all recommended treatments; this was only statistically significant for beta-blockers: age-adjusted OR 1.87 (95% CI 1.16 to 3.00). There were no statistically significant differences in documented prescription of drugs for chronic angina.ConclusionFollowing acute MI in Barbados, the proportion of patients with documented recommended treatment is relatively low. Although women were less likely to receive appropriate acute care than men, by discharge gender differences were reversed.

scholarly journals Study on Psycho-social Problems among COVID-19 Patients in Tirunelveli District, Tamil Nadu, India

2021 ◽  
Vol 53 (03) ◽  
pp. 173-180
Author(s):  
Praveena Daya A ◽  
Keyword(s):  
Health Care Professionals ◽  
Tamil Nadu ◽  
Social Problems ◽  
Social Issues ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Mental Illnesses ◽  
Categorical Variables ◽  
P Value ◽  
Care Institute

Background: COVID-19 crisis leads to significant changes in routine life, loss of employment, financial crisis, living in isolation, and death of loved ones etc. that can create worry and stress among the people infected with COVID-19. The aim of the study is to estimate the burden of psycho-social problems among COVID-19 patients admitted in a tertiary care institute. A hospital-based cross-sectional study carried out among stable 450 RT-PCR confirmed COVID-19 patients admitted in the COVID ward of Tertiary Care Institute, Tirunelveli, Tamil Nadu, India between August and September 2020. Materials and Methods: Participants with self-reported pre-existing mental illnesses were excluded. Psycho-social issues of the participants were studied through telephonic conversation using a predesigned questionnaire including DASS 21 scale. Chi-square test was used to test the association between categorical variables. Variables significant in univariate analysis were included for multivariate analysis. P-value < 0.05 was considered to be statistically significant. Results: Based on DASS21 Scoring, 89 (20%) had depression, 190 (42%) were anxious and 53 (12%) were under stress. Patients aged more than 60 years, literate, with risk factors like diabetes mellitus and hypertension were more likely to have one or more psychological conditions. Conclusion: There is an increased prevalence of psychological morbidities among COVID-19 patients. It warrants the need for a combined action from health care professionals in the early identification of these psychological issues to prevent long term mental health issues among survivors.

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