Influence of Smoking on The Location of Acute Myocardial Infarctions

Objective: To determine the frequency of smokers and to compare the frequency of smokers among patients with inferior and anterior acute myocardial infarction amongst patients presenting with acute myocardial infarction at a Tertiary Care Hospital. Subjects And Methods: This cross-sectional study was conducted on 226 at the Adult Cardiology Department of the National Institute of Cardiovascular Disease (NICVD), Karachi for six months from 20-07-2019 till 20-01-2020. After obtaining verbal consent, researchers prospectively collected data from the participants. The study included 226 patients who were diagnosed with the appropriate conditions. Frequency and percentages were used to present qualitative data, while mean and standard deviation were used to present quantitative data. To see how to effect modifiers affected the outcome, researchers used stratification to keep track of them. For statistical significance, the post-stratification chi-square test was used. Results: A total of 226 presenting with acute myocardial infarction were included in this study. The mean age in our study was 55.92±10.49 years. Out of 226 patients with acute myocardial infarction, 130 (57.5%) and 96 (42.5) smoked and did not smoke respectively. Comparison of smoking status in patients who had anterior and inferior myocardial infarction showed that 39 (53.4%) and 51 (51%) smoked respectively. Conclusion: Smoking is a well-recognized strong modifiable risk factor and predictor of multivessel disease. Smoking cessation has been consistently associated with a mortality benefit in both stable coronary artery disease and post-acute coronary syndromes. Consequently, smoking cessation is one of the cornerstones of secondary prevention despite the improvement in the management of ACS with PCI and pharmacotherapy Keywords: Smoking, coronary vessels, territory and ST elevated myocardial infarction.

Download Full-text

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.5.2104 ◽

2020 ◽

Vol 36 (5) ◽

Author(s):

Faryal Akbar Jalbani ◽

Shiraz Shaikh ◽

Subhani Fatima

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Public Sector ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Positive Association ◽

Cross Sectional Study ◽

Care Hospital ◽

Significant Positive Association ◽

Cross Sectional

Objective: To determine the time from onset of symptoms to start of fibrinolysis and treatment in acute ST elevated myocardial infarction patients and identify the factors which cause delay in treatment. Methods: A cross sectional study was conducted at National Institute of Cardiovascular Diseases, Karachi on 360 conveniently selected patients of ST elevated myocardial infarction from July to September in the year 2017. Structured questionnaire was used to obtain detailed information on socio-demographics, factors which cause delay and timing of onset of symptoms to arrival of patient in emergency ward. Results: Overall, the total average time from the start of symptoms to initiation of treatment was 119.85±63.32 minutes. Only 5.1% patient reached within one hour while 57.7% reached within two hours. Old age group of 60 and above was positively associated with timely arrival (OR=2.75, 95% CI 1.33-5.68, p=0.006). Significant positive association of using personal car as mode of transport to reach the hospital (OR=5.25, 95% CI 2.94-9.35, p<0.001) was also found as compared to using ambulance. Distance from facility was suggestive of negative association in the model but was statistically insignificant. Conclusion: According to the findings of this study, more than one third of patients reached the hospital within two hours of initiation of symptoms while only 5.1% reached within one hour. The delay was mostly pre-hospital attributed to arranging transport, stay at first medical contact and time taken from first medical contact to the hospital. doi: https://doi.org/10.12669/pjms.36.5.2104 How to cite this:Jalbani FA, Shaikh S, Fatima S. Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2104 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

MRI Spectrum of Japanese Encephalitis in Northeast India: A Cross-Sectional Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1722820 ◽

2021 ◽

Vol 12 (02) ◽

pp. 281-289

Author(s):

Pranjal Phukan ◽

Kalyan Sarma ◽

Barun Kumar Sharma ◽

Deb K. Boruah ◽

Bidyut Bikash Gogoi ◽

...

