Maheen Zahid, Adnan Manzar, Waqas Qureshi, Javed Iqbal, Fizza Khursheed, Asma Saeed, Sahar Abdul Rauf, Ishfaq Ahmed``, Muhammad Farrukh Habib
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, leading to inflammation and potential joint damage. Methotrexate (MTX) and Leflunomide (LEF) are commonly used disease-modifying antirheumatic drugs (DMARDs) for RA, but their hepatotoxic effects require careful monitoring. Objective: This study aimed to compare the incidence of liver injury in RA patients treated with Methotrexate versus Leflunomide. Methods: This prospective study was conducted from January 2023 to June 2023 and included 80 RA patients aged 20 years or older, who reported to the Medicine Department at Combined Military Hospital (CMH) Lahore. Patients were divided into two groups: Group A received 20 mg/day Methotrexate (n=40), and Group B received 20 mg/day Leflunomide (n=40). Exclusion criteria included pregnant females, patients with hepatitis B or C, those with known allergies to Methotrexate or Leflunomide, and alcoholics. Baseline investigations, including liver enzyme levels (ALT/AST), were performed, and patients were monitored every three months. Hepatotoxicity was defined as an increase in ALT/AST levels to at least twice the upper limit of normal (ULN). Data were analyzed using SPSS version 25.0, with mean and standard deviation for quantitative data and frequency and percentage for qualitative data. The Chi-square test was used to compare variables, with p<0.05 considered statistically significant. Results: Out of 80 patients, 43 (53.75%) were female, and 37 (46.25%) were male. In Group A, 7 patients (17.5%) had elevated ALT/AST levels, while 6 patients (15%) in Group B exhibited elevated liver enzymes. The mean age was 52.4 ± 8.3 years in Group A and 50.6 ± 9.1 years in Group B. The mean BMI was 26.7 ± 3.5 kg/m² in Group A and 27.1 ± 3.8 kg/m² in Group B. No statistically significant difference in hepatotoxicity was observed between the two groups (p>0.05). Conclusion: Methotrexate and Leflunomide were equally effective in treating RA, with no significant difference in liver toxicity observed between the two groups. Both medications have comparable risks for hepatotoxicity, necessitating regular liver function monitoring during treatment.
{"title":"Comparison of Liver Injury in Patients Taking Methotrexate and Leflunamide in Rheumatoid Arthritis","authors":"Maheen Zahid, Adnan Manzar, Waqas Qureshi, Javed Iqbal, Fizza Khursheed, Asma Saeed, Sahar Abdul Rauf, Ishfaq Ahmed``, Muhammad Farrukh Habib","doi":"10.61919/jhrr.v4i2.570","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.570","url":null,"abstract":"Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, leading to inflammation and potential joint damage. Methotrexate (MTX) and Leflunomide (LEF) are commonly used disease-modifying antirheumatic drugs (DMARDs) for RA, but their hepatotoxic effects require careful monitoring.\u0000Objective: This study aimed to compare the incidence of liver injury in RA patients treated with Methotrexate versus Leflunomide.\u0000Methods: This prospective study was conducted from January 2023 to June 2023 and included 80 RA patients aged 20 years or older, who reported to the Medicine Department at Combined Military Hospital (CMH) Lahore. Patients were divided into two groups: Group A received 20 mg/day Methotrexate (n=40), and Group B received 20 mg/day Leflunomide (n=40). Exclusion criteria included pregnant females, patients with hepatitis B or C, those with known allergies to Methotrexate or Leflunomide, and alcoholics. Baseline investigations, including liver enzyme levels (ALT/AST), were performed, and patients were monitored every three months. Hepatotoxicity was defined as an increase in ALT/AST levels to at least twice the upper limit of normal (ULN). Data were analyzed using SPSS version 25.0, with mean and standard deviation for quantitative data and frequency and percentage for qualitative data. The Chi-square test was used to compare variables, with p<0.05 considered statistically significant.\u0000Results: Out of 80 patients, 43 (53.75%) were female, and 37 (46.25%) were male. In Group A, 7 patients (17.5%) had elevated ALT/AST levels, while 6 patients (15%) in Group B exhibited elevated liver enzymes. The mean age was 52.4 ± 8.3 years in Group A and 50.6 ± 9.1 years in Group B. The mean BMI was 26.7 ± 3.5 kg/m² in Group A and 27.1 ± 3.8 kg/m² in Group B. No statistically significant difference in hepatotoxicity was observed between the two groups (p>0.05).\u0000Conclusion: Methotrexate and Leflunomide were equally effective in treating RA, with no significant difference in liver toxicity observed between the two groups. Both medications have comparable risks for hepatotoxicity, necessitating regular liver function monitoring during treatment.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Male infertility encompasses various etiologies, with Congenital Hypogonadotropic Hypogonadism (CHH) standing out as a significant factor. CHH arises from multiple systems, including genetic abnormalities and hormonal imbalances that impair reproductive capabilities. Objective: This review aims to dissect the biochemical underpinnings of CHH and evaluate its impact on male infertility, highlighting the complexities in its diagnosis and therapeutic management. Methods: The analysis involved a review of current literature on the genetic causes and hormonal disruptions associated with CHH. Diagnostic criteria were assessed based on biochemical markers and clinical symptoms. Treatment efficacy was evaluated through outcomes of hormone replacement therapy, surgical interventions, and assisted reproductive technologies. Results: The majority of CHH patients treated with hormone replacement therapy demonstrated improved sexual maturation and fertility, with approximately 70% achieving spermatogenesis. Surgical interventions corrected anatomical defects in 90% of cases, while assisted reproductive technologies resulted in successful pregnancies in 60% of treated individuals. Conclusion: CHH significantly affects male reproductive health, influencing testicular development and endocrine function. Advances in diagnostic and treatment strategies have enhanced management outcomes, but ongoing research is essential for developing more targeted therapies.
{"title":"Biochemical Analysis of Congenital Hypogonadotropic Hypogonadism in the Context of Male Infertility: A Comprehensive Review","authors":"Tehmina, Laila Siraj, Mahnoor Arif, Layiba Rameen, Husna Anwar, Uroosa Aslam, Hania Ibrar, Shazia Shamas","doi":"10.61919/jhrr.v4i2.851","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.851","url":null,"abstract":"Background: Male infertility encompasses various etiologies, with Congenital Hypogonadotropic Hypogonadism (CHH) standing out as a significant factor. CHH arises from multiple systems, including genetic abnormalities and hormonal imbalances that impair reproductive capabilities.\u0000Objective: This review aims to dissect the biochemical underpinnings of CHH and evaluate its impact on male infertility, highlighting the complexities in its diagnosis and therapeutic management.\u0000Methods: The analysis involved a review of current literature on the genetic causes and hormonal disruptions associated with CHH. Diagnostic criteria were assessed based on biochemical markers and clinical symptoms. Treatment efficacy was evaluated through outcomes of hormone replacement therapy, surgical interventions, and assisted reproductive technologies.\u0000Results: The majority of CHH patients treated with hormone replacement therapy demonstrated improved sexual maturation and fertility, with approximately 70% achieving spermatogenesis. Surgical interventions corrected anatomical defects in 90% of cases, while assisted reproductive technologies resulted in successful pregnancies in 60% of treated individuals.\u0000Conclusion: CHH significantly affects male reproductive health, influencing testicular development and endocrine function. Advances in diagnostic and treatment strategies have enhanced management outcomes, but ongoing research is essential for developing more targeted therapies.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140988488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fazal Ur Rehman, Mujahid Zulfiqar Ali, Maheen Zafar, Madeeha Ikram, Aqsa Tassadduq, Muhammad Farrukh Habib
Background: The global population is aging, leading to an increased incidence of acute cholecystitis and associated complications in the elderly. While laparoscopic cholecystectomy is the gold standard for treating acute cholecystitis, its safety and outcomes in high-risk, elderly patients with comorbidities are not well-documented. Objective: To compare postoperative complications, hospital stay duration, and nursing care requirements between high-risk elderly patients undergoing tube cholecystostomy versus early elective laparoscopic cholecystectomy for acute cholecystitis. Methods: This cross-sectional comparative study was conducted at Combined Military Hospital Rawalpindi from July 2021 to January 2022. A total of 70 patients aged 40-80 years and classified as ASA 3 or 4 were included. Patients were divided into two groups: Group 1 (n=35) underwent tube cholecystostomy followed by interval cholecystectomy after six weeks; Group 2 (n=35) underwent early elective laparoscopic cholecystectomy within 72 hours of admission. Data on hospital stay, postoperative complications, and nursing care were collected and analyzed using SPSS version 25.0. Quantitative data were presented as mean ± standard deviation (SD), and qualitative data as frequency and percentage. Independent t-tests were applied, with a p-value of less than 0.05 considered statistically significant. Results: In Group 1, 91% of patients had a hospital stay of less than 5 days compared to 11% in Group 2 (p=0.000). Group 1 had 94% of patients nursed in the ward/HDU, while 94% of Group 2 required ICU care (p=0.000). Postoperative complications were significantly lower in Group 1, with 97% having no complications compared to 34% in Group 2 (p=0.000). Only 3% of Group 1 required multidisciplinary team management versus 66% in Group 2. Conclusion: Tube cholecystostomy is a safer and more effective initial management strategy for high-risk elderly patients with acute cholecystitis, leading to shorter hospital stays, less intensive postoperative care, and fewer complications compared to early elective laparoscopic cholecystectomy.
{"title":"Perioperative Outcomes after Elective Laparoscopic Cholecystectomy in High Risk Patients","authors":"Fazal Ur Rehman, Mujahid Zulfiqar Ali, Maheen Zafar, Madeeha Ikram, Aqsa Tassadduq, Muhammad Farrukh Habib","doi":"10.61919/jhrr.v4i2.705","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.705","url":null,"abstract":"Background: The global population is aging, leading to an increased incidence of acute cholecystitis and associated complications in the elderly. While laparoscopic cholecystectomy is the gold standard for treating acute cholecystitis, its safety and outcomes in high-risk, elderly patients with comorbidities are not well-documented.\u0000Objective: To compare postoperative complications, hospital stay duration, and nursing care requirements between high-risk elderly patients undergoing tube cholecystostomy versus early elective laparoscopic cholecystectomy for acute cholecystitis.\u0000Methods: This cross-sectional comparative study was conducted at Combined Military Hospital Rawalpindi from July 2021 to January 2022. A total of 70 patients aged 40-80 years and classified as ASA 3 or 4 were included. Patients were divided into two groups: Group 1 (n=35) underwent tube cholecystostomy followed by interval cholecystectomy after six weeks; Group 2 (n=35) underwent early elective laparoscopic cholecystectomy within 72 hours of admission. Data on hospital stay, postoperative complications, and nursing care were collected and analyzed using SPSS version 25.0. Quantitative data were presented as mean ± standard deviation (SD), and qualitative data as frequency and percentage. Independent t-tests were applied, with a p-value of less than 0.05 considered statistically significant.\u0000Results: In Group 1, 91% of patients had a hospital stay of less than 5 days compared to 11% in Group 2 (p=0.000). Group 1 had 94% of patients nursed in the ward/HDU, while 94% of Group 2 required ICU care (p=0.000). Postoperative complications were significantly lower in Group 1, with 97% having no complications compared to 34% in Group 2 (p=0.000). Only 3% of Group 1 required multidisciplinary team management versus 66% in Group 2.\u0000Conclusion: Tube cholecystostomy is a safer and more effective initial management strategy for high-risk elderly patients with acute cholecystitis, leading to shorter hospital stays, less intensive postoperative care, and fewer complications compared to early elective laparoscopic cholecystectomy.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khurram Zohaib, Muhammad Ilyas, Sawera Tahir, Muhammad Asif, Waqar Qamar, Faisal Shiraz, Muhammad Waseem Abbas Khan, Ayesha Saman, Aqsa Iqbal, Sonya Bashir, Obidullah
Background: Migraine, a neurological condition characterized by intense and debilitating headaches, poses a significant public health issue affecting millions worldwide. The complexity of migraine pathophysiology often makes its management challenging. Despite various treatment modalities, the quest for the most effective and rapid relief from acute migraine episodes remains a pertinent concern in clinical practice. Objective: This study aimed to compare the efficacy of magnesium sulfate and a combination of dexamethasone/metoclopramide in treating acute migraine headaches to identify the most effective treatment option for rapid pain relief. Methods: This randomized controlled trial was conducted at the Department of Emergency Medicine, Benazir Bhutto Hospital, Rawalpindi, over six months from November 25, 2015, to May 24, 2016. A total of 70 patients were enrolled, with 35 patients assigned to Group A and 35 to Group B. Group A received 1g of magnesium sulfate in 100ml normal saline over 15 minutes, while Group B received 8mg of dexamethasone and 10mg of metoclopramide in a similar saline solution and infusion time. Pain severity was assessed using the Numeric Rating Scale (NRS) at baseline and two hours after medication administration. Data were analyzed using SPSS Version 25, with mean ± standard deviation calculated for age and NRS scores. Frequency and percentages were computed for gender and efficacy. Efficacy between the groups was compared using Chi-square tests, and stratification was applied to control for age and gender, followed by post-stratification Chi-square testing. A p-value of ≤ 0.05 was considered statistically significant. Results: The results showed a significant difference in pain relief between the two groups. In Group A, 23 patients (65.7%) reported significant pain relief compared to 13 patients (34.3%) in Group B (p=0.017). Stratification by age revealed that in patients under 30 years, 11 patients (31.4%) in Group A experienced pain relief compared to 8 patients (22.9%) in Group B (p=0.202). For patients over 30 years, 12 patients (34.3%) in Group A reported pain relief, compared to 5 patients (14.3%) in Group B (p=0.084). Gender stratification showed that among males, 5 (14.3%) in Group A experienced pain relief compared to 9 (25.7%) in Group B (p=0.408), while among females, 18 (51.4%) in Group A reported pain relief compared to 4 (11.4%) in Group B (p=0.000). Conclusion: Magnesium sulfate was found to be a more effective and faster-acting medication compared to a combination of dexamethasone and metoclopramide for the treatment of acute migraine headaches. This finding highlights the potential of magnesium sulfate as a preferred option for rapid pain relief in clinical settings, particularly for female patients.
{"title":"Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches","authors":"Khurram Zohaib, Muhammad Ilyas, Sawera Tahir, Muhammad Asif, Waqar Qamar, Faisal Shiraz, Muhammad Waseem Abbas Khan, Ayesha Saman, Aqsa Iqbal, Sonya Bashir, Obidullah","doi":"10.61919/jhrr.v4i2.857","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.857","url":null,"abstract":"Background: Migraine, a neurological condition characterized by intense and debilitating headaches, poses a significant public health issue affecting millions worldwide. The complexity of migraine pathophysiology often makes its management challenging. Despite various treatment modalities, the quest for the most effective and rapid relief from acute migraine episodes remains a pertinent concern in clinical practice.\u0000Objective: This study aimed to compare the efficacy of magnesium sulfate and a combination of dexamethasone/metoclopramide in treating acute migraine headaches to identify the most effective treatment option for rapid pain relief.\u0000Methods: This randomized controlled trial was conducted at the Department of Emergency Medicine, Benazir Bhutto Hospital, Rawalpindi, over six months from November 25, 2015, to May 24, 2016. A total of 70 patients were enrolled, with 35 patients assigned to Group A and 35 to Group B. Group A received 1g of magnesium sulfate in 100ml normal saline over 15 minutes, while Group B received 8mg of dexamethasone and 10mg of metoclopramide in a similar saline solution and infusion time. Pain severity was assessed using the Numeric Rating Scale (NRS) at baseline and two hours after medication administration. Data were analyzed using SPSS Version 25, with mean ± standard deviation calculated for age and NRS scores. Frequency and percentages were computed for gender and efficacy. Efficacy between the groups was compared using Chi-square tests, and stratification was applied to control for age and gender, followed by post-stratification Chi-square testing. A p-value of ≤ 0.05 was considered statistically significant.\u0000Results: The results showed a significant difference in pain relief between the two groups. In Group A, 23 patients (65.7%) reported significant pain relief compared to 13 patients (34.3%) in Group B (p=0.017). Stratification by age revealed that in patients under 30 years, 11 patients (31.4%) in Group A experienced pain relief compared to 8 patients (22.9%) in Group B (p=0.202). For patients over 30 years, 12 patients (34.3%) in Group A reported pain relief, compared to 5 patients (14.3%) in Group B (p=0.084). Gender stratification showed that among males, 5 (14.3%) in Group A experienced pain relief compared to 9 (25.7%) in Group B (p=0.408), while among females, 18 (51.4%) in Group A reported pain relief compared to 4 (11.4%) in Group B (p=0.000).\u0000Conclusion: Magnesium sulfate was found to be a more effective and faster-acting medication compared to a combination of dexamethasone and metoclopramide for the treatment of acute migraine headaches. This finding highlights the potential of magnesium sulfate as a preferred option for rapid pain relief in clinical settings, particularly for female patients.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140988161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nayab Qaiser, Sadaf Manzoor, Iqra Zakaullah, Mishal Khan, Nimra Fazal
Background: Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is characterized by an uncomfortable sensation in the legs, often occurring at the onset of sleep, which triggers an irrepressible urge to move the legs. This condition is particularly prevalent among pregnant women, with symptoms typically worsening during the third trimester. Despite its impact, many pregnant women are unaware of RLS, attributing their discomfort to normal pregnancy symptoms. Objective: To assess the frequency and associated factors of RLS in pregnant females during the third trimester and to evaluate its impact on their quality of life. Methods: A cross-sectional study was conducted involving 250 pregnant females in their third trimester, recruited from Shalimar Hospital, Nawaz Sharif Hospital, Zahida Welfare Trust, Alshad Clinic, Ali Hospital, Ahsan Hospital, Nargis Clinic, Manawa Government Hospital, and Sultan Medical Center. Participants aged 15-45 years were included, while those with rheumatoid arthritis, diabetes mellitus, neurological disorders, preeclampsia, and gestational diabetes mellitus were excluded. Data were collected using structured questionnaires incorporating the International Restless Legs Syndrome Study Group (IRLSSG) criteria and the Pittsburgh Sleep Quality Index (PSQI). Ethical approval was obtained, and the study adhered to the Declaration of Helsinki principles. Statistical analysis was performed using SPSS version 25, with descriptive statistics, frequencies, and graphical representations employed to summarize and analyze the data. Results: The mean age of participants was 26.32 years (SD = 5.08). The prevalence of RLS in the third trimester was found to be 89.2%. The age group most affected was 18-23 years. Factors associated with RLS included inadequate calcium intake (40.4%), insufficient daily water intake (40.4%), poor food intake (48%), mood disturbances (89.2%), lack of movement or light exercise (78%), caffeine consumption (16%), disturbances in sexual activities (48%), and disruption in daily activities (45.2%). Conclusion: RLS is highly prevalent among pregnant women, particularly in the third trimester, significantly impacting their quality of life. Despite its prevalence, many women remain unaware of RLS, mistaking it for typical pregnancy discomfort. Raising awareness and implementing screening and management strategies during prenatal care could improve the quality of life for affected women.
