Association between Free Tri-iodothyronine Level and In-Hospital Outcome in Patients with Acute ST-Elevation Myocardial Infarction Treated with Streptokinase Therapy.

Low free Tri-iodothyronine (FT₃) levels are generally associated with poor prognosis in patients with various critical illnesses. Acute ST-segment Elevation Myocardial Infarction (STEMI) represents the most lethal form of Acute Coronary Syndrome (ACS) with substantial short- and long-term mortality. This study was done to assess the association between FT₃ levels and in-hospital outcome of the STEMI patients treated with streptokinase therapy.

Early Postoperative Outcome of Continuous Heparin Infusion versus Intermittent Intravenous Heparin after Initial Bolus Dose during Off-Pump Coronary Artery Bypass Surgery: An Eminent Time worthy Study.

Heparin is an anticoagulant used invariably in all cardiac surgery. Heparin dosing and its reversal were determined by monitoring activated clotting time (ACT). Intermittent heparin dosing after initial bolus dose is widely practiced to maintain ACT level 200-300 seconds in Off-pump coronary artery bypass surgery (OPCAB).

Diagnostic Accuracy of High-Resolution Computed Tomography (HRCT) in Detecting Pneumocystis carinii in Renal Transplant Patients With Pulmonary Infection: A Study Using Bronchoalveolar Lavage As the Gold Standard.

Introduction: Patients receiving renal transplants have weakened immune systems and are more vulnerable to lung infections.

Objectives: To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) in detecting pneumocystis carinii in renal transplant patients presenting with pulmonary infection in a tertiary care transplant center, keeping bronchoalveolar lavage (BAL) as the gold standard.

Methods:  This cross-sectional study was conducted at the Department of Radiology, Sindh Institute of Urology and Transplant, Karachi, from February 14, 2023, to August 13, 2023.

Contribution of continuous intravenous lidocaine in managing congenital long QT syndrome with 2:1 atrioventricular block.

Congenital long QT syndrome (LQTS) is a rare hereditary cardiac disorder characterized by prolongation of the QT interval on electrocardiogram (ECG), predisposing affected individuals to life-threatening arrhythmias. We present a case of a newborn with congenital LQTS and 2:1 atrioventricular (AV) block who presented with bradycardia and QT prolongation. Continuous intravenous lidocaine infusion was initiated, because of hypoglycemia with beta-blockers, resulting in stabilization of AV conduction and prevention of malignant arrhythmias.

Pharmacist-led interventions for vascular surgery patients: a prospective study on reducing drug-related problems.

Background: Vascular surgery patients are at a high risk of polypharmacy and drug-related problems. Only a limited number of studies have explored the impact of hospital pharmacists being members of a multidisciplinary team in the care of vascular surgery patients. The clinical study (Trial Registration Number NCT04930302, 16 June 2021) aimed to assess the impact of pharmacist-led interventions on the prevalence of drug-related problems among patients hospitalised at the vascular surgery department.

Pneumoperitoneum after placement of the temporary pacing wires: transverse colon injury at the base of a diverticulum.

We present the successful management of a patient presenting with pneumo-peritoneum early after surgery due to transvere colon injury after placement of the temporary pacing wires. The patient was asymptomatic, underwent computed tomography, the temporary pacing wires were removed and he was managed conservatively.

Upgrading Right Ventricular Pacing to Cardiac Resynchronization in HFrEF Patients Improves Symptoms and Functional Outcomes.

Background: In the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the authors have demonstrated improved mortality and morbidity after cardiac resynchronization therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction (HFrEF) with high right ventricular (RV) pacing burden.

Objectives: This substudy sought to examine the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.

Methods: In the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145).

ADMISSION FRAILTY SCORE AS A GOOD CLINICAL SUBSTITUTE OF SOFA SCORE TO PROGNOSTICATE POST-PERCUTANEOUS CORONARY INTERVENTION PATIENTS ON ADVANCED LIFE-SUPPORT.

Background: This study aimed to assess and compare the prognostic value of frailty score (FS), Sequential Organ Failure Assessment (SOFA) score, and additive of FS and SOFA score, at the time of admission to the coronary care unit (CCU), for the prediction of short-term poor prognosis in post-myocardial infarction (MI) patients, requiring advanced life-support.

Methods: A cohort of post-MI patients admitted to CCU. The FS and SOFA score were obtained at the time of CCU admission.

Assessing Mortality Disparities Among Non-Alcoholic Fatty Liver Disease Metabolic Dysfunction Fatty Liver Disease and Metabolic Dysfunction-Associated Liver Disease: A Comprehensive Meta-Analysis.

