Association of Total Ischemic Times and In-Hospital Outcomes of Acute STEMI Patients who Underwent Primary Angioplasty at a Tertiary Cardiac Care Facility

Aims: To determine the association between total ischemic time and in-hospital outcome of acute ST elevation myocardial infarction (STEMI) patients who underwent primary angioplasty. Study Design: Prospective observational study. Place & Duration of Study: Department of Cardiology, Dow university of health sciences Karachi between October 2017 till March 2021. Methodology: Data for total ischemic time analysis were collected from 366 STEMI patients who consecutively underwent primary angioplasty. Total ischemic time was measured from the onset of chest pain to o the first balloon inflation during primary angioplasty and in hospital outcome was measured. Results: Total ischemic times were available in 366 STEMI patients which was ≥ 30 minutes and < 24 hours: ≤ 2 hours in 15.5%, >2-3 hours in 11.4%, >3-5 hours in 25.4%, and >5 hours in 47.5% of STEMI patients. In addition, STEMI patients with total ischemic times <5 hours demonstrated complete ST-segment resolution and reduced death rate than those with total ischemic times >5 hours. Conclusion: This study showed that shorter ischemic times are significantly related to improved myocardial reperfusion and decreased mortality.

In-hospital mortality due to breakthrough COVID-19 among recipients of COVISHIELD (ChAdOx nCoV-19) and COVAXIN (BBV152)

BackgroundMultiple vaccines have received emergency-use authorization in different countries in the fight against the COVID-19 pandemic. India had started its vaccination campaign using the COVISHIELD (ChAdOx nCoV-19) and the COVAXIN (BBV152) vaccines. However, there is a lack of head-to-head comparisons of the different vaccines.MethodsWe performed a retrospective cohort study during the second wave of the pandemic in India with predominant circulation of the delta strain of SARS-CoV-2. We enrolled adult patients who were hospitalized with breakthrough COVID-19 infection after vaccination. We compared in-hospital outcomes between patients who had received the COVISHIELD (n=181) or COVAXIN vaccines.ResultsBetween April and June 2021, a total of 353 patients were enrolled, among whom 181 (51.3%) received COVAXIN (156 partially vaccinated and 25 fully vaccinated) and 172 (48.7%) received COVISHIELD (155 partially vaccinated and 17 fully vaccinated). The in-hospital mortality did not differ between the recipients of COVISHIELD or COVAXIN in either the fully vaccinated [2 deaths (11.8%) vs 0 deaths (0%), respectively p=0.08] or the partially vaccinated cohorts [31 deaths (20%) vs 28 deaths (17.9%), respectively, p=0.65].ConclusionsPatients who are hospitalized with breakthrough COVID-19 had similar in-hospital outcome irrespective of whether they received COVISHIELD or COVAXIN.

Common Comorbidities Among Stroke Patient and Their Outcome in a Tertiary Care Hospital, Bangladesh

Background: Stroke is worldwide second leading cause of death and the most common cause of disability. The aim of the study is to evaluate the common comorbidities and their impact on hospital outcome in patients after stroke Methods: This observational study was carried out amongst 228 of acute stroke patients after fulfills the inclusion and exclusion criteria and were admitted indifferent medicine unit of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from May 2020 to April 2021. All cases were confirmed by CT scan or MRI of brain. Stroke were categorizes as Ischemic stroke, Intra-cerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH). HTN, DM, IHD were considered as common comorbidities. Prognostic factors were included stage II or III hypertension, altered level of consciousness, previous stroke and large size of stroke. Results: In this study, male affected more than female (68.42% vs 31.58% and ratio 2.1:1). Age >60 years were more affected (68.86%). Most affected patients were Ischemic stroke (61.40%), then ICH (34.21%) and then SAH (3.07%). Common comorbidities were HTN and DM (48.68% and 34.64% respectively). Most of expired patients had comorbidities (80.64%). Worst prognostic factors were altered level of consciousness, stage II or III hypertension and large size of stroke (27.19%, 25.0% and 19.29% respectively). Among hospital outcome most of patients improved and discharged eventfully (41.22%), Deteriorate (17.98%), remain static and discharged (14.03%) and death 13.59%. Conclusion: The most of patients had been suffered from ischemic stroke which were more common in male. The commonest risk factor of stroke was hypertension followed by diabetes mellitus and ischemic heart disease. Our pooled result showed that majority of the patients were improved and discharged and around one sixth of stroke patients have died during hospitalization. The control of comorbid conditions will be much help for prevention of occurrence of stroke and will reduces the disability from stroke events. Bangladesh J Medicine July 2022; 33(1) : 8-11

Hyperuricaemia as a predictor of hospital outcome in patients with sepsis: results of a prospective study

Background Early management of sepsis in the emergency department improves patient outcomes. The identification of at-risk patients for aggressive management by an easily available biomarker could go a long way in the triage of patients in the emergency department. It is postulated that during sepsis, the majority of patients undergo ischaemic reperfusion injury or inflammation, and uric acid with its oxidant and antioxidant properties may be playing some role and, hence, the measurement of uric acid could possibly predict the hospital course in patients with sepsis. We were prompted to undertake this study as serum uric acid estimation is readily available and economical compared to newly evolving biomarkers in sepsis. Estimation of serum uric acid levels on arrival to the emergency department may prove a useful predictor of hospital outcome in patients with sepsis especially in regions with limited resources. Results Of 102 patients, 55 (53.9%) were males. The mean age of the study cohort was 63.2 ± 10.48. Patients with higher qSOFA scores had higher uric acid levels on admission. While 12 (11.8%) patients had a septicaemic shock, acute kidney injury was recorded in 48 (47.1%) patients and 11 (10.8%) patients required dialysis. Thirty-four (33.3%) patients had respiratory failure, and of these, 21 (20.6%) patients required mechanical ventilation. The overall median stay in the medical intensive care (MICU) was 3days (range 2–7 days). The patients with higher uric acid levels had higher rates of respiratory failure but did not reach significant levels. In 15 (14.7%) patients, 7 males expired (mortality rate of 14.7%). There was a significant association between SOFA score and mortality. Patients who succumbed to sepsis had higher serum uric acid levels on arrival. Conclusions Patients with higher qSOFA scores had higher uric acid levels on admission. Hyperuricaemia predicted acute kidney injury, a requirement of mechanical ventilation and mean hospital stay in patients with sepsis. Further studies may be required to confirm the association.