Biography:

Dr Ghanem was qualified in 1974, Mansoura University, Egypt. He obtained his FRCSEd from the royal college of surgeons of Edinburgh in 1983, and MD (Urology) from Mansoura University, Faculty of medicine in 1988, He gained all postgraduate experience in UK where he was promoted in posts up to the consultant level. He practiced as consultant Urologist in UK, Saudi Arabia and Egypt. During his career life he reported over 100 articles of which he made important discoveries in medicine, physiology, urology, nephrology, cardiovascular and surgery. He discovered two new types of vascular shocks, proved that one physiological law is wrong and provided an alternative. He resolved the puzzles of 3 clinical syndromes: the transurethral of the prostate (TURP) syndrome, the loin pain haematuria syndrome (LPHS) and the adult respiratory distress syndrome (ARDS). He is now on the editorial board member and peer reviewer of many medical and surgical journals, Editor-in-Chief of one journal, land he is happily retired in Egypt. He is happily retired in Egypt happily retired in Egypt dedicated to scientific medical reading and writing that helps the practicing physicians to practice precision medicine as well as correctly directing future research.

Abstract:

Abstract

Introduction and objective

To report the complete evidence that Starling's law is wrong, and the correct replacement is the hydrodynamic of the G tube detailed. New physiological evidence is provided with clinical relevance and significance.

Material and methods

The physics proof is based on G tube hydrodynamic. Physiological proof is based on study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema.  The clinical significance is based on 2 studies one prospective and a 23 cases series on volumetric overload shocks (VOS).

Results

Hydrodynamic of G tube showed that proximal, akin to arterial, pressure induces suction "absorption" not "filtration". In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis, The physiological evidence proves that the capillary works as G tube not Poiseuille's tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or albumin. The wrong Starling's law dictates the faulty rules on fluid therapy inducing VOS causing ARDS.

Conclusion                              

Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed. The puzzles of TURP syndrome, Dilution HN and ARDS are resolved.

References

1. Ghanem AN. The Correct Replacement for the Wrong Starling’s law is the Hydrodynamic of the Porous Orifice (G) Tube: The Complete Physics and physiological Evidence with Clinical Relevance and Significance. Research Article.  Cardiology: Open Access Cardio Open, 2020 Volume 5 | Issue 1 | 1-9
2. Ghanem AN and Ghanem, SA.  Volumetric Overload Shocks: Why Is Starling’s Law for Capillary Interstitial Fluid Transfer Wrong? The Hydrodynamics of a Porous Orifice Tube as Alternative. Surgical Science 2016; 7: 245-249. http://dx.doi.org/10.4236/ss.2016.76035
3. Ghanem SA, Ghanem KA, Ghanem A N. Volumetric Overload Shocks in the Patho-Etiology of the Transurethral Resection of the Prostate (TURP) Syndrome and Acute Dilution Hyponatraemia: The Clinical Evidence Based on Prospective Clinical Study of 100 Consecutive TURP Patients. Surg Med Open Access J. 2017: 1(1);1-7
4. Ghanem KA and Ghanem AN. Volumetric overload shocks in the patho-etiology of the transurethral resection prostatectomy syndrome and acute dilution hyponatraemia: The clinical evidence based on 23 case series. Basic Research Journal of Medicine and Clinical Sciences 2017; Vol. 6(4): pp. 35-43
5. Ghanem KA and Ghanem AN. (2017) The proof and reasons that Starling’s law for the capillary-interstitial fluid transfer is wrong, advancing the hydrodynamics of a porous orifice (G) tube as the real mechanism. Blood, Heart and Circ, Volume 1(1): 1-7.  doi: 10.15761/BHC.1000102 Available online.
6. Ghanem KA, Ghanem AN. The Physiological Proof that Starling’s Law for the Capillary-Interstitial Fluid Transfer is wrong: Advancing the Porous Orifice (G) Tube Phenomenon as Replacement. Open Acc Res Anatomy. 1(2). OARA.000508. 2017

Biography:

Sergey Suchkov was born in the City of Astrakhan, Russia, in a family of dynasty medical doctors. In 1980, graduated from Astrakhan State Medical University and was awarded with MD. In 1985, Suchkov maintained his PhD as a PhD student of the I.M. Sechenov Moscow Medical Academy and Institute of Medical Enzymology. In 2001, Suchkov maintained his Doctor Degree at the National Institute of Immunology, Russia.