Non-alcoholic fatty liver disease (NAFLD) has emerged as a major global health concern due to its association with increased mortality. While previous studies have indicated a link between NAFLD and mortality, variations in risk factors such as age, sex, and disease severity warrant a comprehensive meta-analysis to clarify these associations. This meta-analysis aimed to evaluate the overall cardiovascular disease (CVD) mortality risk associated with NAFLD, considering various subgroups defined by age, sex, disease severity, presence of cirrhosis or fibrosis, study quality, and follow-up duration.

Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors.

Objective: The aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large tertiary care cardiac centre in Pakistan.

Design: Observational study.

Setting: Tertiary care cardiac hospital in Karachi, Pakistan.

Magnesium Matters: A Comprehensive Review of Its Vital Role in Health and Diseases.

Magnesium (Mg), an essential mineral abundantly present within the human body, is intricately involved in a multitude of biochemical processes vital for maintaining health and overall well-being. This review aims to delve into the multifaceted impact of Mg on human health, exploring its physiological functions, dietary sources, and potential health implications of deficiency or insufficiency. Mg plays a pivotal role in various physiological processes, including energy metabolism, muscle contraction, protein synthesis, and DNA synthesis.

Challenges in the Concurrent Management of Severe Mitral Stenosis With LAA Thrombus and Symptomatic Adenomyosis.

A 49-year-old woman with untreated severe mitral stenosis faced complex management challenges in a resource-limited setting. Initially presenting with abnormal uterine bleeding, her cardiac condition was discovered during a preoperative work-up for a planned hysterectomy. This case emphasizes the necessity for tailored and transdisciplinary management approaches.

Large Right Atrial Thrombus Alongside Left Atrial Thrombus in a Rheumatic Severe Mitral Stenosis Patient.

We present finding of right atrial thrombus concomitant with recurrent left atrial thrombus in a patient diagnosed with rheumatic severe mitral stenosis. Its significance lies in the potential complications associated with right atrial thrombus, including spontaneous or iatrogenic pulmonary embolism or paradoxical systemic embolization, underscoring the importance of thorough imaging.

Successful Percutaneous Mitral Balloon Commissurotomy in a Pregnant Patient With Symptomatic Severe Rheumatic Mitral Stenosis.

This paper presents a case of a pregnant woman diagnosed with severe rheumatic mitral stenosis and pulmonary hypertension at 22 weeks. Using multimodality imaging and a multidisciplinary approach, prompt percutaneous mitral balloon commissurotomy resulted in symptom relief and a pulmonary artery pressure reduction of more than 50%.

Multidisciplinary Innovations in Managing Complex Rheumatic Valve Disease in Low- and Middle-Income Countries: Insights From the NICVD Heart Valve Registry in Pakistan.

The National Institute of Cardiovascular Diseases Heart Valve Registry prospectively enrolled 1218 consecutive patients referred for surgery for valvular heart disease. A multidisciplinary management approach was used changing the plan from surgical to catheter based or medical in a significant number of patients. Rheumatic heart disease was the most common type of valve disease.

Using point-of-care ultrasound to determine incidence of deep vein thrombosis after right-sided radiofrequency catheter ablation.

Introduction: Femoral venous access is routinely used for radiofrequency catheter ablation (RFA) procedures. Deep vein thrombosis (DVT), which is often sub-clinical, is uncommon following RFCA. Point-of-care ultrasound (POCUS) is a cost-effective way to diagnose DVT.

Health related quality of life and associated factors among patients treated for ischaemic heart disease in two public sector hospitals of Karachi, Pakistan.

Objectives: To determine the level of health-related quality of life among patients treated for ischaemic heart disease in two public-sector tertiary care settings.

Methods: The analytical cross-sectional study was conducted from July to September 2021 at two tertiary care hospitals in Karachi after approval from the ethics review boards of the National Institute of Cardiovascular Diseases and the Dow University of Health Sciences, and comprised patients of either gender treated for ischaemic heart disease after being diagnosed within the preceding year who were coming for follow-up in the outpatient department. Data was collected using the short version of the World Health Organisation quality of life tool.

Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course.

Background: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).

Methods: The study included consecutive STE-ACS patients undergoing pPCI.

Left Ventricular Intramyocardial Dissecting Hematoma With Late Ventricular Tachycardia Storm.

This case describes an uncommon discovery of a left ventricular intramyocardial dissecting hematoma in a patient experiencing a ventricular tachycardia storm. Imaging modalities, including 2-dimensional and 3-dimensional echocardiography and cardiac magnetic resonance, assisted in diagnosing the intramyocardial dissecting hematoma. The patient underwent conservative treatment and received a single-chamber implantable cardioverter defibrillator.

The Cost-Effectiveness of Early Invasive Procedures for Acute Coronary Syndrome in Low-Income Regions: A Prospective Cohort Study in Pakistan.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited.