bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Knowledge of Nurses regarding Bioethics
Authors: Saini Radha , Saini Parvesh , Alagh Preety
Published: December 2022

Nurses involved in research, whether as a principal investigator, a study coordinator, clinical trials nurse, or as a staff nurse caring for patients who are research subjects have a responsibility to promote the ethical conduct of clinical research. Will a registered nurse be ever able to challenge and infact unearth the unscrupulous medical practices which make poor patients guinea pigs in pharmaceutical company-sponsored clinical trials? Keeping this in view an exploratory study was carried out to assess the knowledge of bioethics among MSc Nursing students studying in recognised Nursing Colleges of North India. 92 percent of MSc nursing students scored below average knowledge regarding bioethics even after studying ethics in MSc (N) 1st year and B.Sc. Nursing degree programme. This research study strongly recommends the Indian Nursing Council-the statutory licensing body of nurses in India to ensure strict compliance of all researches (at masters as well as bachelors level) in nursing education with all the principles and components of bioethics. Need of the hour is to include at least one clinical nurse in the Institutional Ethics Committee in every medical and research institution. Key Words- Nurses, Bioethics, Indian Nursing Council, Institutional ethics committee
The Work of Maṭlaʻuʼl-Fecr by Salahuddin Ushshaqi (Salahi) As an Example of The First Regāʼibiyya in Ottoman Literature
Authors: Seljaci Emrah
Published: December 2022

This paper presents the work of Maṭlaʻuʼl-fecr by a famous Ottoman poet of the 18th century, Sheikh Abdullah Salahuddin Ushshaqi - Salahi. The work is of enormous importance for the entire Ottoman literature since it is the first poetic work that thematizes the conception of the Prophet of Islam. Thus, this is the first Regaʼibiyya written and composed for the purpose of performing at religious ceremonies on the occasion of Laylatur-regaib, the blessed night of the first Thursday in the month of Rajab. According to Islamic tradition, that night the Prophet’s mother Amina conceived Muhammad. Although this type of poetry is not as frequent in Ottoman literature as the Mawlid and Miʻrajiyya, its importance should not be neglected. It is particularly significant that the first Regaʼibiyya in the history of Ottoman literature was written by Salahuddin Ushshaqi, a poet of Bosnian descent. Therefore, in the continuance of the paper, general information about the author, his life and work is offered, and after the basic characteristics of Salahi’s Regaʼibiyya, an integral translation of the Mathnawi Maṭlaʻuʼl-fecr is presented. The translation itself is accompanied by additional explanations and interpretations of certain terms or verses.
On the Concept of the Ottoman Medreses՚ Curriculum During the Classical Age (1470-1839)
Authors: Mataradžija Velida
Published: December 2022

Some of the main characteristics of the centralised Ottoman system of education are the unitary basic curriculum, determined medrese categorisation and clearly defined the way of muderrises promotion. This paper aims to present the curriculum of the Ottoman medreses in the classical age (1470–1839) that is based on primary sources: laws passed by the Ottoman sultans Mehmed II The Conqueror (1451–1481) and Suleiman The Magnificent (1520–1566). The scientific autobiography of the Ottoman scholar Ahmad Tashköprüzade and the official report from 1741 for the French embassy are discussed in this paper. The analysis of the teaching methods, representation of some sciences in the curriculum, and contents of some textbooks are also presented.
Profesionalni stres i sagorijevanje medicinskih sestara u radu s djecom i odraslim bolesnicima
Authors: Vuković Marinela , Antičević Vesna , Mišetić Irena
Published: December 2022

Ciljevi ovog istraživanja bili su ispitati razlike u profesionalnim stresorima i razinama sagorijevanja između medicinskih sestara koje rade s djecom i onih koje rade s odraslim pacijentima te ispitati doprinos profesionalnih stresora s razinama sagorijevanja medicinskih sestara. Metode: U ovoj presječnoj studiji su sudjelovale 123 medicinske sestre od kojih je 30 zaposleno na pedijatrijskim odjelima, a 93 na odjelima za liječenje odraslih bolesnika. Primijenjeni su upitnici o ispitivanju profesionalnog stresa i sagorijevanja na poslu. Rezultati su ukazali na veću vulnerabilnost medicinskih sestara zaposlenih na pedijatrijskim odjelima prema profesionalnom stresu (t=3,77; p<0,001) i sagorijevanju na poslu (t=1,81, p<0,05), pri čemu percipirani rizici (B=0,08, p<0,01) i zahtjevi posla (B=0,07, p<0,01) na dječjim odjelima predviđaju više razine sagorijevanja. Stupanj sagorijevanja medicinskih sestara koje rade s odraslim bolesnicima povezan je s međuljudskim sukobima (B=0,1, p<0,01) i organizacijsko-financijskim problemima na poslu (B=0,14, p<0,01). Zaključak: Rezultati ukazuju na početne stupnjeve profesionalnog sagorijevanja kod svih medicinskih sestara, pogotovo kod onih koje rade na pedijatrijskim odjelima.
Dijagnoza Brugada sindroma na temelju konfiguracije signala električne aktivnosti srca
Authors: Tomas Božo , Jelčić Mate
Published: December 2022