From 1989 through 1995, Dr Suchkov was being a Head of the Lab of Clinical Immunology, Helmholtz Eye Research Institute in Moscow. From 1995 through 2004 - a Chair of the Dept for Clinical Immunology, Moscow Clinical Research Institute (MONIKI). In 1993-1996, Dr Suchkov was a Secretary-in-Chief of the Editorial Board, Biomedical Science, an international journal published jointly by the USSR Academy of Sciences and the Royal Society of Chemistry, UK.

At present, Dr Sergey Suchkov, MD, PhD, is:

● Professor, Director, Center for Personalized Medicine, I.M.Sechenov First Moscow State Medical University and Dept of Clinical Immunology, A.I.Evdokimov Moscow State Medical and Dental University;

● Professor, Chair, Dept for Translational Medicine, Moscow Engineering Physical Institute (MEPhI), Russia

● Secretary General, United Cultural Convention (UCC), Cambridge, UK.

Dr Suchkov is a member of the:

● New York Academy of Sciences, USA

● American Chemical Society (ACS), USA;

● American Heart Association (AHA), USA;

● European Association for Medical Education (AMEE), Dundee, UK;

● EPMA (European Association for Predictive, Preventive and Personalized Medicine), Brussels, EU;

● ARVO (American Association for Research in Vision and Ophthalmology);

● ISER (International Society for Eye Research);

● Personalized Medicine Coalition (PMC), Washington, DC, USA

● All-Union (from 1992 - Russian) Biochemical Society;

● All-Union (from 1992 - Russian) Immunological Society.

Dr Suchkov is a member of the Editorial Boards of “Open Journal of Immunology”, EPMA J., American J. of Cardiovascular Research and “Personalized Medicine Universe”

Abstract:

A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized and precision medicine (PPM). To achieve the implementation of PPM concept, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of biomarkers of hidden abnormalities long before the disease clinically manifests itself.

Each decision-maker values the impact of their decision to use PPM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients resulting in improved patient outcomes, reduced adverse events, and more cost effective use of the latest health care resources including diagnostic (companion ones), preventive and therapeutic (targeted molecular and cellular) etc. A lack of medical guidelines has been identified by responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PPM! Implementation of PPM requires a lot before the current model “physician-patient” could be gradually displaced by a new model “medical advisor-healthy person-at-risk”. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PPM to elicit the content of the new branch.

Biography:

Segundo Mesa Castillo. As Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba.  He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990.

Abstract:

Abstract
There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed  to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.

Biography:

Seema Jaga completed her M.D. from Medical University of Sofia. She is currently a second year Internal Medicine resident at Largo Medical Center with aspirations of becoming a Cardiologist

Abstract:

Abstract
Idiopathic chylopericardium is a rare clinical condition that consist of pericardial effusion composed of high concentrations of triglycerides known as chyle. It may occur as a result of chest trauma, mediastinal neoplasms, mediastinal tuberculosis, mediastinal radiotherapy, and thrombosis of the subclavian vein or can be idiopathic. We hereby present a case that illustrates a healthy female fitness trainer in her 50s who presented with dyspnea that progressively worsened to the point where she was referred to a Cardiologist. Subsequently, chylopericardium was diagnosed with pericardiocentesis. She successfully responded to two and a half weeks of continuous drainage and low fat diet. It has only been a month since discharge. In conclusion, this case demonstrates an rare condition to help elucidate medical literature.

