Rāwalpindi, Pakistan
Rāwalpindi, Pakistan

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Miyoshi H.,National Hospital Organization | Oishi Y.,National Hospital Organization | Mizuguchi Y.,National Hospital Organization | Iuchi A.,National Hospital Organization | And 3 more authors.
Journal of the American Society of Hypertension | Year: 2013

Our aim was to investigate the relationships between left atrial (LA) structural and functional changes and left ventricular (LV) dysfunction related to LV pressure overload in asymptomatic patients with hypertension. One hundred and twenty-six asymptomatic patients with hypertension and LV ejection fraction (EF) ≥60% were studied. Conventional, pulsed and tissue Doppler, and two-dimensional speckle-tracking echocardiography (2DSTE) were performed to seek the independent determinants for alterations in LA structure and function. LA volume index (LAVI) correlated with age, body mass index (BMI), end-diastolic ventricular septal thickness (VSth), end-diastolic LV posterior wall thickness, relative LV wall thickness (RWT), LV mass index, peak A velocity of transmitral flow, E/e', and peak systolic and early diastolic LA strains and strain rates. Peak LA strain during ventricular systole (S-LAs) correlated with age, BMI, heart rate (HR), end-systolic LV diameter, LAVI, VSth, RWT, LVEF, e', E/e', peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate. Multivariate regression analyses indicated that LV mass index, peak A velocity, E/e', and S-LAs are defined as strong predictors related to LAVI, and that BMI, HR, LAVI, and peak systolic LV radial strain are defined as strong predictors related to S-LAs. In conclusion, 2DSTE demonstrated that alterations in LA structure and function are mainly associated with LV diastolic and systolic dysfunction, respectively, in preclinical patients with hypertension. © 2013 American Society of Hypertension. All rights reserved.

Oishi Y.,National Hospital Organization | Miyoshi H.,National Hospital Organization | Iuchi A.,National Hospital Organization | Nagase N.,National Hospital Organization | And 2 more authors.
Circulation Journal | Year: 2013

Background: The aim of the present study was to detect earlier the negative effect of cardiovascular risk (CVR) factors on left atrial (LA) and left ventricular (LV) function related to abdominal aortic (AAO) stiffness using 2-dimen-sional speckle-tracking echocardiography (2DSTE) in asymptomatic patients. Methods and Results: One hundred and twelve patients with CVR factors and 56 healthy individuals were studied. 2DSTE data were acquired for determination of LA and LV myocardial and AAO wall deformations. LA volume index, LV mass index, ratio of early diastolic transmitral flow to mitral annular velocity (E/e')/peak systolic LA strain (S-LAs), and AAO stiffness were greater, and peak early diastolic LV longitudinal strain rate (SR-LVe) was lower in the patient group. Among the significantly correlated variables with AAO stiffness on univariate analysis, multivariate linear regression analysis identified SR-LVe and (E/e')/S-LAs in the patient group, and only age in the healthy group, as independent predictor of AAO stiffness. Conclusions: Structural and functional changes in the LA and LV and AAO stiffening were accelerated with CVR factors, and higher AAO stiffness was associated with deteriorated LA compliance and impaired LV relaxation in asymptomatic patients with CVR factors. 2DSTE has a potential for earlier detection of abnormal LA and LV function related to increased AAO stiffness.

Oishi Y.,National Hospital Organization | Miyoshi H.,National Hospital Organization | Iuchi A.,National Hospital Organization | Nagase N.,National Hospital Organization | And 2 more authors.
Heart and Vessels | Year: 2013

Increased arterial stiffness is becoming an increasing health care problem as the population ages. Our aim was to detect the vascular aging of common carotid artery (CCA) and abdominal aorta (AAO) more easily and earlier using two-dimensional speckle-tracking echocardiography, and to evaluate the regional differences in mechanical properties related to changes in aging between the two arteries in preclinical patients. Twenty-nine clinically normal individuals and 68 preclinical patients with cardiovascular risk factors were examined. The peak circumferential strains were measured from the short-axis views of the CCA and AAO, and each stiffness β was determined. The CCA and AAO diameters increased with advanced age, and the latter diameter was widely distributed in patients of 50 years or older. The mean strain and stiffness index of the AAO were greater and lower, respectively, than those of the CCA at all ages. The CCA and AAO strains decreased with age, expressing dramatic declines before the fifth decade of life. The CCA and AAO stiffness indices increased with age, expressing rapid ascents after the fifth decade of life, particularly in the AAO. The best markers of subclinical arterial aging were strain in younger persons and stiffness in older individuals. Two-dimensional speckle-tracking echocardiography is a new tool that can be used to directly and easily evaluate arterial function. © 2012 Springer.