U ovom radu su prikazani postupci dijagnosticiranja i klasificiranja bolesti srca, koja se naziva Brugada sindrom, na temelju konfiguracije signala električne aktivnosti srca. Prikazi signala akcijskog potencijala srca i signala elektrokardiograma u obliku krivulja pružaju informacije o pravilnosti ili nepravilnosti električne srčane aktivnosti odnosno o pravilnom ili nepravilnom radu srčanog mišića. Kako je elektrokardiogram najpouzdaniji alat za dijagnosticiranje i klasifikaciju ovog sindroma, opisani su para-metri tj. konfiguracije elektrokardiograma na temelju kojih se otkriva Brugada sindrom i klasificiraju definirani tipovi tog sindroma. Razumijevanje poveznica Brugada sindroma i parametara elektrokardiogramskog signala pomaže liječnicima da lakše upoznaju i shvate Brugada sindrom, što je veoma značajno za dijagnosticiranje, ali i za postupak terapije i liječenja ove bolesti.
De publicatiejaarrekening van kleine en microrechtspersonen
Authors: Camfferman Kees , Veldman Hanne
Published: December 2022

In dit artikel doen wij verslag van een onderzoek naar de verslaggeving van kleine en microrechtspersonen, waarvoor vereenvoudigde verslaggevingsvoorschriften van toepassing zijn. Wij concluderen dat de voorschriften in het algemeen redelijk worden nageleefd. Mogelijkheden voor verbetering zien wij vooral in toelichting die meer is afgestemd op de omstandigheden van de onderneming. Een kleine minderheid van met name kleine rechtspersonen schiet tekort; bij deze categorie rechtspersonen ontbreekt de toelichting grotendeels of geheel.
LIP FILLER WITH HYALURONIC ACID
Authors: Duarte Vieira Byrro Daniella , Silvia Nogueira Garcia Ana
Published: December 2022

The present work addresses the technique of lip filling with Hyaluronic Acid (HA) in a dental office environment. For the elaboration of this article, a literature review was carried out, with searches in the following databases: SCIELO, PubMed, NLM. In addition, a clinical case of lip filling procedure with HA was performed using microcannula. This study aimed to present theoretical support on the safety and efficacy of using HA for the lip filling procedure, as well as to present the applicability of this technique for facial aesthetic treatment. The technique used improved the patient’s labial contour, offering greater volume to the lips. After 30 days there were no complications and the client showed a high degree of satisfaction with the procedure. The performance of lip filling with HA is a very popular procedure nowadays, patients who seek this procedure aim to improve the appearance of the lips, making them more voluminous and designed. It is a safe and minimally invasive procedure. Since HA is a substance that does not suffer rejection, it is a molecule naturally produced by fibroblasts present in the dermis.
Accuracy and Documentation of Drug Allergies on Ward in a Cardiology Tertiary Care Unit (A Clinical Audit and Re-Audit)
Authors: Saif Mohsin , Rahman Fahd Ur , Siddique Muhammad Bilal , Rana Omer Rehman , Khan Sikandar Azam , Safi Shoaib Iqbal , Ullah Syed Saif , Khan Aleena , Khan Ajmal , Kamal Daniyal Ahmad
Published: December 2022

Objective: To assess whether status of allergies is accurately documented in clinical notes and drug prescription charts in two medical wards in Armed Forces Institute of Cardiology (AFIC) as compared to NICE guidelines. Study Design: We designed a classic audit of measuring current practice against guidelines.Place and duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from May to Oct 2020.Methodology: Each cycle contained of a two weeks’ period in which all new patients admitted in coronary care ward 3 and ward 10 were assessed. A total of 110 patients were assessed in each cycle. Repeat audit cycle was performed after 6 months similarly.Results: In first audit cycle, we assessed 110 patients. The status of allergies for most patients was recorded in clerking proforma (n=103, 93%) but there were deficiencies found in recording of allergies on drug kardex (n=25, 22%). After education and awareness, the second cycle showed that the status of allergies for all patients was recorded in clerking proforma (n=110, 100%) and documentation on drug kardex also improved from 22% to 78%. Conclusion: Repeat audit cycle showed significant improvement in documentation of allergies in clerking proforma and on drug kardex.
Prevalence of Acute Gastro Intestinal Tract Bleeding in Patients Undergoing Primary Percutaneous Coronary Intervention After Acute Myocardial Infarction
Authors: Tariq Muhammad Naeem , Samore Naseer Ahmed , Rashid Muhammad Humayoun , Chaudhery Ghoza , Shafique Hafiz Muhammad , Shahzad Syed Khurram , Nadeem Asif , Noeman Ahmad , Bukhari Syeda Neelam Yamin , Aziz Zohair
Published: December 2022

Objective: To determine the prevalence of acute gastro-intestinal tract bleeding and the factors associated with it in patients undergoing Primary PCI after acute myocardial infarction.

Study Design: Analytical Cross sectional study.

Place and Duration of Study: Department of Interventional Cardiology, Tertiary Cardiac Care Center, Rawalpindi Pakistan, from May 2021 to April 2022.