Biography:

Dr Shivaji Bikram Silwal is a Cardiologist working at Norvic International Hospital, Kathmandu (as Consultant Interventional Cardiologist) and Scheer Memorial Hospital Banepa (as Head, Department of Cardiology). He holds Master degree in Cardiology from Sun Yat-Sen University, China and has obtained interventional cardiology training from Medanta, The Medicity Hospital, New Delhi. He is one of the best known cardiologists in the country in the field of cardiac intervention. He has contributed significantly in the prevention of heart diseases in Nepal by increasing public awareness on cardiovascular diseases and associated risk factors.

Abstract:

Abstract
ThapaKeywords: Tenecteplase, Coronary Angiography, Percutaneous Coronary intervention, Thrombolysis

Corresponding Author: Dr. Shivaji Bikram Silwal, Consultant Cardiologist,

Head, Department of Cardiology , Scheer Memorial Hospital, Banepa, Kavre

BACKGROUND: In the absence of contraindications, fibrinolytic therapy is administered to ST-elevation MI (STEMI) patients with symptom onset within 12 hours after diagnosis of STEMI in partly limited availability of primary percutaneous coronary intervention (PCI) hospital. Reperfusion treatment in acute STEMI represents the main indication for thrombolytic therapy in a community hospital set up.

OBJECTIVE: To study newer fibrin specific thrombolytic agent for the management of acute STEMI.

RESULT: In our study, we had 38 patients presented to the emergency department of Scheer Memorial Hospital and were diagnosed as STEMI presented within the window period. Among 38 patients, 18 were male (37-80 years) and 11 were female (45-82 years). All patients were in killips class I-II. They did not have any contraindications for thrombolysis. Informed consent was obtained. They were thrombolysed with tenecteplase (TNKase) according to body weight. Successful thrombolysis was observed with post TNKase (after 90 minutes). Electrocardiograms were recorded to those patient treated. Successful thrombolysis was observed in both genders. Nine patients underwent coronary angiography (CAG) soon after thrombolysis. Out of nine CAG, three patients had single vessel disease, two normal CAG and four unknown. Three patients with complete heart block were sent to cardiac centre following TNKase. Three died in the hospital ICU. Four patients (> 75 years) had COPD, Pneumonia. Twenty-one patients are still living comfortably with LVEF: > 45%. Two died after two years follow up. Six patients are living with LVEF: <30%. Details of five patients could not be obtained. None of the patients had intracranial bleeding.

CONCLUSION: TNKase appears to be effective and well tolerated in the management of STEMI. TNKase is associated with reduced risk of major bleeding in patient treated for STEMI and has higher thrombolytic potency. TNKase is easy to administer and can be used in community hospital. The entire bolus dose is delivered over five seconds; no second dose is required, and gives very competitive result that can be expected for majority of patients present in first three hours of ACS at community hospital. TNkase offers timely reperfusion in community hospital to prevent the catastrophe in STEMI

Biography:

Mohammadali has completed his MSc at the age of 25 years from University College London. He is currently studying medicine at European University Cyprus. His aim is to increase awareness about the potential capacities of fast-growing topics in regenerative heart researches

Abstract:

Abstract
Zebrafish is widely becoming more and more useful model to study heart regeneration due to fast re-growing of both myocardial and epicardial cells. Therefore, the regenerative capacity and such genetic tractability in zebrafish encouraged scientists to use this model for their stud-ies. The cheap supply of zebrafish for laboratories also add another reason to use zebrafish rather other animal models.

A new transgenic zebrafish line model added a new approach to understand the underlying signalling pathways requiring for cardiac regeneration. Therefore, this model also provided an extensive genetic fate map for cardiac cell arrangement during cardiac regeneration.

Here in this review, the attempt has been made to elucidate three major injury models in zebrafish and analysing how zebrafish model can potentially become a permanent solution for establishing a new platform for cardiac regenerative medicine

Biography:

Michela Martinuzzi is a medical student at King’s college London who previously completed an intercalated BSc in Medical sciences with management at Imperial College London.

Abstract:

Background.