Keyword(s):

Japanese Encephalitis ◽

Statistical Significance ◽

Tertiary Care ◽

Care Hospital ◽

Mri Findings ◽

Mri Scan ◽

Cross Sectional ◽

Adc Value ◽

Group 2 ◽

Group 1

Abstract Objective Japanese encephalitis (JE) is an arthropod-borne flavivirus infection having high mortality and morbidity. This study was performed to evaluate the conventional magnetic resonance imaging (MRI) findings in JE and to find out any difference between pediatric and adult JE. Materials and Methods This retrospective study was performed on serologically positive 54 JE patients presented to a tertiary care hospital with acute encephalitic symptoms between April 2016 and October 2019. Relevant neurological examination, cerebrospinal fluid analysis, and MRI scan of the brain were performed. Results Fifty-four JE patients (n = 31 males and n = 23 females) having 32 pediatric and 22 adult JE were included in the study sample. Group 1 JE (n = 16) patients had encephalitic symptoms with duration less than 15 days up to the day of MRI scan and group 2 JE (n = 38) had symptoms more than 15 days. Group 1 JE had mean apparent diffusion coefficient (ADC) value of 0.563 ± 0.109 (standard deviation [SD]) × 10–3 mm2/sec and group 2 JE had 1.095 ± 0.206 (SD) × 10–3 mm2/sec. The mean ADC value of pediatric JE was 0.907 ± 0.336 (SD) × 10–3 mm2/sec and adult JE was 0.982 ± 0.253 (SD) × 10–3 mm2/sec. Conclusion The majority of the JE patient shows abnormal signal alterations in bilateral thalami and substantia nigra. Diffusion-weighted imaging with ADC mapping helps in evaluating the stage of the JE. No statistical significance of the various conventional MRI findings was found between the pediatric JE and adult JE.

Download Full-text

Knowledge in palliative care of nursing professionals at a Spanish hospital

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1610.2847 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 8

Author(s):

Elena Chover-Sierra ◽

Antonio Martínez-Sabater ◽

Yolanda Lapeña-Moñux

Keyword(s):

Palliative Care ◽

Basic Education ◽

Statistical Significance ◽

Descriptive Analysis ◽

Tertiary Care ◽

Educational Background ◽

Cross Sectional Study ◽

Study Data ◽

Care Hospital ◽

Cross Sectional

Resume Objective: to determine the level of knowledge in palliative care of nursing staff at a Spanish tertiary care hospital. Method: descriptive, cross-sectional study. Data were collected about the results of the Spanish version of the Palliative Care Quiz for Nurses (PCQN), sociodemographic aspects, education level and experience in the field of palliative care. Univariate and bivariate descriptive analysis was applied. Statistical significance was set at p < 0.05 in all cases. Results: 159 professionals participated (mean age 39.51 years ± 10.25, with 13.96 years ± 10.79 of professional experience) 54.7% possessed experience in palliative care and 64.2% educational background (mainly basic education). The mean percentage of hits on the quiz was 54%, with statistically significant differences in function of the participants’ education and experience in palliative care. Conclusions: although the participants show sufficient knowledge on palliative care, they would benefit from a specific training program, in function of the mistaken concepts identified through the quiz, which showed to be a useful tool to diagnose professionals’ educational needs in palliative care.

Download Full-text

Gender-Related Differences of Cardiac Troponin-I Levels in Patients with Acute Myocardial Infarction at Time of Acute Chest Pain

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i52a33576 ◽

2021 ◽

pp. 199-205

Author(s):

Mahir Abdulkadhum Khudhair Alzughaibi ◽

Ammar Waheeb Obeiad ◽

Nassar Abdalaema Abdalhadi Mera ◽

Mohammed Sadeq Hamzah Al-Ruwaiee

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Troponin I ◽

Statistical Significance ◽

Acute Chest Pain ◽

Blood Analysis ◽

P Value ◽

Cross Sectional ◽

Time Of Admission

Background: Cardiac Troponins-I (CTNI) are myoregulatory polypeptides that control the actin-myosin interface, considered specific to cardiomyocytes. Age and sex variances in the extent of CTNI levels have arisen a recent debatable emphasis. Existing revisions do not display a reliable clinical power of sex-specific CTNI 99th centiles, which actually might mirror procedural aspects. Nevertheless, from a biochemical viewpoint, the trends of sex-specific CTNI 99th centiles seem sensible for the ruling-in of acute myocardial infarction AMI. Vulnerable females may be missed when applying the male sex-specific threshold. This study aimed to determine whether gender differences in CTNI exist in patients with AMI presented with chest pain. Methodology: The study was a cross-sectional, single-center, included 236-patients with AMI diagnosis by cardiologists at Merjan teaching hospital during the period from April to July 2020 from patients attending the hospital for cardiac consultation complaining of acute chest pain suggestive of AMI. Blood analysis had initiated at the time of admission included serum creatinine, blood urea, R/FBS, WBCs, PCV, and serum CTNI. A p-value below 0.05 specifies statistical significance. All statistical bioanalyses had performed by IBM-SPSS, version-25 for Windows. Results: The mean age of participants was 67.5 years, the men were dominant 76.2%. The incidence of DM and hypertension were significantly high and 24.5% of the patients were current smokers. Biochemical serum analysis revealed mean creatinine, urea, sugar, and STI values were 79.8±4.2 mmol/l, 15.9±1.7 mmol/l, 10.9±0.9 mmol/l, and 7.9±0.6 ng/ml separately. Both hypertension and smoking were significantly (p-0.001) more among males compared to the females, which is not the case for the prevalence of DM. The males were heavier significantly than females (p-0.001). Almost, there was no impact of gender on most of the other study variables other than serum TNI levels, which were significantly higher among the males (p-0.001). Conclusion: In patients with AMI presented with acute chest pain, the routine of CTNI in the diagnosis of AMI is based on the patient's gender. The application of gender-dependent cutoff levels for CTNI analyses appears to be highly suggested.

Download Full-text

ACUTE MYOCARDIAL INFARCTION;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.700 ◽

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.

Download Full-text

Cross-sectional Study on MyocardialInfarction in Young Adults in an EmergencyDepartment of a Rural Tertiary Care Hospital, Davanagere,Karnataka, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49377.14903 ◽

2021 ◽

Author(s):

CH Karthik Reddy ◽

Mahesh Krishnamurthy ◽

Ashray Vasanthapuram ◽

Girish Narayan ◽

SS Narendra

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Young Adults ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Vessel Disease

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young has been increasing globally. Research in this population has been limited in developed countries or urban areas in developing countries. Identifying the various epidemiologic features in this age group is crucial to understand the disease. Aim: To describe the clinical characteristics of young adults presenting with ACS in a rural tertiary care hospital. Materials and Methods: This cross-sectional study included 50 patients diagnosed with ACS. Data were collected from consecutive patients between the ages of 18 to 45 years diagnosed with ACS between January 2014 to January 2015 in the Emergency Medicine Department of a tertiary care hospital in Davanagere, India. Data were collected on demographic characteristics, risk factors, laboratory tests, and angiographic findings. Range, mean and percentages were calculated for continuous and categorical variables, respectively. A 95% confidence intervals were calculated for all variables. Results: The mean age was 38.1±5.8 years with male preponderance 46 (92%). Risk factors were smoking 36 (72%), diabetes 17 (34%), hypertension 6 (12%) and Body Mass Index (BMI) >23 kg/m2, 36 (72%). Anterior Wall Myocardial Infarction (AWMI) was observed in 35 (70%) of subjects with angiography revealing Single Vessel Disease (SVD) 28 (56%), Double Vessel Disease (DVD) 5 (10%), Triple Vessel Disease (TVD) 3 (6%) and Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) 11 (22%). Three patients died during their course of treatment before initiating an interventional procedure. Conclusion: Smoking, diabetes mellitus and elevated BMI are associated with ACS among young patients. Interventions targeting these risk factors among younger individuals should be developed.

Download Full-text

An evaluation of knowledge, attitude and practice of pharmacovigilance among medical students and doctors at a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180107 ◽

2018 ◽

Vol 7 (2) ◽

pp. 324 ◽

Cited By ~ 1

Author(s):

Ravindra S. Beedimani ◽

Sameer Uz Zaman ◽

Subrahmanyam Darb ◽

Sharat Chandra Potturi

Keyword(s):