Methodology: Five hundred patients (n =500) between 30-80 years of age, presented at the emergency of Tertiary cardiac care center, Rawalpindi and diagnosed with Acute Myocardial Infarction were planned to undergo the Primary Percutaneous Coronary Intervention (PCI) procedure. After the procedure, patients were evaluated for acute gastro-intestinal tract bleeding within first 48 hrs. Blood samples were taken before and after 24 hrs and 72 hrs of primary PCI. The blood hemoglobin level was assessed and fall in its level was noted. SPSS 26 was used to enter and analyze the collected data.

Results: Out of n=500 patients enrolled in the study, 440(88%) were males and 60(12%) were females. The mean age of patients was 64.27 ± 6.47 years. The mean time from symptoms onset to primary PCI was 9.74±5.15 hrs. The mean duration of the procedure was 34.99 ± 6.01 mins. After the procedure, 23(4.60%) patients had developed the acute gastro-intestinal tract bleeding. In patients who developed acute gastro-intestinal bleeding, mean blood hemoglobin level before the procedure was 11.95 ± 1.05 g/dl, which was reduced to 8.46 ± 0.51 g/dl after the procedure. In patients who did not develop it, the mean blood hemoglobin level before the procedure was 11.94±1.03 g/dl, which was reduced to 11.80 ± 1.04 g/dl after the procedure. The blood hemoglobin level after the procedure was significantly less in patients who suffered from acute gastro-intestinal tract bleeding.

Conclusion: The research study concluded that the frequency of acute gastro-intestinal tract bleeding in patients after primary PCI for acute myocardial infarction was very low but on the other hand marked reduction in blood hemoglobin level was observed, which can lead to many adverse sequelae.
Spectrum of Cardiac Arrhythmias During Initial 48 Hours of Acute Myocardial Infarction Patients and their Association with in-Hospital Outcome
Authors: Shiram Syed Ali , Shabbir Muhammad , Rehman Waheed Ur , Ali Jahanzab , Virk Mutahir Abbas , Mehreen Sobia , Ahmed Iftikhar , Imtiaz Areeba , Azad Naseem , Chaudry Azhar Ali
Published: December 2022

Objective: To determine the spectrum of arrhythmias during initial 48 hours of AMI and their impact on the in-hospital outcome.

Study Design: Analytical Cross-sectional study.

Place and Duration of Study: This study was conducted at a Tertiary Cardiac Center of Rawalpindi Pakistan from Jun 2021 till Jan 2022.

Methodology: A total of (n=150) patients of Acute Myocardial Infarction (AMI) undergoing immediate or early revascularization and meeting the inclusion and exclusion criteria were included in the study. They were monitored for arrhythmias during initial 48 hours of hospitalization and their in-hospital outcomes were noted on a predesigned Performa.Chi square test applied for arrhythmia association with adverse outcome at 95% confidence interval and 5% margin of error.

Results: This study comprised (n=117; 78%) males and (n=33; 22%) females. Mean age was 62.9 years. ST elevation MI(STEMI) constituted (n=127; 84.7%) and Non-ST Elevation MI (NSTEMI) (n=23;15.3%) of total patients. Arrhythmias documented in overall (n=122;81.3%) patients, 81.8% (n=104) in STEMI and (n=18; 77.2%) in NSTEMI. Sinus tachycardia(n=52;34.7%) was most common rhythm followed by accelerated idioventricular rhythm (n=20;13.4%) and sinus bradycardia12.7% (n=19). In-hospital mortality was (n=25;16.7%) with p-value=0.009, mostly in patients with ventricular tachycardia/ventricular fibrillation, atrial fibrillationand complete heart block. Other outcomes included (n=23;14.7%) acute left ventricular failure, (n=9; 6%) cardiogenic shock (n=5;3.3%) acute stent thrombosis, (n=2; 1.3%) cerebrovascular accident (CVA)and (n=31; 20.7%) prolonged hospitalization (p-value 0.05).

Conclusion: Arrhythmias are common in acute myocardial infarction during initial 48 hours of presentation with sinus tachycardia being most common followed by accelerated idioventricular rhythm and sinus bradycardia. Arrhythmias are associated with increased in-hospital mortality and adverse outcome.
Maternal and Neonatal Outcomes in Pregnant Patients with Pre-Existing Cardiac Diseases
Authors: Rahman Fahd Ur , Saif Mohsin , Khan Ismail Ahmed , Siddique Muhammad Bilal , Yousaf Husnain , Alam Waqas , Safi Shoaib Iqbal , Khan Aleena , Samore Naseer Ahmed , Azad Naseem
Published: December 2022

Objective: To assess the maternal and fetal outcome in pregnant patients with preexisting cardiac conditions and to determine the prevalence of different cardiac diseases among pregnant patients.

Study Design: This was across sectional study.

Place and Duration of Study: Tertiary Cardiac Care Center in Rawalpindi Pakistan, from Dec 2021 to Apr 2022.