Echocardiography is a key diagnostic investigation used for many cardiac conditions. Significant delays in the availability of echocardiogram findings and a backlog of echocardiograms requests, were identified as having an impact on clinical decision making in a focused questionnaire delivered to doctors and echocardiographers on a cardiac ward in a district general hospital in London, UK.

Aim. This quality improvement project aimed to expedite delivery of key echocardiogram information to doctors by applying two strategies; 1) introduce a provisional report, and 2) reduce the number of referral requests by implementing a new echocardiogram triage system.

Methods: Baseline data were gathered during a 9-week period aimed at understanding and calculating the median time needed to order, perform and report an echocardiogram, as well as monitoring the total number of echocardiogram requests made. The first intervention (strategy 1), lasting 6 weeks, involved a provisional report (PR) containing key clinical information such as left ventricular function and, if present, any valvular, wall motion or any other relevant abnormalities.   This was then given by echocardiographers to doctors soon after an echocardiogram was completed.  The number of requests, rate of PR uptake and the time from echocardiogram completion to PR availability were monitored during this period.

A second intervention (strategy 2), aimed at reducing unnecessary requests, was implemented 4 weeks after the conclusion of the first intervention and it involved a consultant cardiologist triaging the echocardiogram requests daily, for a 6-week period. The number of requests, procedures and the time from referral to full report availability were again monitored. Semi-structured questionnaires were proposed to doctors (FY2 to consultant level) in cardiac wards at the beginning and end of both cycles to explore participants’ subjective opinion.

We enhanced staff motivation and adherence through visual aids on wards and stakeholder involvement through regular weekly meetings and constant feedback.

Results:

The provisional report (PR) reduced the median time for key information to be available to clinicians from 227 to 48.5 minutes, without negatively affecting the time needed to obtain a full report. However, uptake of the PR varied widely across the intervention window being at best, 40% of the total number of echocardiograms performed.

Triaging resulted in a decrease in the median number of referrals per week, from 47 to 27.5, and a reduction from 2.73 days to 1.87 days in the median time from referral to full report availability. The results were stable across the observation window.

62% of interviewed doctors reported they noticed improvements in speed of echocardiogram information delivery after strategy 1 which increased to 71% after the application of strategy 2.  87% of participants felt strategy 1 and 71% felt strategy 2 improved patient outcomes and timely discharge.

Biography:

Assistant Professor Maja Karaman Ilić, M:D:, Ph.D

In 2011. I received my Ph.D. from the Zagreb University School of Medicine.

In 2018. I was elected Assistant Professor at Faculty of Medicine, JJ Strossmayer University of Osijek, Croatia.

Since 2019 I have been working at Radiochirurgia Sveta Nedjelja,Croatia as an expert in anesthesiology, resuscitation and intensive care.

Some of my papers were published in reputed journals. Since 2017. I am an invited speaker on Cardiologists conference in Paris 2017. , Barcelona 2018., and Rome in June 2019.                                                                                                

Abstract:

Abstract
Aim

Prevention of post-operative cardio-respiratory deterioration in cardiac and non-cardiac patients who have undergone non cardiac surgical procedure  due to perioperative fluid overload.

Introduction

Induction in general anesthesia (GA) drives patients in hypotension.

Vasodilation, particularly veno-dilatation, is the primary cause of relative hypovolemia produced by anesthetic drugs. Relative hypovolemia is a consequence of increased venous compliance, decreased venous return and reduced response to vasoactive substances. Maintenance of adequate cardiac output (CO) and arterial blood pressure are vital for preserving tissue perfusion and oxygen delivery (DO2).To preserve CO and adequate organ perfusion, anesthesiologists may chose between liberal perioperative fluid approach and a restrictive one with small dose of vasoactive drugs. Each choice carries its own risks. In general, a liberal perioperative volume replacement strategy  is more common choice. As a consequence of selected therapy,  fluid overload is often seen. The clinically most significant complication of excessive volume is ”Lung -Swelling” respectively - pulmonary edema.

Standard monitoring that includes clinical exam, chest X ray, oxygen saturation of peripheral blood (SpO2) and blood lactate level lacks sensitivity and specificity for pulmonary edema diagnose. Additionally, those are late indicators of tissue and organ hypo-perfusion.

Lung ultrasound provides high diagnostic sensitivities and specificities in detecting various lung pathologies: interstitial syndrome (interstitial sy), pneumothorax and alveolar consolidation. Interstitial sy represents a variety of clinical situations, including pulmonary edema, respiratory distress syndrome,pneumonia and interstitial diseases. Due to the development of pulmonary edema, transition of A-profile (normal lung ultrasound finding) to B-profile (that is specific for interstitial sy) occurs.This findings enable us to act therapeutically  even before the late indicators of cardio-respiratory deterioration appear.

Conclusion

Lung ultrasonography is a helpful, non-invasive method for early detection and treatment of perioperative fluid overload.

Reference

Anthony Mclean,Stephen Huang.Lung and pleural ultrasound. In: Critical Care Ultrasound Manual.Chatswood,NSW:Elsevier Australia, 2012;126-134.

Biography:

Friederike Seggewies has earned her medical degree at the Medical University Graz, Austria. She started her work carreer at the University Hospital Eppendorf, Germany in the position of a resident physician at the pediatric cardiology (Head of the department: PD Dr. Kozlik-Feldmann). After 2 years of experience in cardiology she amplified her knowledge in pediatric metabolic medicine at the University Hospital Eppendorf, Germany (Head of the department: Prof. Dr. Ania Muntau).  In 2019 she did a metabolic observership at the Great Ormond Street Hospital, London, where she got to know Dr. Grunewald. With her she worked on the above-mentioned project.

Abstract:

Abstract
Background:

MADD results in deficient electron transfer from FAD-dependent dehydrogenases to the mitochondrial respiratory chain. The riboflavin non-responsive phenotype presents as a potential neonatal life-threatening disorder complicated by severe acidosis, hyperammonemia, hypoglycemia and seizures. Early severe cardiomyopathy is frequent and only very few patients are known to have reached adulthood as the treatment of this disorder is very difficult. Orally supplemented OHB is an additional treatment option to be considered in severe cases.

Case study:

We report on 2 cousins (now 18 and 19 years old) with enzymatically and genetically confirmed riboflavin non-responsive MADD. There is a strong family history of severe MADD: 4 siblings died in neonatal period. Both cousins developed a neonatal life-threatening cardiomyopathy unresponsive to conventional treatment. After commencing OHB, the cardiac contractility showed progressive and sustained improvement. The elder cousin presented with a prolonged out-of-hospital cardiac arrest presumed secondary to ventricular arrhythmias in association with cardiomyopathy at the age of 12 years. He was successfully resuscitated. As a preventive measure, both children underwent an implantable cardioverter-defibrillator (ICD) insertion. The younger cousin needed MitraClip placement at the age of 18 years, because of severe mitral valve regurgitation on a background of a longstanding history of left atrial enlargement.

Discussion:

Early and long-term treatment with OHB is a promising lifesaving therapeutic add-on option for patients with severe MADD. It has ameliorated the potentially lethal outcome in our patients. However the risk of long term complications, particularly cardiac life-threatening events including arrhythmias and cardiomyopathy necessitate careful monitoring and management.

Biography:

Dr. Ananda G.C, Chitwan Medical College, Bharatpur, Chitwan, Nepal

Abstract:

Introduction:

Rheumatic heart disease is one of the most common heart diseases in developing country. One of the most common complications of Rheumatic Heart Disease is Mitral Stenosis which ultimately lead to pulmonary hypertension and heart failure and death. So, PTMC (Percutaneous Transluminal Mitral Commissurotomy) is a well-established simple, effective, and safe therapeutic intervention for mitral stenosis.

While many literatures reviewed till date have shown that it takes 3-6 months’ time period for the reduction of pulmonary artery pressure after PTMC, this study is designed to see the result in pulmonary artery pressure immediately after procedure.