Akhtar N.,Rawalpindi Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the frequency of nosocomial infections and causative organisms in medical intensive care unit (ICU) patients and antimicrobial susceptibility pattern of the isolates. Study Design: A cross-sectional study. Place and Duration of Study: The Holy Family Hospital, Rawalpindi, during the period of May 2007 to April 2008. Methodology: Clinical samples from patients having any signs of site-specific infections or fever appearing anytime after 48 hours of admission into ICU were collected. The samples were cultured onto suitable culture media and bacterial isolates were identified using standard biochemical methods. Antimicrobial susceptibility testing to conventional and newer antibiotics was performed on Mueller Hinton agar using disc diffusion method. Frequency percentages were determined. Results: Bacteria or Candida spp. were isolated from 269/440 (60.1%) samples. The most frequent site of infection was respiratory tract (47.95%) followed by urinary tract (25.3%). Pseudomonas (P.) aeruginosa, Klebsiella (K.) pneumoniae, Escherichia (E.) coli and Candida spp. were the commonest organisms. The isolation rate of Gram-positive bacteria was relatively low. Majority (> 50%) of the Gram-negative isolates were resistant to many of the antibiotics tested. Relatively low resistance was only observed against amikacin (21.3%) and imipenem (26.1%). Majority (> 60%) of Gram-negative isolates were resistant to cefotaxime, ceftriaxone and ceftazidime. The isolates showed high resistance to ofloxacin (65.9%) and ciprofloxacin (73.9%). Conclusion: The high frequency of HAIs and antibiotic resistance rate, suggests that more strict infection control practices along with prescription of antibiotics after antibiotic susceptibility testing should be implemented to limit the emergence of antibiotic resistant organisms.

Mahmud W.,Rawalpindi Medical College | Hyder O.,Rawalpindi Medical College | Butt J.,Rawalpindi Medical College | Aftab A.,Rawalpindi Medical College
Anatomical Sciences Education | Year: 2011

In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College in Pakistan, divided into two groups, dissected one limb in first term and switched over to the other limb in the second term. During the second term, instruction was supplemented by dissection videos. Second-term anatomy examination marks were compared with first-term scores and with results from first-year medical students in previous years. Multiple linear regression analysis was performed, with term scores (continuous, 0-200) as the dependent variable. Students shown dissection videos scored 1.26 marks higher than those not shown. The relationship was not statistically significant (95% CI: -1.11, 3.70; P = 0.314). Ninety-three percent of students favored regular inclusion of dissection videos in curriculum, and 50% termed it the best source for learning gross anatomy. Seventy-six percent of students did not perform regular cadaver dissection. The most frequent reason cited for not performing regular dissection was high student-cadaver ratio. Dissection videos did not improve performance on final examination scores; however, students favored their use. © 2011 American Association of Anatomists.

Mahmud W.,Rawalpindi Medical College | Hyder O.,Rawalpindi Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2012

Objective: To conduct a systematic review of primary research in undergraduate medical education in Pakistan in order to evaluate PBL programs, examine outcomes and competencies influenced by PBL, and compare them with conventional learning (lecture based learning, LBL). Study Design: Qualitative content analysis. Place and Duration of Study: Rawalpindi Medical College, Rawalpindi, from June 2010 - February 2011. Methodology: Literature was searched using online resources. Studies evaluating outcomes influenced by PBL, or comparing PBL with lecture based learning (LBL) were selected. Due to heterogeneity, a qualitative content analysis was performed in which studies were classified according to the methods of assessment; results were then summarized by outcome and frequencies were calculated. Results: Eleven studies were included. Apart from knowledge acquisition, students gave high ratings to PBL in selected outcomes, alone, and in comparison with LBL. There was a disagreement among results of studies that evaluated knowledge acquisition alone. Conclusion: Based on student perceptions, PBL has many advantages. However, the results of this review are limited due to heterogeneity and methodological weakness of studies, specially the studies that compared exam scores to assess knowledge acquisition.

Chaudhry B.Y.,Rawalpindi Medical College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Maternal vaginal colonisation with Group B Streptococcus (GBS, Streptococcus agalactiae) at the time of delivery can cause vertical transmission to the neonate. GBS is the leading cause of sepsis, meningitis and pneumonia in the infants. Asymptomatic colonisation of the vagina with GBS varies with the geographical location. This was a cross-sectional study conducted in 2009 at Benazir Bhutto Hospital, Rawalpindi, Pakistan. Lower vaginal swabs were obtained from 200 pregnant women at the time of admission in the Gynaecology and Obstetrics Department for term, normal vaginal delivery and swabs from the skin of abdomen and ear canals of their respective neonates immediately after delivery were collected. Swabs were inoculated on blood agar and incubated aerobically and on Group B Streptococcus agar (GBS agar) and incubated anaerobically in an anaerobic jar. Identification of GBS was made on the basis of colonial morphology (beta-haemolytic colonies on blood agar and orange pigmented colonies on GBS agar), Gram stain, catalase test and conformation was done by means of latex agglutination tests. A GBS carriage rate of 8.5% among pregnant women before delivery and an acquisition rate of 53% on the abdominal skin and 18% in the ear canals by the neonates of colonised mothers were found. GBS colonisation in pregnant women and its transmission to the neonates is present in our population so GBS infections in the prenatal and neonatal period might not be uncommon in Pakistan, so routine screening should be carried out.

