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Rāwalpindi, Pakistan

Miyoshi H.,Higashi Tokushima Medical Center | Oishi Y.,Higashi Tokushima Medical Center | Mizuguchi Y.,Higashi Tokushima Medical Center | Iuchi A.,Higashi Tokushima Medical Center | And 3 more authors.
Journal of the American Society of Hypertension

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. Source

Akhtar N.,Rawalpindi Medical College
Journal of the College of Physicians and Surgeons Pakistan

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. Source

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

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. Source

Oishi Y.,Higashi Tokushima Medical Center | Miyoshi H.,Higashi Tokushima Medical Center | Iuchi A.,Higashi Tokushima Medical Center | Nagase N.,Higashi Tokushima Medical Center | And 2 more authors.
Circulation Journal

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. Source

Khan J.S.,Rawalpindi Medical College
Journal of Postgraduate Medical Institute

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. Source

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