Method

Total 42 patients with Rheumatic Mitral Stenosis in Cath Lab under Department of Cardiology of Chitwan Medical College from October 1 2018 to August 30 2019 were included in the study. Pulmonary artery pressure was assessed by Right heart catheterization by using multipurpose /pigtail catheter under conscious sedation.

Results

It is a prospective observational study on a total of 42 patients who underwent PTMC, 30 were female and 12 were male. Age ranged from 30 to 61 years with the mean age of 45.36±10 years. The mean mitral valve area increased from 0.87±0.2 cm2 to 1.74±0.17 cm2 whereas Mean Pressure Gradient decreased from 13.59± 7.30 mmHg to 5.15±30 mmHg. Mean Pulmonary Artery Pressure decreased from 41.50 ±16.00 mmHg to 33.50±12.00 mmHg. Similarly, the mean left atrial pressure decreased from 26.57±8.62 mmHg to 15.50±5.95 mmHg whereas, the mean Aortic Pressure increased from 91.43 ±23.02 mmHg  to  98.29±24.92 mmHg . Eighteen (42.85%) patients had an increase in MR by 2 grades but there is no need of immediate mitral valve replacement. During procedure, paroxysmal PSVT was noted in six (14.285%) patients and also local hematoma was observed in five (11.90%) patients.

Conclusion

There is reduction in pulmonary artery pressure immediately post PTMC which is directly correlated with left atrial pressure without significant MR and tachycardia.

This study is limited in terms of single center with small sample size.

Biography:

Dr Shradha Satish Runwal has completed her MBBS, M.D in General Medicine from Government Medical College and Hospital, Aurangabad, India. She is currently working as 3rd D.M. Cardiology Resident under Professor Dr.Tejas M.Patel at SVP Hospital, Ahmedabad, India

Abstract:

INTRODUCTION:

Reperfusion therapy has become the mainstay for the treatment of acute myocardial infarction with the goal of restoring flow in the occluded infarct-related artery and thus potentially salvaging ischemic myocardium.1 However, reperfusion has been referred as a double edged sword because reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone. This results in a spectrum of reperfusion associated pathologies, collectively called as reperfusion injury.2 Reperfusion arrhythmias are an important noninvasive marker of successful recanalization of infarction related coronary artery. However they are also a sign of reperfusion injury and a finding which may limit the favourable effect of reperfusion.3

AIM:

To study the course of ECG rhythm changes during and within six hours of thrombolysis in patients of acute myocardial infarction.

OBJECTIVE: To analyse the prevalence of various arrhythmias within six hours of thrombolysis in patients of STEMI.

INCLUSION CRITERIA:

All patients presenting to intensive cardiac care unit of our tertiary care centre with acute STEMI within 2 years of study.

EXCLUSION CRITERIA:

Patients with previous history of myocardial infarction, pericarditis, valvular heart disease, pacemaker device.

MATERIAL AND METHODS :

Every 4th patient of acute onset STEMI presenting to our tertiary care centre thrombolysed with  Inj. Streptokinase (15 lac U IV over 1 hour) was monitored for arrhythmias using Holter monitor during and within 6 hours of thrombolysis. A total of 200 patients were studied. It was a cross sectional study. Statistical analysis was done using Chi Square test .P value <0.005 was considered statistically significant.

RESULTS:

In this study of 200 cases, the prevalence of arrhythmias was 84%.

The mean age of patients with ST elevation myocardial infarction was 57.01±12.37 years. Occurrence of idioventricular rhythm and monomorphic couplets was significantly more between 41-70 years of age group (p<0.0001).

The prevalence of arrhythmias was 83.09% in males and 85.94% in females. No significant relationship was observed between gender and type of arrhythmia except ventricular tachycardia which was significantly more common in females.

Ventricular premature complexes (VPCs) were observed in 84% cases. Most common arrhythmia in both genders was idioventricular rhythm, followed by nonsustained ventricular tachycardia.