{"title":"The Frequency and Associated Factors of Restless Leg Syndrome among Pregnant Women in 3rd Trimester","authors":"Nayab Qaiser, Sadaf Manzoor, Iqra Zakaullah, Mishal Khan, Nimra Fazal","doi":"10.61919/jhrr.v4i2.854","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.854","url":null,"abstract":"Background: Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is characterized by an uncomfortable sensation in the legs, often occurring at the onset of sleep, which triggers an irrepressible urge to move the legs. This condition is particularly prevalent among pregnant women, with symptoms typically worsening during the third trimester. Despite its impact, many pregnant women are unaware of RLS, attributing their discomfort to normal pregnancy symptoms.\u0000Objective: To assess the frequency and associated factors of RLS in pregnant females during the third trimester and to evaluate its impact on their quality of life.\u0000Methods: A cross-sectional study was conducted involving 250 pregnant females in their third trimester, recruited from Shalimar Hospital, Nawaz Sharif Hospital, Zahida Welfare Trust, Alshad Clinic, Ali Hospital, Ahsan Hospital, Nargis Clinic, Manawa Government Hospital, and Sultan Medical Center. Participants aged 15-45 years were included, while those with rheumatoid arthritis, diabetes mellitus, neurological disorders, preeclampsia, and gestational diabetes mellitus were excluded. Data were collected using structured questionnaires incorporating the International Restless Legs Syndrome Study Group (IRLSSG) criteria and the Pittsburgh Sleep Quality Index (PSQI). Ethical approval was obtained, and the study adhered to the Declaration of Helsinki principles. Statistical analysis was performed using SPSS version 25, with descriptive statistics, frequencies, and graphical representations employed to summarize and analyze the data.\u0000Results: The mean age of participants was 26.32 years (SD = 5.08). The prevalence of RLS in the third trimester was found to be 89.2%. The age group most affected was 18-23 years. Factors associated with RLS included inadequate calcium intake (40.4%), insufficient daily water intake (40.4%), poor food intake (48%), mood disturbances (89.2%), lack of movement or light exercise (78%), caffeine consumption (16%), disturbances in sexual activities (48%), and disruption in daily activities (45.2%).\u0000Conclusion: RLS is highly prevalent among pregnant women, particularly in the third trimester, significantly impacting their quality of life. Despite its prevalence, many women remain unaware of RLS, mistaking it for typical pregnancy discomfort. Raising awareness and implementing screening and management strategies during prenatal care could improve the quality of life for affected women.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140992875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Epicardial adipose tissue (EAT) is the fat deposited between the myocardium and epicardium. Due to its unique anatomical position, EAT has both protective and harmful effects on the heart, influencing conditions such as coronary artery disease, atrial fibrillation, and heart failure. This study aimed to quantify the amount of EAT by analyzing the color shades of the heart's anterior surface during coronary artery bypass grafting (CABG) procedures. Objective: To assess the number of color shades in different sub-regions of the heart and quantify EAT using real-time 2D images captured during CABG procedures, and to correlate these findings with clinical conditions and risk factors. Methods: The study was conducted at Rehman Medical Institute, Peshawar, from October 2023 to April 2024. Images were captured using an iPhone 11 with a 12-megapixel camera during CABG procedures, specifically before cannulation, after opening the pericardium, and tucking the pericardium to the skin on a beating heart. Photographs were taken at a 90-degree angle and one-foot distance during systole, including surrounding tissues and a self-retaining retractor with a ruler for measurement reference. The images from three patients were processed to form the "HEART ANTERIOR VIEW THROUGH STERNOTOMY (HATS)" dataset. The data were cleaned and standardized for consistency. The surgical team annotated and labeled the images using the LabelMe tool, identifying the full heart region and its sub-regions: Aorta, Right Ventricle (RV) Myocardium, RV and Pulmonary Artery (PA) Epicardial Fat, and Right Atrium (RA) Appendage. Image segmentation techniques isolated the heart region and identified fat deposits. The total area of fat on the anterior surface of RV, PA, and RA was quantified using appropriate algorithms. Pixel analysis was conducted to determine the color shades, with each pixel having three color channels (Red, Green, Blue) and 256 intensity values per channel. Results: The total pixel count for the full image (heart and surrounding region) was 1600x1200 for Patient 1, 480x624 for Patient 2, and 480x848 for Patient 3. The heart regions contained 218,864 pixels (Patient 1), 44,020 pixels (Patient 2), and 77,919 pixels (Patient 3). The EAT areas were found to be 158,213 pixels (Patient 1), 35,608 pixels (Patient 2), and 52,723 pixels (Patient 3). The percentage areas of the sub-regions varied, with RV and PA Epicardial Fat comprising 72.3%, 80.9%, and 67.7% of the heart regions for Patients 1, 2, and 3, respectively. The top 100 color shades were identified, with unique colors in the Aorta (23,323), Appendage (7,030), Epicardial Fat (80,257), and Myocardium (10,131). Conclusion: The study demonstrated that EAT and the color shades of heart sub-regions could be accurately quantified using advanced imaging and computational techniques. These findings provide valuable insights into the correlation between EAT and cardiac risk factors, enhancing the ability to predict p
{"title":"Quantitative Analysis of Epicardial Adipose Tissue: 120K Shades of Heart","authors":"Yasir Jan, Azam Jan, Wahaj Ayub, Muhammad Wasim Sajjad, Rashid Qayyum, Hafiz Hammad Sharafat Satti","doi":"10.61919/jhrr.v4i2.915","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.915","url":null,"abstract":"Background: Epicardial adipose tissue (EAT) is the fat deposited between the myocardium and epicardium. Due to its unique anatomical position, EAT has both protective and harmful effects on the heart, influencing conditions such as coronary artery disease, atrial fibrillation, and heart failure. This study aimed to quantify the amount of EAT by analyzing the color shades of the heart's anterior surface during coronary artery bypass grafting (CABG) procedures.\u0000Objective: To assess the number of color shades in different sub-regions of the heart and quantify EAT using real-time 2D images captured during CABG procedures, and to correlate these findings with clinical conditions and risk factors.\u0000Methods: The study was conducted at Rehman Medical Institute, Peshawar, from October 2023 to April 2024. Images were captured using an iPhone 11 with a 12-megapixel camera during CABG procedures, specifically before cannulation, after opening the pericardium, and tucking the pericardium to the skin on a beating heart. Photographs were taken at a 90-degree angle and one-foot distance during systole, including surrounding tissues and a self-retaining retractor with a ruler for measurement reference. The images from three patients were processed to form the \"HEART ANTERIOR VIEW THROUGH STERNOTOMY (HATS)\" dataset. The data were cleaned and standardized for consistency. The surgical team annotated and labeled the images using the LabelMe tool, identifying the full heart region and its sub-regions: Aorta, Right Ventricle (RV) Myocardium, RV and Pulmonary Artery (PA) Epicardial Fat, and Right Atrium (RA) Appendage. Image segmentation techniques isolated the heart region and identified fat deposits. The total area of fat on the anterior surface of RV, PA, and RA was quantified using appropriate algorithms. Pixel analysis was conducted to determine the color shades, with each pixel having three color channels (Red, Green, Blue) and 256 intensity values per channel.\u0000Results: The total pixel count for the full image (heart and surrounding region) was 1600x1200 for Patient 1, 480x624 for Patient 2, and 480x848 for Patient 3. The heart regions contained 218,864 pixels (Patient 1), 44,020 pixels (Patient 2), and 77,919 pixels (Patient 3). The EAT areas were found to be 158,213 pixels (Patient 1), 35,608 pixels (Patient 2), and 52,723 pixels (Patient 3). The percentage areas of the sub-regions varied, with RV and PA Epicardial Fat comprising 72.3%, 80.9%, and 67.7% of the heart regions for Patients 1, 2, and 3, respectively. The top 100 color shades were identified, with unique colors in the Aorta (23,323), Appendage (7,030), Epicardial Fat (80,257), and Myocardium (10,131).\u0000Conclusion: The study demonstrated that EAT and the color shades of heart sub-regions could be accurately quantified using advanced imaging and computational techniques. These findings provide valuable insights into the correlation between EAT and cardiac risk factors, enhancing the ability to predict p","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Usama Farooq, Tariq Mehmood, Rashid Ali, Neelofar Yousaf, Hafiz Ahmed Hassam Bhalli, Kenan Anwar Khan, Muhammad Farrukh Habib
Background: Piriformis syndrome, a condition that affects predominantly females, leads to significant morbidity and impacts the quality of life. Despite its prevalence, it remains underdiagnosed, especially in the developed world. Treatment options include physiotherapy, painkillers, massage, heat, corticosteroids, local anesthetics, and botulinum toxin. However, comparative analysis of combination therapy versus botulinum toxin alone is limited. Objective: To compare the efficacy of intravenous steroids combined with bupivacaine versus botulinum toxin (Botox) injections in the treatment of piriformis syndrome. Methods: This quasi-experimental study was conducted at the Department of Anesthesiology, Combined Military Hospital, from January 2022 to December 2022, following ethical approval. The study included 100 patients diagnosed with piriformis syndrome, divided into two groups: Group L (n=50) received 10 ml of 0.25% bupivacaine with 40 mg of methylprednisolone, and Group B (n=50) received 100 U of botulinum toxin type A diluted in 10 ml distilled water. Standard monitoring was applied, and injections were performed under ultrasound guidance with the patients in the prone position. Pain scores were assessed using the Visual Analog Scale (VAS) at 24 hours, 72 hours, 7 days, and 28 days post-procedure. Patient satisfaction was measured using a 5-point Likert scale at 28 days. Data were analyzed using t-tests and chi-square tests, with significance set at p<0.05. Results: The mean age was 36 ± 3.35 years in Group L and 35.82 ± 3.42 years in Group B (p=0.297). The mean weight was 75.82 ± 5.23 kg in Group L and 77.64 ± 4.47 kg in Group B (p=0.066). Before the procedure, both groups had a median VAS pain score of 7.0. At 24 hours, the median pain score was 4.0 in Group L and 5.0 in Group B (p=0.292). At 72 hours, Group L had a median pain score of 3.0 compared to 4.0 in Group B (p=0.010). At 7 days, the scores were 2.0 and 3.0 respectively (p=0.013), and at 28 days, they were 2.0 and 3.0 respectively (p=0.013). The median satisfaction score at 28 days was 1.0 in Group L and 2.0 in Group B (p=0.043). Conclusion: Combination therapy with local anesthetics and steroids is superior to botulinum toxin in reducing pain and improving patient satisfaction in piriformis syndrome. This approach should be considered the first-choice treatment.
{"title":"Efficacy of Piriformis Block Using Intravenous Steroids with Bupivacaine versus Botox in Piriformis Syndrome","authors":"Usama Farooq, Tariq Mehmood, Rashid Ali, Neelofar Yousaf, Hafiz Ahmed Hassam Bhalli, Kenan Anwar Khan, Muhammad Farrukh Habib","doi":"10.61919/jhrr.v4i2.350","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.350","url":null,"abstract":"Background: Piriformis syndrome, a condition that affects predominantly females, leads to significant morbidity and impacts the quality of life. Despite its prevalence, it remains underdiagnosed, especially in the developed world. Treatment options include physiotherapy, painkillers, massage, heat, corticosteroids, local anesthetics, and botulinum toxin. However, comparative analysis of combination therapy versus botulinum toxin alone is limited.\u0000Objective: To compare the efficacy of intravenous steroids combined with bupivacaine versus botulinum toxin (Botox) injections in the treatment of piriformis syndrome.\u0000Methods: This quasi-experimental study was conducted at the Department of Anesthesiology, Combined Military Hospital, from January 2022 to December 2022, following ethical approval. The study included 100 patients diagnosed with piriformis syndrome, divided into two groups: Group L (n=50) received 10 ml of 0.25% bupivacaine with 40 mg of methylprednisolone, and Group B (n=50) received 100 U of botulinum toxin type A diluted in 10 ml distilled water. Standard monitoring was applied, and injections were performed under ultrasound guidance with the patients in the prone position. Pain scores were assessed using the Visual Analog Scale (VAS) at 24 hours, 72 hours, 7 days, and 28 days post-procedure. Patient satisfaction was measured using a 5-point Likert scale at 28 days. Data were analyzed using t-tests and chi-square tests, with significance set at p<0.05.\u0000Results: The mean age was 36 ± 3.35 years in Group L and 35.82 ± 3.42 years in Group B (p=0.297). The mean weight was 75.82 ± 5.23 kg in Group L and 77.64 ± 4.47 kg in Group B (p=0.066). Before the procedure, both groups had a median VAS pain score of 7.0. At 24 hours, the median pain score was 4.0 in Group L and 5.0 in Group B (p=0.292). At 72 hours, Group L had a median pain score of 3.0 compared to 4.0 in Group B (p=0.010). At 7 days, the scores were 2.0 and 3.0 respectively (p=0.013), and at 28 days, they were 2.0 and 3.0 respectively (p=0.013). The median satisfaction score at 28 days was 1.0 in Group L and 2.0 in Group B (p=0.043).\u0000Conclusion: Combination therapy with local anesthetics and steroids is superior to botulinum toxin in reducing pain and improving patient satisfaction in piriformis syndrome. This approach should be considered the first-choice treatment.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Usama Farooq, Rashid Ali, Tariq Mehmood, Neelofar Yousaf, Hafiz Ahmed Hassam Bhalli, Kenan Anwar Khan, Muhammad Farrukh Habib
Background: The induction of general anesthesia is a critical phase in anesthetic practice, often associated with significant hemodynamic changes. These changes can lead to complications due to autonomic adrenergic responses. Esmolol, a beta-1 antagonist, is commonly used to blunt these responses, but its availability is limited in some settings. Morphine, a pure mu receptor antagonist, presents a potential alternative. Objective: This study aimed to compare the efficacy of intravenous esmolol versus intravenous morphine in stabilizing the hemodynamic profile during the induction of general anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesiology, Combined Military Hospital, from January to June 2023. After obtaining ethical approval and trial registration, 220 ASA-II patients aged 25-55 years scheduled for elective surgeries under general anesthesia were enrolled. Patients were randomized into two groups: Group E (n=110) received 1.5 mg/kg intravenous esmolol three minutes before laryngoscopy and intubation, and Group M (n=110) received 0.1 mg/kg intravenous morphine five minutes before laryngoscopy and intubation. Baseline heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded after pre-oxygenation with 100% oxygen for three minutes. Post-intubation, the same parameters were measured five minutes after intubation. Statistical analysis was performed using SPSS version 25.0, with independent samples T-tests used to compare means. A p-value of ≤0.05 was considered statistically significant. Results: The mean age was 39.41 ± 5.13 years in Group E and 39.97 ± 5.08 years in Group M (p=0.414). Mean weight was 68.14 ± 3.88 kg in Group E and 68.08 ± 3.80 kg in Group M (p=0.916). Pre-induction mean heart rate was 71.75 ± 2.33 bpm in Group E and 71.58 ± 2.35 bpm in Group M (p=0.585). Five minutes post-intubation, mean heart rate was significantly lower in Group E (80.73 ± 2.54 bpm) compared to Group M (87.62 ± 2.83 bpm) (p<0.001). Mean systolic blood pressure post-intubation was 132.88 ± 4.65 mm Hg in Group E and 140.25 ± 2.39 mm Hg in Group M (p<0.001). Mean diastolic blood pressure post-intubation was 77.58 ± 2.35 mm Hg in Group E and 85.33 ± 3.71 mm Hg in Group M (p<0.001). Oxygen saturation remained stable in both groups. Conclusion: Intravenous esmolol is superior to intravenous morphine in blunting the hemodynamic responses to laryngoscopy and intubation, providing a more stable hemodynamic profile during the induction of general anesthesia.
{"title":"Comparison between the Hemodynamic Profile with Esmolol versus Morphine as an Adjuvant Agent during Induction of Anesthesia","authors":"Usama Farooq, Rashid Ali, Tariq Mehmood, Neelofar Yousaf, Hafiz Ahmed Hassam Bhalli, Kenan Anwar Khan, Muhammad Farrukh Habib","doi":"10.61919/jhrr.v4i2.348","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.348","url":null,"abstract":"Background: The induction of general anesthesia is a critical phase in anesthetic practice, often associated with significant hemodynamic changes. These changes can lead to complications due to autonomic adrenergic responses. Esmolol, a beta-1 antagonist, is commonly used to blunt these responses, but its availability is limited in some settings. Morphine, a pure mu receptor antagonist, presents a potential alternative.\u0000Objective: This study aimed to compare the efficacy of intravenous esmolol versus intravenous morphine in stabilizing the hemodynamic profile during the induction of general anesthesia.\u0000Methods: This randomized controlled trial was conducted at the Department of Anesthesiology, Combined Military Hospital, from January to June 2023. After obtaining ethical approval and trial registration, 220 ASA-II patients aged 25-55 years scheduled for elective surgeries under general anesthesia were enrolled. Patients were randomized into two groups: Group E (n=110) received 1.5 mg/kg intravenous esmolol three minutes before laryngoscopy and intubation, and Group M (n=110) received 0.1 mg/kg intravenous morphine five minutes before laryngoscopy and intubation. Baseline heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded after pre-oxygenation with 100% oxygen for three minutes. Post-intubation, the same parameters were measured five minutes after intubation. Statistical analysis was performed using SPSS version 25.0, with independent samples T-tests used to compare means. A p-value of ≤0.05 was considered statistically significant.\u0000Results: The mean age was 39.41 ± 5.13 years in Group E and 39.97 ± 5.08 years in Group M (p=0.414). Mean weight was 68.14 ± 3.88 kg in Group E and 68.08 ± 3.80 kg in Group M (p=0.916). Pre-induction mean heart rate was 71.75 ± 2.33 bpm in Group E and 71.58 ± 2.35 bpm in Group M (p=0.585). Five minutes post-intubation, mean heart rate was significantly lower in Group E (80.73 ± 2.54 bpm) compared to Group M (87.62 ± 2.83 bpm) (p<0.001). Mean systolic blood pressure post-intubation was 132.88 ± 4.65 mm Hg in Group E and 140.25 ± 2.39 mm Hg in Group M (p<0.001). Mean diastolic blood pressure post-intubation was 77.58 ± 2.35 mm Hg in Group E and 85.33 ± 3.71 mm Hg in Group M (p<0.001). Oxygen saturation remained stable in both groups.\u0000Conclusion: Intravenous esmolol is superior to intravenous morphine in blunting the hemodynamic responses to laryngoscopy and intubation, providing a more stable hemodynamic profile during the induction of general anesthesia.","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fahad Raja Khan, S. Memon, Samra Rehmat, Bahlool Khan
Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with Triple Vessel Disease (TVD) representing a severe form that poses significant treatment challenges. In Pakistan, the burden of CVDs is high, exacerbated by genetic and lifestyle factors. Objective: To evaluate and compare the clinical outcomes of Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) in patients diagnosed with Triple Vessel Disease (TVD) in a Pakistani cohort. Methods: This prospective cohort study was conducted at Lady Reading Hospital, Peshawar, from January 1, 2020, to December 31, 2021. A total of 400 patients diagnosed with TVD based on angiographic findings were enrolled. Inclusion criteria included age above 18 years, clinical diagnosis of stable angina or non-ST elevation myocardial infarction, and consent to participate. Exclusion criteria were previous revascularization procedures, concomitant valvular or congenital heart disease, and life expectancy less than a year due to non-cardiac conditions. Patients were assigned to either PCI or CABG based on clinical decisions by their managing cardiologists, considering anatomical considerations, comorbid conditions, and patient preferences. Baseline demographic and clinical data, including age, gender, smoking status, presence of diabetes, hypertension, and previous myocardial infarction (MI), were collected through patient interviews and medical record reviews. Clinical outcomes were monitored for 12 months post-procedure. Primary outcome measures included mortality, myocardial infarction, repeat revascularization, and stroke within 12 months. Secondary outcomes were hospital readmission rates and quality of life scores, measured using a standardized 10-point scale. Statistical analyses were performed using SPSS version 25, with continuous variables expressed as means and standard deviations and categorical variables as percentages. The chi-square test or Fisher’s exact test was used for categorical outcomes, and the student’s t-test or Mann-Whitney U test for continuous outcomes, with a p-value of less than 0.05 considered statistically significant. Results: The mean age of the participants was 62.5 ± 7.8 years, with 62 ± 8 years in the PCI group and 63 ± 7 years in the CABG group (p=0.45). Gender distribution was similar, with 255 males and 145 females overall (p=0.55). Smoking status, diabetes, hypertension, and previous MI were comparably distributed between the groups. Mortality was 5% in the PCI group and 3% in the CABG group (p=0.31). Myocardial infarction occurred in 10% of PCI patients compared to 5% of CABG patients (p=0.05). Repeat revascularization was required in 15% of the PCI group versus 7% of the CABG group (p=0.01). Stroke incidence was 2% in the PCI group and 1% in the CABG group (p=0.45). Hospital readmission rates were 20% for PCI and 15% for CABG (p=0.10). Quality of life scores were higher in the CABG group (8.0 ± 1.1) compared to
{"title":"PCI Vs. CABG: Battle For Better Outcomes in Pakistani Triple Vessel Disease Patients","authors":"Fahad Raja Khan, S. Memon, Samra Rehmat, Bahlool Khan","doi":"10.61919/jhrr.v4i2.905","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.905","url":null,"abstract":"Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with Triple Vessel Disease (TVD) representing a severe form that poses significant treatment challenges. In Pakistan, the burden of CVDs is high, exacerbated by genetic and lifestyle factors.\u0000Objective: To evaluate and compare the clinical outcomes of Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) in patients diagnosed with Triple Vessel Disease (TVD) in a Pakistani cohort.\u0000Methods: This prospective cohort study was conducted at Lady Reading Hospital, Peshawar, from January 1, 2020, to December 31, 2021. A total of 400 patients diagnosed with TVD based on angiographic findings were enrolled. Inclusion criteria included age above 18 years, clinical diagnosis of stable angina or non-ST elevation myocardial infarction, and consent to participate. Exclusion criteria were previous revascularization procedures, concomitant valvular or congenital heart disease, and life expectancy less than a year due to non-cardiac conditions. Patients were assigned to either PCI or CABG based on clinical decisions by their managing cardiologists, considering anatomical considerations, comorbid conditions, and patient preferences. Baseline demographic and clinical data, including age, gender, smoking status, presence of diabetes, hypertension, and previous myocardial infarction (MI), were collected through patient interviews and medical record reviews. Clinical outcomes were monitored for 12 months post-procedure. Primary outcome measures included mortality, myocardial infarction, repeat revascularization, and stroke within 12 months. Secondary outcomes were hospital readmission rates and quality of life scores, measured using a standardized 10-point scale. Statistical analyses were performed using SPSS version 25, with continuous variables expressed as means and standard deviations and categorical variables as percentages. The chi-square test or Fisher’s exact test was used for categorical outcomes, and the student’s t-test or Mann-Whitney U test for continuous outcomes, with a p-value of less than 0.05 considered statistically significant.\u0000Results: The mean age of the participants was 62.5 ± 7.8 years, with 62 ± 8 years in the PCI group and 63 ± 7 years in the CABG group (p=0.45). Gender distribution was similar, with 255 males and 145 females overall (p=0.55). Smoking status, diabetes, hypertension, and previous MI were comparably distributed between the groups. Mortality was 5% in the PCI group and 3% in the CABG group (p=0.31). Myocardial infarction occurred in 10% of PCI patients compared to 5% of CABG patients (p=0.05). Repeat revascularization was required in 15% of the PCI group versus 7% of the CABG group (p=0.01). Stroke incidence was 2% in the PCI group and 1% in the CABG group (p=0.45). Hospital readmission rates were 20% for PCI and 15% for CABG (p=0.10). Quality of life scores were higher in the CABG group (8.0 ± 1.1) compared to ","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fahad Raja Khan, S. Memon, Samra Rehmat, Bahlool Khan
Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, particularly among patients with Type 2 Diabetes Mellitus (T2DM). Diabetic patients are at a higher risk of developing CAD due to factors such as poor glycemic control, lipid metabolism abnormalities, and endothelial dysfunction. Prior studies have demonstrated that diabetic patients tend to present with more extensive coronary artery involvement and worse outcomes following cardiovascular interventions. Objective: This study aimed to assess the impact of T2DM on coronary angiography outcomes, specifically focusing on the incidence of multi-vessel disease and the severity of coronary artery stenosis. Methods: This observational cohort study was conducted at Lady Reding Hospital, a tertiary care center specializing in cardiovascular diseases. Participants were recruited from the outpatient cardiology clinic between January 2020 and January 2022. Inclusion criteria included patients aged 40 to 80 years undergoing coronary angiography for the first time due to suspected CAD. Exclusion criteria were previous coronary artery interventions, congenital heart disease, active infections, and renal insufficiency (creatinine > 2.0 mg/dL). Baseline characteristics such as age, gender, BMI, hypertension status, and smoking history were collected. Diabetes status was confirmed via HbA1c levels (≥6.5%). Coronary angiography was performed using standard techniques, with angiograms analyzed by two blinded cardiologists. Primary outcomes included the presence of multi-vessel disease (≥70% stenosis in two or more major coronary arteries) and the severity of stenosis (>70% blockage). Additional assessments using Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) evaluated plaque characteristics and vessel sizes in a subset of patients. Statistical analysis was performed using SPSS version 25.0, employing Chi-square tests for categorical variables, independent t-tests for continuous variables, and multivariable logistic regression to adjust for confounders. Results: The study included 300 participants, with 150 diabetic and 150 non-diabetic patients. Diabetic patients had a mean age of 62.3 ± 10.4 years, while non-diabetic patients had a mean age of 58.2 ± 9.8 years. The prevalence of hypertension was higher among diabetic patients (60%) compared to non-diabetic patients (40%). The incidence of multi-vessel disease was significantly higher in diabetic patients (70%) compared to non-diabetic patients (50%) (p < 0.05). Severe stenosis was observed in 65% of diabetic patients versus 45% of non-diabetic patients (p < 0.01). IVUS and OCT analyses showed a higher prevalence of lipid-rich plaques in diabetic patients (55% vs. 30%) and a smaller mean luminal diameter (2.8 ± 0.6 mm vs. 3.4 ± 0.5 mm). Conclusion: Diabetes significantly impacts the severity and extent of coronary artery disease, with diabetic patients exhibiting higher rates of multi-vessel
{"title":"Unveiling the Effects of Diabetes on Coronary Artery Disease Through Angiography","authors":"Fahad Raja Khan, S. Memon, Samra Rehmat, Bahlool Khan","doi":"10.61919/jhrr.v4i2.906","DOIUrl":"https://doi.org/10.61919/jhrr.v4i2.906","url":null,"abstract":"Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, particularly among patients with Type 2 Diabetes Mellitus (T2DM). Diabetic patients are at a higher risk of developing CAD due to factors such as poor glycemic control, lipid metabolism abnormalities, and endothelial dysfunction. Prior studies have demonstrated that diabetic patients tend to present with more extensive coronary artery involvement and worse outcomes following cardiovascular interventions.\u0000Objective: This study aimed to assess the impact of T2DM on coronary angiography outcomes, specifically focusing on the incidence of multi-vessel disease and the severity of coronary artery stenosis.\u0000Methods: This observational cohort study was conducted at Lady Reding Hospital, a tertiary care center specializing in cardiovascular diseases. Participants were recruited from the outpatient cardiology clinic between January 2020 and January 2022. Inclusion criteria included patients aged 40 to 80 years undergoing coronary angiography for the first time due to suspected CAD. Exclusion criteria were previous coronary artery interventions, congenital heart disease, active infections, and renal insufficiency (creatinine > 2.0 mg/dL). Baseline characteristics such as age, gender, BMI, hypertension status, and smoking history were collected. Diabetes status was confirmed via HbA1c levels (≥6.5%). Coronary angiography was performed using standard techniques, with angiograms analyzed by two blinded cardiologists. Primary outcomes included the presence of multi-vessel disease (≥70% stenosis in two or more major coronary arteries) and the severity of stenosis (>70% blockage). Additional assessments using Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) evaluated plaque characteristics and vessel sizes in a subset of patients. Statistical analysis was performed using SPSS version 25.0, employing Chi-square tests for categorical variables, independent t-tests for continuous variables, and multivariable logistic regression to adjust for confounders.\u0000Results: The study included 300 participants, with 150 diabetic and 150 non-diabetic patients. Diabetic patients had a mean age of 62.3 ± 10.4 years, while non-diabetic patients had a mean age of 58.2 ± 9.8 years. The prevalence of hypertension was higher among diabetic patients (60%) compared to non-diabetic patients (40%). The incidence of multi-vessel disease was significantly higher in diabetic patients (70%) compared to non-diabetic patients (50%) (p < 0.05). Severe stenosis was observed in 65% of diabetic patients versus 45% of non-diabetic patients (p < 0.01). IVUS and OCT analyses showed a higher prevalence of lipid-rich plaques in diabetic patients (55% vs. 30%) and a smaller mean luminal diameter (2.8 ± 0.6 mm vs. 3.4 ± 0.5 mm).\u0000Conclusion: Diabetes significantly impacts the severity and extent of coronary artery disease, with diabetic patients exhibiting higher rates of multi-vessel","PeriodicalId":507812,"journal":{"name":"Journal of Health and Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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