Khan J.S.,Rawalpindi Medical College
Journal of Postgraduate Medical Institute | Year: 2014

Objective: The aim of the study is to review the frequency of Common Bile Duct (CBD) injury in laparoscopic cholecystectomy (LC) and its management in our set up. Methodology: This descriptive study was conducted at Surgical Department, Rawalpindi Medical College and the author's Surgical Clinics from January 1998 to December 2012. Two thousand patients undergoing laparoscopic cholecystectomy were included in the study. The cases were operated between January 1998 and December 2012. The important variables included were frequency of CBD injury and its management. Results: There were 1723 females and 277 males with mean age 45.04±11 years. 67.8% patients had chronic cholecystitis with cholelithiasis and were admitted through Out Patient Department whereas 32.2% patients were admitted through A&E department. Abdominal ultrasound showed multiple calculi in 1535 (76.7%) patients and 435 (23.3%) patients had single calculus preoperatively. Empyema was found in 245(12.2%) cases whereas adhesions were present in 783(39.1%) patients. Conversion rate to open cholecystectomy was 3.4%. Seventeen cases had CBD injury (0.85%). 14 cases (82.3%) were diagnosed intraoperatively whereas 3 cases (17.7%) were diagnosed postoperatively. In 13 cases (76.5%) CBD repair was done over T.tube. Mean operating time was 30 minutes. Conclusion: The frequency of CBD injury in LC in our setup was less than 1% and is comparable to international experience. Most of the cases were diagnosed intraoperatively. Repair over T.tube is commonest method employed for management of CBD injury with favorable results.

Akhtar N.,Rawalpindi Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the frequency of staphylococcal nasal carriage of health care workers (HCWs) and antimicrobial susceptibility profile of the isolates for appropriate decolonization therapy. Study Design: An observational study. Place and Duration of Study: The study was conducted at Holy Family Hospital, Rawalpindi, during the period from May 2007 to April 2008. Methodology: Nasal swabs from anterior nares of HCWs were cultured and identified as Staphylococcus aureus, coagulase-negative staphylococci (CoNS), methicillin-resistant S. aureus (MRSA), methicillin-resistant CoNS (MRCoNS) by using standard methods. Antimicrobial susceptibility testing was performed on Muller Hinton Agar using disc diffusion method. Results: Of the 468 HCWs, 213 (45.5%) participants were men and 255 (54.5%) were women. Eighty five (18.2%) were nasal carriers of S. aureus, 07 (1.5%) for MRSA, 343 (73.3%) for CoNS and 10 (2.1%) for MRCoNS. The highest carriage rate for S. aureus was in midwives (30%) followed by maintenance staff (28.6%), security guards (25%), technicians (23.5%), staff nurses (22.7%) and < 20% in house physicians and nursing students. Carriage rate in HCWs from different departments was: surgical ICU (40%), gynaecology (34.9%), delivery room (30%), gynaecology operation rooms (25%), medicine (22.7%) and < 20% in pediatrics and surgery. All isolates were susceptible to vancomycin, imipenem and levofloxacin and > 90% of S. aureus and CoNS were susceptible to amikacin, gentamicin and fluoroquinolones tested. Conclusion: Fluoroquinolones, preferably oral levofloxacin in combination with topical gentamicin ointment, in places like Pakistan where mupirocin is not routinely available, can be used for decolonization of nasal staphylococcal carriage.

Stethoscope diaphragms are frequently colonized by bacteria. This cross-sectional study described the frequency and factors associated with reporting ever cleaning stethoscopes among 408 medical students and doctors at a medical college and 2 teaching hospitals in Rawalpindi, Pakistan. A minority of the respondents (37.7%) reported having ever cleaned their stethoscope. Following normal clinical use, wiping with a dry cloth was the most frequently reported method of cleaning (53.2%). After contamination of the diaphragm with blood or secretions, cleaning with an alcoholic swab was the most common method (64.3%). In univariate and multivariate analyses, history of receiving information on stethoscope cleaning, utilization of personal stethoscope at last use and affiliation with internal medicine department were factors strongly associated with ever cleaning of stethoscope. Future research for improving stethoscope cleaning practices should explore educational interventions aimed at health care professionals.

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