Diabetes, hypertension, tobacco, and alcohol consumption did not increase the risk of arrhythmias in a statistically significant way. Ventricular tachycardia (75%) and sinus tachycardia (58.3%) were more common in anterior wall infarction, but the difference was not statistically significant. Complete heart block (87.5%) and sinus bradycardia (64.7%) were more common in inferior wall infarction, but the difference was not statistically significant. Most common arrhythmia in patients of both anterior and inferior wall MI was idioventricular rhythm followed by nonsustained ventricular tachycardia.

Biography:

Dr Naveed has completed his MBBS at the age of 25 years from Liaquat University of Medical Health Sciences,Jamshoro Hyderabad, Pakistan and postdgraduate studies from National Institute of Cardiovascular Diseases Karachi. He is the Clinical Fellow of Adult Cardiology. He is also certified BLS and ACLS Instructor from AHA in College of Physicians and Surgeons in Pakistan

Abstract:

Introduction:

Increased ratio of Triglyceride (TG)/ High-density Lipoprotein (HDL) has been known as an accompanying finding in conditions like obesity and metabolic syndrome. Therefore, the aim of this study was to assess the utility of TG/HDL ratio as a diagnostic tool for the assessment of coronary artery disease (CAD).

Methods:

This study was conducted at a semi-private hospital Karachi; patients above 15 years of age and undergone angiography or PCI were included. Patients with Congenital Heart Disease and familial hyperlipidmeia were excluded. TG/HDL ratio was obtained for all patients, severity of the disease was classified as normal, mild to moderate, moderate to severe, and very severe based on coronary angiography. Analysis of variance was applied to assess significant differences in mean TG/HDL ratio among severity of disease. P-value<0.05 was considered significant.

Results: 

A total of 2,212 CAD patients were reviewed out of which 1613 (72.9%) were male and 599 (27.1%) were female. Average age of the patients was 55.12 years (±SD=9.93). Of these 2212 patients, 533 (24.1%) had very severe disease, 1213 (54.8%) had moderate to severe disease, 258 (11.7%) had mild to moderate disease, and 208 (9.4%) were normal. A Significant and an increasing trend was observed in TG/HDL ratio with the severity of disease (p=0.0001) Statistically significant difference was observed in the TG/HDL ratio of patients with mild to moderate, moderate to severe and very severe disease from normal patients. However, no statistically significant difference was seen in the TG/HDL ratio between the patients with moderate to severe and very severe disease.

Conclusions:

A positive relationship between Triglyceride to HDL Ratio and severity of coronary artery disease was observed. Therefore, TG/HDL ratio can be used as an indicator of severity of coronary artery disease in addition to other parameters of lipid profile

Biography:

DR ABDUL MUEED, have completed fellowship in cardiology from college of physician and surgeon of Pakistan in 2016, and than second fellow ship in cardiac electrophysiology in 2019. Age 35. Have also presented in APHRS BANGKOK 2019.

Currently working as assistant professor , in NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES, TANDO MUHAMMAD KHAN

Abstract:

INTODUCTION :

Heart failure (HF) is the leading cause of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission for patients in the Pakistan and worldwide. . Despite this recent attention to HF readmission, we know relatively little about its actual causes.[2 ]despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmissions. National Institute Of Cardiovascular Diseases, NICVD is a tertiary care hospital, which is one of the biggest cardiac care unit, with all the cardiac modalities under one roof. Therefor this is the most appropriate institute to study the reason of readmission of heart failure patient, and its impact resource used in term of hospital stay. The purpose of our study was to systematically investigate patient perspectives about the reasons for their readmission following a hospital discharge for HF. And to study than what could be done to improve the system to decrease the number of readmission in cost effective way.

METHOD:

Patients were recruited for this study were admitted to national institute of cardiovascular diseases, through emergency. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study.  Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital. . Interview was conducted by heath care professional, fellow cardiology in training who have in depth knowledge of heart failure management and its care. . Detail was taken for medication included beta blocker, ACEI dose at the time of discharge, whether it was maximize to optimum tolerated dose or not compliance to medication. Proper counseling of patient disease and care was given or not.