Methodology: This was across sectional study done in a tertiary cardiac care center in Rawalpindi. A total of (n=100) pregnant patients with pre-existing cardiac diseases were included in the study from Dec 2021 to Apr 2022 over a period of 5 months. Prospective data including patients' demographics and their outcomes was collected using preformed proformas. Data was analyzed by SPSS version-23. Prevalence of maternal death, fetal death, maternal complications and neonatal complications were the primary outcomes of study. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α=5%).

Results: A total of (n=100) patients were included in our study which was conducted from Dec 2021 to Apr 2022. Maternal mortality was observed in 6% (n=6) of patients. Maternal outcomes of pulmonary edema were seen in 24% (n=24) of patients and post-partum hemorrhage was seen in 14% (n=14) patients. Three parameters of perinatal outcome were studied i.e., low birth weight, preterm delivery and death. 39% (n=39) neonates were found to have low birth weight, 22% (n=22) were preterm and perinatal mortality was 21% (n=21). The primary results of our study showed 6% (n=6) maternal mortality and 21% (n=21) perinatal mortality.

Conclusion: Overall maternal mortality was 6% while perinatal mortality was 21%. There existed a statistically significant (p<0.05) association of age and neonatal outcome with maternal complications. With proper counseling, some of the avoidable maternal and perinatal deaths can be prevented.
Mitral Annular Disjunction in Mitral Leaflet Prolapse: Prevalence, Clinical Profile and Echocardiographic Features at Tertiary Cardiac Care Centre, Rawalpindi
Authors: Virk Mutahir Abbas , Siddique Muhammad Bilal , Iqbal Usman , Ahmed Sajjad , Shiram Syed Ali , Ahmed Adeel , Shahzad Syed Khurram , Sana Ayesha , Yousaf Hussain
Published: December 2022

Objective: To determine the prevalence of Echocardiographically-recognizable Mitral Annular Disjunction in patients of Myxomatous Mitral Valve Disease/Mitral Leaflet Prolapse.

Study design: Analytical Cross sectional .

Place & Duration of study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD),Rawalpindi Pakistan from Jul 2021 to Sep 2021.

Methodology: A total (n=45) diagnosed patients of Myxomatous Mitral Valve disease, were included through non-probability consecutive sampling. Mitral Annular Disjunction (MAD) was assessed by 2D TTE imaging as the distance between the point of insertion of the posterior leaflet into the left atrial wall (upper boundary of the disjunction) and the link between the left atrium and the left ventricle myocardium (lower border of the disjunction)at end-systole in parasternal long axis view. A distance equal to or greater than 2mm was used as a threshold for diagnosing the presence of MAD. The data analysis was done with the help of computer software programme SPSS version 24.

Results: Total number of patients were 45 patients with males being 32 (71.11%) while females being 13 (28.88%), with a mean age of 30.24 + 5.21 years. MAD was present in 26 (57.8%) of the patients with mean length of 2.88mm + 2.77 mm. Patients with MAD had more chest pain, palpitations and dyspnoea than those without MAD. Mitral regurgitation was more severe in patients with MAD than without. The MAD severity correlated with the presence of Non Sustained Ventricular Tachycardia.

Conclusion: MAD is not an uncommon finding in patients having myxomatous mitral valve disease/mitral valve prolapse........
Comparison of Left Ventricular Ejection Fraction in Heart Failure Patients on Echocardiography, Cardiac Magnetic Resonance Imaging and Single Photon Emission Computed Tomography
Authors: Ahmed Iftikhar , Nadeem Asif , Saeed Nazish , Shiram Syed Ali , Hussain Zahid , Tariq Muhammad Naeem , Kamran Javeria , Mustafa Attiya , Azad Naseem , Shahzad Syed Khurram
Published: December 2022

Objective: To compare the left ventricular ejection fraction on echocardiograph, cardiac magnetic resonance imaging and single-photon emission computed tomography scan in heart failure patients.

Study Design: This was a prospective cross-sectional study.

Place and Duration of Study: Tertiary Cardiac Care Center of Rawalpindi, Pakistan, from Nov 2021 to Apr 2022.

Methodology: This was a prospective cross-sectional study conducted from November 2021 to April 2022 at a tertiary cardiac care center of Rawalpindi. Thirty (n=30) heart failure patients of either gender with reduced ejection fraction were selected by consecutive sampling technique and were analyzed to quantify their left ventricular ejection fraction (LVEF) using Echo, CMR and SPECT scan. All three modalities were used to measure LVEF in these patients and were compared accordingly.

Results: The LVEF measured by Cardiac Magnetic Resonance Imaging, Single Photon Emission Computed Tomography Scan and Echocardiography was in the range of 15% to 67%. The mean LVEF was 37.2±14.2 by CMR, 37.17±14.1 by SPECT and 38±12.3 by Echo. The mean LVEF determined by SPECT was slightly lower while that determined by Echocardiography was slightly higher. The measured p-value of LVEF by the three modalities, however, indicated statistically difference (p-value <0.05).