Medical Students ◽

Statistical Significance ◽

Tertiary Care ◽

Care Hospital ◽

Medical Doctors ◽

Cross Sectional ◽

Attitude And Practice ◽

Validated Questionnaire ◽

Correct Definition ◽

Knowledge Attitude And Practice

Background: Drugs are one of the most commonly used interventions in medical therapeutics. Spontaneous reporting of adverse drug reactions (ADRs) is the backbone of pharmacovigilance (PV) program. Under-reporting of ADRs by prescribers was possibly due to lack of knowledge, attitude and practices regarding PV. This study was done to assess the knowledge, attitude, and practice (KAP) of medical students (grouped to sixth and eighth semester) and medical doctors about PV in a tertiary care hospital.Methods: It was a questionnaire based cross-sectional study administered to 246 medical students and doctors. Study tool was a validated questionnaire containing 15 questions to evaluate KAP of PV among medical students and doctors. A descriptive analysis of data was done where necessary, statistical significance for associations between the group and their responses to questionnaire was provided using Pearson Chi square test and Fisher exact test.Results: Sixty-eight percent of the participants (90% doctors; 76% eighth-semester and 46% sixth-semester medical students) know the correct definition of PV. Sixty-one percent of the participants (67% sixth-semester, 61% doctors and 53% eighth-semester) think that reporting is a professional obligation for them. Only 15% of the participants have ever been taught or trained on how to report an ADR.Conclusions: Medical doctors and students lack adequate knowledge and practice of reporting ADRs, but they seem to have a positive attitude towards the PV program. Our study findings strongly suggest that there is a great need to create awareness amongst them to promote reporting of ADRs.

Download Full-text

Clinical presentation, risk factors, complications and outcome of acute myocardial infarction in elderly patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174669 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4765 ◽

Cited By ~ 2

Author(s):

Sandhya S. ◽

Mohanraj P.

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Elderly Patients ◽

Epigastric Pain ◽

Tertiary Care ◽

Care Hospital ◽

Wide Range ◽

Atypical Presentations

Background: Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. This article enlightens the clinical features, risk factors, complications, prognosis and outcome of Acute myocardial infarction in elderly patients. The objective of this study was to assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with Acute myocardial Infarction (AMI). Methods: This is a prospective study done over a period of two years in a tertiary care hospital in South India. 80 elderly patients who were diagnosed as AMI were included in the study.Results: Among the eighty patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%.Conclusions: This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like shortness of breath, giddiness, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly though they may not present typically.

Download Full-text

Resurgence of leprosy in post elimination era

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194182 ◽

2019 ◽

Vol 5 (4) ◽

pp. 743

Author(s):

Swapna Subhash Khatu ◽

Nachiket Madhukarrao Palaskar ◽

Garima Laxminarayan Balpande ◽

Nitin Dinkar Chaudhari

Keyword(s):

Statistical Significance ◽

Tertiary Care ◽

National Level ◽

Public Health Problem ◽

Cross Sectional Study ◽

Care Hospital ◽

Duration Of Treatment ◽

Cross Sectional ◽

Leprosy Case ◽

Leprosy Patients

Background: Leprosy is a slowly progressive mildly infectious disease caused by Mycobacterium leprae primarily affecting skin and peripheral nerves. After introduction of multidrug therapy in the country recorded leprosy case load has come down. In December 2005, India announced elimination of leprosy as public health problem at national level under the NLEP but new cases are still being registered.Methods: It was a hospital based cross sectional study conducted on over 109 leprosy patients attending a tertiary care hospital in Narhe, Pune during the period from 1st January 2018 to 31st December 2018. The statistical package for Social Sciences (SPSS) for Windows version (16.0) was used to analyze the data (SPSS Inc., Chicago, IL). Statistical significance was declared at p<0.05 or mentioned otherwise.Results: Out of 109 patients, 57 were new and 52 were old. Maximum patients belong to age group 40-49 years, 25 patients had type 1 reaction and 18 had type 2 reaction. Out of which 83 were on treatment and 12 are defaulter, 9 were in relapse, 6 patients released from treatment.Conclusions: In post elimination era of leprosy still new cases have been registered and hence the burden and morbidity of the disease is still high in the community. It strongly suggests that by early detection, increasing the duration of treatment and by increasing the community awareness, utilizing information, education and communication at all levels, we can hope to reduce the burden of disease in the community and to achieve the dream of leprosy free India.

Download Full-text