Rescue angioplasty after thrombolysis.
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Biomedical subjects
Publications and source records attributed to Shahid Aziz.
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OBJECTIVE: To investigate the effect of HCV infection on hepatic fibrosis in patients of thalassaemia major with iron overload in order to modify Pesaro criteria for classification into prognostic groups for allogenic haemopoietic stem cell transplant in these patients. DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Armed Forces Bone Marrow Transplant Center and Departments of Pediatrics of Military Hospital and Combined Military Hospital, Rawalpindi, from July 2003 to June 2004. SUBJECTS AND METHODS: Twenty-eight HCV- and 18 HCV+ patients of thalassaemia major, who were prospective recipients of allogeneic bone marrow transplant, were included in the study. Serum ferritin was estimated by chemiluminescent immunoassay. Degree of fibrosis in liver biopsy was scored using Knodell s scoring system. Correlation between the two was evaluated statistically through Pearson s correlation coefficient. RESULTS: Mean serum ferritin was lower and degree of hepatic fibrosis was less in hepatitis C negative patients of TM. The correlation between serum ferritin and the degree of hepatic fibrosis was much stronger in hepatitis C negative patients with r value of 0.507 and p value of 0.006, which was statistically significant. CONCLUSION: A strong correlation between serum ferritin and degree of hepatic fibrosis was observed in patients of thalassaemia major not infected with hepatitis C infection. Serum ferritin levels alone are, therefore, not sufficient to assess degree of fibrosis in HCV positive patients of TM.
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OBJECTIVE: To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis. DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003. SUBJECTS AND METHODS: One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein (CRP), erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for polymorphs were used for diagnosis of neonatal sepsis. RESULTS: CRP was positive in 24/28 (85.7%) of group-A (proven sepsis) and 58/72 (80.5%) of group-B (probable sepsis) and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4 % for group-A and 63.9 % for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values (PV) of the individual tests and different tests combination was also calculated for group-A and B. CONCLUSION: A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests.
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OBJECTIVE: The occurrence of isolated positive sputum cultures among pulmonary tuberculosis (PTB) patients during treatment is not widely reported. This study describes the frequency of isolated positive sputum cultures among PTB patients after initiation of chemotherapy. METHODS: Fifty sputum culture positive PTB patients, consisting of 38 (76%) males and 12 (24%) females with a mean age of 34.31 +/- 19.54 (13-75) years, were studied prospectively over a period of 10 months (September 1999 to June 2000) at Sahary Chest Hospital, Riyadh, Kingdom of Saudi Arabia. The majority of patients received standard 4-drug short-course antimicrobial chemotherapy. Weekly sputum smears and cultures were carried out for each patient during the treatment. RESULTS: Isolated positive sputum cultures were encountered in 4 (8%) of the studied patients. Two of them had 2 consecutive positive smears and cultures in their third and fourth week during treatment and were attributed to poor compliance to the treatment. Of the remaining 2 patients, one had single isolated culture in his fourth week, while the fourth patient showed a slight growth in the fifth week of the treatment. Due to the undetermined status of the smear and very few colonies in the culture, these 2 isolated cultures were attributed to the carry-over contamination during the laboratory procedures. The same treatment was continued with strict monitoring of compliance to the treatment and laboratory protocols. All of the 4 patients converted to negative before leaving the hospital. CONCLUSION: Isolated positive sputum cultures might appear (infrequently) during treatment either due to the treatment noncompliance or carry over contamination. However, under either circumstance, the same treatment should be continued along with strict monitoring of treatment compliance and specimen decontamination and related laboratory protocols.
Percutaneous coronary intervention (PCI) for bifurcation lesions is technically limited by the risk of side branch occlusion. Despite using various strategies for the treatment of bifurcation lesions, adequate stent coverage of the side branch ostium remains difficult with conventional stent design. The Multi-Link Frontier stent is a specifically designed bifurcation stent that allows stenting of the main branch and the side branch ostium with a single stent, whilst preserving access to the side branch. Requirement for a 7 French (Fr) guide has discouraged operators from using this device via a transradial approach. We present the immediate results of using the Multi-Link Frontier stent in 5 consecutive cases with bifurcation coronary lesions using a transradial approach.
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Aortic dissection is an acute medical emergency with a high mortality. Crucial to improving survival is early recognition and appropriate treatment. This review describes the presenting clinical features and imaging techniques used in the diagnosis of aortic dissection and outlines the treatment modalities.
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BACKGROUND AND OBJECTIVE: Complex percutaneous coronary intervention (PCI) often requires introduction of numerous devices into and out of the arterial circulation and this may result in an increased risk of bacteraemia or even septicaemia. This study was undertaken to detect the frequency of bacteraemia that may be associated with such procedures. METHODS: 147 patients undergoing complex PCI had blood culture tests immediately after and 12 hours after the procedure. RESULTS: Of 147 patients, 26 (17.7%) had detectable bacteraemia immediately after PCI. Coagulase-negative staphylococcus was isolated most commonly. An additional 12% of patients yielded positive blood cultures in the next 12 hours with femoral sheaths still in-situ. There were no associated clinical sequelae. CONCLUSIONS: Uncomplicated bacteraemia is not uncommon as a result of complex PCI procedures. Although there are usually no clinical sequelae, these findings are important for those patients who are considered to be at moderate or high risk of infective endocarditis who require an invasive procedure such as PCI. This paper emphasizes the need for maximum sterility during PCI procedures if infective complications and stent infection are to be avoided.
OBJECTIVE: To evaluate and compare the response between food supplemented with iron in powdered and iron in syrup forms for the treatment of iron deficiency anemia in children aged 1-5 years. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: This study was conducted at Combined Military Hospital, Multan, from January 2000 to December 2000. PATIENTS AND METHODS: Consecutive 200 cases of iron deficiency anemia, aged 1-5 years, were included in the study. Diagnosis was based on history, physical examination, complete blood counts (CBC) and serum ferritin levels. The patients were randomized to receive either iron in syrup form (Group A) or equivalent doses of iron powder sprinkled over food (Group B). The patients were followed up with hemoglobin estimation (Hb) and reticulocyte response at 2 weeks, 4 weeks and 6 weeks. CBC and serum ferritin were repeated at 6 weeks. RESULTS: Over half (51%) of the patients were between 1-2 years of age. One hundred thirty-two were males and 68 females. Most of the patients belonged to poor socioeconomic class. The iron in powder form was better tolerated than iron syrup as this group witnessed fewer episodes of gastrointestinal disturbances. The rise in mean Hb level after 6 weeks of treatment in group A and B was 1.6 g/dl and 1.9 g/dl respectively. Hemoglobin rise in group B was more than group A but this was statistically non-significant (p > 0.05). There was small but significant (p < 0.05) rise in serum ferritin in both the groups. There was no significant difference between the two groups for response to the two forms of iron administration. CONCLUSION: The powdered form of iron is a cost-effective and better tolerated method of iron administration in children and can be considered as an alternate option for the treatment of iron deficiency anemia in children.
We present a case of a left internal mammary artery (LIMA) originating from the third part of the subclavian artery. Awareness of this possibility is particularly important when considering reintervention after coronary artery bypass surgery and the LIMA appears to be missing rather than obviously occluded.