Conclusion: Although the literature shows diversity in results of these modalities, CMR is considered the standard reference for assessment of LVEF when interpreted by an expert observer. We in our study found that all three modalities are complimentary to each other and can be used interchangeably depending upon the availability of the equipment and reporting expertise of the observers.
In-Hospital Outcome of Early Versus Late Coronary Intervention in Patients Undergoing Thrombolysis after Acute Myocardial Infarction
Authors: Tariq Muhammad Naeem , Samore Naseer Ahmed , Rashid Muhammad Humayoun , Nadeem Asif , Saif Mohsin , Jokhio Abdul Rehman , Azad Naseem , Noeman Ahmad , Yamin Bukhar Syeda Neelam , Chaudhry Azhar Ali
Published: December 2022

Objective: To determine the In-hospital outcome of early versus late coronary intervention in patients undergoing thrombolysis after acute myocardial infarction (STEMI).

Study Design: Analytical Cross sectional study.

Place and Duration of Study: Department of Cardiology, Punjab Institute of Cardiology, Lahore Pakistan from Jul 2021 to Dec2021.

Methodology: Total of (n=100) patients regardless of gender between 30-80 years of age, presented with acute ST-elevated myocardial infarction (STEMI) at emergency room of PIC, Lahore and undergo thrombolysis with a thrombolytic agent after taking the informed consents were selected by a consecutive sampling technique. The demographic information which includes (name, age, gender, H/O diabetes, duration of STEMI) was noted. Then patients were randomly divided in two groups (Group A & B). In Group-A, patients were undergone PCI within 24 hours of thrombolysis. In Group-B, patients were undergone PCI after 24 hours of thrombolysis. Then all patients were followed-up in coronary care units for 07 days. If reinfarction occurs or patient was died during hospital stay, it was recorded. All the information was noted in a preformed structured proforma.

Results: Out of 100 patients, 10 % (n=10) were in age group of 30-45 years and 90 % (n=90) were in age group of 46-80 years. The mean age was calculated as 60.16 ± 7.13 years. There were 90 (90 %) males whereas 10 (10 %) were females. The frequency of Re-Infarction in early Intervention group was 2(2%) and in late Intervention group it was 10%. (p<0.05).The frequency of mortality in early Intervention group was 2 (02%) and in late Intervention group it was 10%. (p< 0.05).Conclusion: Frequency of re-infarction as well as mortality was comparatively low in Intervention group. Therefore, the immediate restoring the patency of occluded coronary arteries can prevent or decrease myocardial damage due to acute myocardial infarction and henceforth, decrease morbidity and mortality..
Renal Artery Doppler as Screening Imaging Modality Required for theEvaluation of Hypertension in Cardiac Patients Experience at Tertiary Cardiac Care Centre
Authors: Israr Afshan , Dildar Nazia , Azmat Sadia , Khan Sara , Nadeem Farrukh , Khan Sehrish Shawrez
Published: December 2022

Objective: To evaluate the efficiency of renal artery Doppler in diagnosis of secondary hypertension among cardiac patients.

Study Design: Analytical Cross-sectional study.

Place and Duration of Study: The present study was performed at Tertiary Care Center, Rawalpindi from Jan 2019 to July 2019.

Methodology: The study comprised of 50 patients with age range of 12-75 years with 90% confidence interval and 10% margin of error with prevalence of hypertension in Pakistan as 26.34%12. The study population included hypertensive patients referred for Doppler assessment of renal artery stenosis (RAS), in order to assess secondary cause of hypertension. The patients underwent angiography of kidneys within 14 days following Doppler assessment of RAS. The positive and negative outcome was presented as frequencies and percentages. The mean age was depicted as means ± standard deviation. The diagnostic features of specificity, sensitivity, negative predictive value and positive predictive values were calculated through a 2x2 table with angiographic findings considered as gold standard.

Results: In only 4(8%) patients bilaterally raised resistive index (RI) were evident. The diagnostic attributes of Doppler showed sensitivity of 48%, positive predictive value of 100% and diagnostic accuracy of 48%.

Conclusion: The role of renal artery Doppler in evaluating secondary hypertension has been over estimated. Thus, its application needs to be restricted for elderly patients to minimize time and cost expenses.
The Predictive Value of CHADS-VASC Score in No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention
Authors: Farahe Ali , Samore Naseer Ahmed , Ali Azhar , Shafique Hafiz Muhammad , Tariq Muhammad Naeem , Shabbir Saddaf , Kamran Javeria , Azad Naseem
Published: December 2022

Objectives: To determine the role of CHADS-VASc Score in predicting No Reflow phenomenon in STEMI patients undergoing primary PCI.

Study Design: Analytical cross-sectional study.

Place and Duration of Study: This study was carried out at a Tertiary Cardiac Care Center from Feb to May 2022.

Methodology: A total of (n = 320) patients who underwent PPCI at Armed Forces Institute of Cardiology from 4th February to 3rd May 2022 were enrolled in this study. Patients were divided into 2 groups, Comparision group with no NRP and NRP group. Descriptive statistics was run to present the categorical data in frequencies and percentages and continuous data in Mean±SD. Chi square test was applied to compare both groups regarding categorical and continuous variables. CHADS-VASc score was also compared in both groups.

Results: Out of (n=320) patients, 80(25%) patients developed NRP. Age, Diabetes, LV EF, history of stroke or TIA, peripheral arterial disease, TIMI thrombus grade, total stented length and CHADS-VASc score were found to be significantly associated with NRP. Binary logistic regression analysis revealed diabetes, LV EF, TIMI thrombus grade, total stented length and CHADSVaSc score to be independent predictors of NRP.ROC analysis revealed a cutoff CHADS-VaSc score of 3 to be a good predictor of NRP (sensitivity 65% and specificity 82%).

Conclusion: CHADS-VASc score can be an important pre PCI tool to predict NRP during primary PCI.
Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement onCardiac Magnetic Resonanace in Patients with Hypertrophic Cardiomyopathy
Authors: Mehreen Sobia , Ahmed Adeel , Sidiqqui Abdul Hameed , Maken Ghulam Rasool , Jokhio Abdul Rehman , Shiram Syed Ali , Kamran Javeria , Saeed Nazish , . Waqar , Khan Ismail Ahmed
Published: December 2022

Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy.

Study Design: Analytical cross-Sectional Study.

Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021.

Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale <0.05 was considered statistically significant.

Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47.

Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients.
Echocardiographic Findings in Hemodialysis Patients in a Tertiary Care Hospital
Authors: Balqees Nayab , Hussain Sajjad , Yusuf Rizwan , Din Mir Jalal-ud- , Ali Jahanzab , Muzaffar Tabasum , Khalil Hafsa , Naseem Shaista , Sana Ayesha
Published: December 2022

Objective: To find out the echo abnormalities in a south Asian cohort on maintenance hemodialysis in a tertiary care hospital.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Combined Military Hospital Abbottabad, from Feb 2022 to Apr 2022.

Methodology: 57 adult patients on maintenance hemodialysis had a non-contrast transthoracic echocardiographic study recording parameters of left and right ventricular systolic and diastolic function.

Results: We had 57 patients. 71.9% (n=41) were male, and females 28.1% (n=16), diabetics 47.4 % (n=27), hypertensives 84.2%(n=48), smoking 28.1% (n=16); 15.8%(n=9) had some form of ischemic heart disease. Left ventricular hypertrophy was noted in 78.9% (n=45) of the entire patient population. 84% (n=48) of hypertensive patients had LVH. Overall, 82% (n=47) of hypertensive patients had some degree of diastolic dysfunction compared to non-hypertensive patients (p<0.0001). Diastolic dysfunction of Grades I, II, III was seen in 35.1%(n=20), 29.8%(n=17), 17.5% (n=10). Mean E/e' ratio was 24.9±15, with 40.3%(n=23) having a value ≥15. The LV systolic dysfunction noted was: Mild 26.3%(n=15), Moderate 19.3%(n=11), Severe 1.8%(n=1). For the medial mitral annular systolic velocity(s’) 19.3%(n=11) had normal s’, while 80.7%(n=46) had reduced s’.The mean Pulmonary artery acceleration time (PA-AT) was was <100 ms in 68.4%(n=39). The mean tricuspid plane systolic excursion (TAPSE) was < 17 mm in 19.3%(n=11) of patients indicating RV systolic dysfunction. The Minimum PASP was 16, max 64, mean 41.5±14mm Hg.

Conclusion: In our study of CKD patients on regular hemodialysis, we found high rates of LVH, DD, LV systolic dysfunction,RV systolic function, and pulmonary hypertension. This creates a case for a larger scale study of these patients in a south Asian cohort as well as institution of a screening program in CKD patients on hemodialysis.
Comparison of Two Techniques of Measuring Activated Clotting Time During Cardiac Surgery
Authors: Alam Waqas , Hussain Syed Aqeel , Ali Muhammad , Akram Muhammad Adnan , Farooq Muhammad Umar , Masroor Rehan , Khalil Hafsa , Sana Ayesha
Published: December 2022

Objective: To compare two techniques of activated clotting time (ACT) measurement by two different devices to evaluate the correlation and agreement between these techniques at different points of time during cardiac surgery.

Study Design: Comparative Cross-sectional Study.

Study settings: Cardiac Anesthesia Department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2022 to Apr 2022.

Methodology: 100 patients undergoing CABG surgery on pump were included by non-probability consecutive sampling technique. Two devices operating on different techniques of measurement were used to measure ACT at four different points of time during surgery. Same sample was used to measure ACT from both devices. Data was collected and analysed by SPSS V.20.0. Pearson's chi square test and paired sample t-test were applied to measure the significance. Linear regression analysis was done to find correlation and Bland Altman plot was used for checking agreement between ACT values from both devices.p-value less than 0.05 was considered significant.

Results: Out of 100, male patients were 79 and female patients were 21. Their mean age was 54.18±11.91 years and mean weight was 79.06±18.49 kg. Moderate positive correlation was found with Pearson r value of 0.55. There was poor agreement between the ACTs measured by two devices. On average Hem R measures ACT 63.54±50.83 seconds higher than Hem JSP. Average mean and median values for Hem R group are 400.03±59.39 sec and 397.75sec respectively and for Hem JSP group are 336.49±44.63 sec and 340.5 sec respectively.

Conclusion: There is moderate positive correlation but poor agreement between the values of ACT measured by Hem R and Hem JSP due to different techniques of measurement so these should not be used interchangeably.
Pre-operative N-Acetyl Cysteine for Prevention of Atrial Fibrillation After CABG Surgery in Pakistan
Authors: Shah Syed Ali Raza Ali , Hasan Kirmani Syed Muzaffar , Hussain Syed Aqeel , Khalil Hafsa , Naqvi Syeda Sarah , Zahra Kirmani Syeda Khursand
Published: December 2022

Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG.

Study Design: Quasi experimental study.

Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months.

Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables.

Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%).

Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.
Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study
Authors: Ain Noor-Ul- , R Hasan Kirmani Syed Muzaffar , Siddique Ayesha , Siddique M Umer , Javaid Rehana , Khan M Aamir
Published: December 2022

Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients.

Study Design: Comparative Cross-sectional study.

Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022.

Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared.

Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress.

Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.
Percutaneous Device Closure of Ductus Arteriosus in a 1.3Kg Baby
Authors: Ara Andaleeb , Mahmood Amjad , Akhtar Khurram , Imtiaz Sana , Ahmed Tufail , Farhan Mohammad Asad
Published: December 2022

Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart diseases. The incidence increases in premature, very low birth weight neonates. Transcatheter closure is a standard procedure for treating PDA.However, in pre-term and very low birth weight neonates it presents special problems thus becoming a limitation in performing the procedure. This case report describes a PDA closure in a 1.3 Kg infant in Armed Forces Institute of Cardiology,Rawalpindi.
Late Post-Operative Complete Heart Block after Ventricular Septal Defect Repair Procedure
Authors: Imtiaz Sana , Akhtar Khurram , Mehmood Amjad , Akbar Hajira , Sadiq Nadeem , Ara Andaleeb
Published: December 2022

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.
Management of an Elderly Patient Via Trans-Catheter Approach for a Post-Cardiac Surgery Aortic Pseudoaneurysm: A Case Report
Authors: Sadiq Nadeem , Iqbal Afsheen , Sami Ashar , Maqsood Sarah , Kamal Dawood , Masroor Rehan , Younas Umair , Akhtar Khurram , Javaid Rehana , Sana Ayesha
Published: December 2022

Pseudoaneurysm of the ascending aorta is a rare but dreadful complication following cardiac surgery and it has more chances of rupturing in elderly females. It occurs as a result of lengthy cardiopulmonary bypass time and associated degenerative changes in old patients. Due to the poor prognosis, early diagnosis and management of this complication is essential. Our case is of a 68-year old female who developed a 44 mm large ascending aortic pseudoaneurysm 7 days after undergoing (coronary artery bypass grafting) CABG for long-standing. (Triple vessel coronary artery disease) TVCAD. The location of the pseudoaneurysm was found to be just above the vein graft to the RCA on (computerized tomography) CT-Aortogram. 2D-Echocardiography showed an Ejection Fraction of 45% and a 22 mm neck of the aneurysmal sac. Trans-catheter device closure was planned and the neck was successfully closed with no residual leak seen on (computerized tomography) CT-Aortogram performed after 3 days. However, she developed cardiac arrest during the device closure and even after successful resuscitation she went into a state of septic shock in the following weeks that did not respond to maximum medical treatment which unfortunately led to her death. A review of 3 similar cases of post-cardiac surgery aortic pseudoaneurysms which were successfully managed via trans-catheter device closure is also discussed. Early diagnosis and interventional treatment of post-cardiac surgery aortic pseudoaneurysms in elderly patients is necessary alongside very careful surgical technique while performing cardiac surgery to minimize the risk of aneurysm formation.
Recording the Door-To-ECG Time for Patients Presenting with Acute Chest Pain to a Cardiac Emergency Unit: A Clinical Audit and Quality Improvement Project
Authors: Sami Ashar , Maqsood Sarah , Iqbal Usman , Safdar Haadia , Khalil Hafsa , Yasir Saad Bin , Khan Aleena , Shafique Hafiz Muhammad , Javaid Rehana , Sana Ayesha
Published: December 2022

Objective: To measure the door-to-ECG time of patients presenting with chest pain at a Cardiac Emergency Unit.

Study Design: Descriptive Cross-Sectional.

Place and Duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease, Emergency Department (ER) from Feb2022 to Apr 2022.

Methodology: A total of 170 patients presenting to the ER with chest pain were reported. Their demographics were entered alongside the nature (cardiac/non-cardiac) and duration of their chest pain after which the time the first ECG strip was drawn till the time it was interpreted by a doctor (Door-To-ECG time) was recorded on a questionnaire. The patients were categorized in 4 different groups based on their ECG findings and were followed till their clinical decisions (PCI/Admission/Discharge/Referral) within the ER were made.

Results: Out of 170 patients, 101(59.4%) had a door-to-ECG time within 10 minutes. Amongst these 101 patients, 23(22.7%)patients were diagnosed with STEMI and shifted for PCI, 15(14.8%) had NSTEMI and were admitted for management,41(40.6%) had cardiac chest pain without ECG changes and were admitted for workup while 22(21.8%) had non-cardiac chest pain and were discharged with out-patient follow-up or referred elsewhere. Non-availability of a bed in the emergency department accounted for the majority (49.3%) of the patients whose door-to-ECG time was more than 10 minutes while a higher ratio of patients that needed to be attended by doctors was identified as the second most common cause of delay(31.9%).

Conclusions: Our findings suggest that the door-to-ECG time recorded for patients at our setup was almost 10 minutes....
Effect of Moderate Exercise Training on Vitals and Peak VO2 in Different Age Categories of Adults in COVID-19 Pandemic
Authors: Saleem Nayab , Sana Ayesha , Murtaza Farah , Ahmed Hina , Saleem Mahrukh , Agha Sharmen , Malik Mubina , . Alveena , Azad Naseem
Published: December 2022

Objective: To determine the effect of moderate exercise training on vitals i-e., Blood pressure (Systolic and diastolic), Pulse Rate(PR), Respiratory Rate(RR) and Peak VO2 in different age categories of adults during COVID-19 pandemic.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: This study was carried out at a tertiary cardiac care center from Feb 2021 to May 2021.

Methodology: It was a descriptive cross sectional study conducted generally for 6 months in tertiary care center. A total of 104 participants were included and divided into three groups i-e., Young adults (17-30 years), Middle age adults (31-45 years) and Old age (>45 years) Participants were selected through non-probability convenient sampling technique and allocated in groups based on their age. Participant, after meeting inclusion criteria were supervised during moderate exercise training which includes walking for 23 minutes, cycling for 23 minutes and stepping for 5 minutes. Participants were assessed Pre and Post through Manual sphygmomanometer for BP, NMQ for muscle discomfort. Borg scale was used to assess exertional level and 6 Minute Walk test to assess Peak VO2.

Results: Post intervention between the groups showed the significant effect on all three assessment factors of VO2,Borg Scale and SBP with Kruskal Wallis test (p<0.05). Post intervention within the group showed significant effect on all three assessment factors of SBP,DBP,PR,RR,VO2 and Borg RPE scale with Friedman test (p<0.05). Post assessment of muscle discomfort shows highest frequency i-e 13.8(4%) in shoulder, thigh, upper and lower back region.

Conclusion: This study reported that disturbed vitals and reduced VO2 due to inactivity because of COVID-19 pandemic. Post COVID-19 affects can be recovered through 6 weeks of moderate training. Furthermore, this study reported that participants belonging to old age showed maximum improvement in vitals in response to training while showed maximum muscle discomfort frequency in shoulder, thigh, lower and upper back
Frequency of Subclinical Atherosclerosis in Patients of Psoriasis
Authors: Awan Sobia , Kiyani Asma , Aman Pooner Fiaz , Fatima Syeda Midhat , Siddiqui Abdul Hameed , Rehman Farid-Ur-
Published: December 2022

Objective: To find out how common subclinical atherosclerosis is in psoriasis patients.

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Dermatology unit of Fauji Foundation, Rawalpindi Pakistan, from Jan 2020 to Jun 2020.

Methodology: After receiving informed consent, 314 cases that met the selection criteria were enrolled. Psoriasis was diagnosed depending on physical examination the family history of patients. Ultrasonography high-resolution B mode was opted to assess carotid atherosclerosis (Xario color Doppler probe frequency 5 to 7mHZ.). If the (IMT) was less than 0.9mm, it was regarded normal; values greater than 0.9mm were termed thickened intima, while digits greater than 1.5mm were considered atherosclerotic plaque. SPSS version 21.0 was used for data analysis.

Results: Age of patients was from 18 to 70 years old, with a Mean±SD (44.00 ±12.12) years. Males made up 47(15%) of the population, while females made up 267(85%). There were 33(10.5%) smokers and 281(89.5%) non-smokers. The mean IMT was 0.84±0.61, with 0.1mm and 2.05mm as the minimum and maximum, respectively. Subclinical atherosclerosis was found in 96 patients (30.6%) (p<0.05). SPSS 21 was used to enter and evaluate the data. Age, BMI, IMT, and disease duration were all expressed as a Mean±SD. Other parameters like gender, smoking, subclinical atherosclerosis be measured by frequency and percentage.

Conclusion: Subclinical atherosclerosis is significantly higher in patients of psoriasis. Early detection and management can help to reduce risks of cardiovascular complications.
MULTIMODALITY AND MULTIMEDIALITY IN THE FRAMEWORK OF CONTEMPORARY PUBLIC DISCOURSE
Authors: SIMONYAN ANI
Published: December 2022

New technologies have changed the nature of public discourse enabling
politicians to use the infinite promotion opportunities offered by
contemporary media and modes of communication, i.e. technological
advancements result in the emergence of new modes aimed at making public
messages more powerful. In this respect, it is essential to discuss political
campaigns, political posters and online platforms which can be illustrative of
the fact how different media and modes of communication can benefit the
candidate if chosen carefully and properly. In terms of political posters,
through the methods of case study, semiotic, linguo-stylistic and multimodal
analyses, the research will be carried out to reveal the use of various modes
used, the differences and similarities in this respect between the chosen
posters. What comes to media platforms, President Biden’s social networking
accounts are under analysis to detect the interaction between media and
multimodal ensemble.