RESULT:

We recruit patients over the period of 3 month form June 2019 till august 2019, all patients were admitted to hospital from emergency room. For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischemic cardiomyopathy 400 (80%). No death recorded. Common reason for readmission , lack of counseling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%).

CONCLUSION:

Heart failure readmission is increasing now days which are financial burden on hospital and patient, and also the extra use of resources which can be easily control taking certain measure by physician and patient. For patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements to care off according to this study which can be improve with psychotherapies and proper counseling session. For physician side proper information and detail discussion should be done with patient at the time of diagnosis. With each follow up visit symptom assessment and according to which dose adjust is very necessary to reduce the readmission.

Small steps can really make a big difference in the quality of life of patient we should take it.

Biography:

Aniruddha Singh is a key cardiology faculty at the University of Kentucky (UK) in Bowling Green. He is the chairman of the local research foundation (WKHL-RF) and is actively conducting research activities for the medical students, residents, and fellows. He is also the research assistant professor of Medicine at Vanderbilt University and is currently the PI for two multicenter randomized control trials. Dr Singh is also the internal medicine clerkship director for the 3rd year medical students at UK school of Medicine.

Abstract:

COVID-19 may contribute to delayed presentations of acute myocardial infarction. Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes. Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19.  Also, standardized personal protective equipment (PPE) precautions are established for all members of the team, regardless of pending COVID-19 testing which might further add to delays.

We compared performance measures and outcomes of all patients who presented to our facility with ST elevation myocardial infarction (STEMI) during the COVID-19 pandemic to same time cohort from 2018 and 2018. There was a trend towards longer time interval from symptom onset to first medical contact (FMC) and time to first electrocardiogram (ECG) in the COVID-19 group. Peak troponin levels were significantly higher in the COVID-19 group (p 0.04). The likelihood of an in-hospital MACE was significantly higher among the COVID-19 group with 20% (3 of 16) patients experiencing an in-hospital MACE, while none occurred among the matched group (x2 = 5.82, df = 1, p = 0.02). 

This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which is translating into worse clinical outcomes.

Biography:

Dr Shradha Satish Runwal has completed her MBBS, M.D in General Medicine from Government Medical College and Hospital, Aurangabad, India. She is currently working as 3rd D.M. Cardiology Resident under Professor Dr.Tejas M.Patel at SVP Hospital, Ahmedabad, India

Abstract:

Biography:

Dr Shradha Satish Runwal has completed her MBBS, M.D in General Medicine from Government Medical College and Hospital, Aurangabad, India. She is currently working as 3rd D.M. Cardiology Resident under Professor Dr.Tejas M.Patel at SVP Hospital, Ahmedabad, India

Abstract:

INTRODUCTION:

Reperfusion therapy has become the mainstay for the treatment of acute myocardial infarction with the goal of restoring flow in the occluded infarct-related artery and thus potentially salvaging ischemic myocardium.1 However, reperfusion has been referred as a double edged sword because reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone. This results in a spectrum of reperfusion associated pathologies, collectively called as reperfusion injury.2 Reperfusion arrhythmias are an important noninvasive marker of successful recanalization of infarction related coronary artery. However they are also a sign of reperfusion injury and a finding which may limit the favourable effect of reperfusion.3

AIM:

To study the course of ECG rhythm changes during and within six hours of thrombolysis in patients of acute myocardial infarction.

OBJECTIVE: To analyse the prevalence of various arrhythmias within six hours of thrombolysis in patients of STEMI.

INCLUSION CRITERIA:

All patients presenting to intensive cardiac care unit of our tertiary care centre with acute STEMI within 2 years of study.

EXCLUSION CRITERIA:

Patients with previous history of myocardial infarction, pericarditis, valvular heart disease, pacemaker device.

MATERIAL AND METHODS :

Every 4th patient of acute onset STEMI presenting to our tertiary care centre thrombolysed with  Inj. Streptokinase (15 lac U IV over 1 hour) was monitored for arrhythmias using Holter monitor during and within 6 hours of thrombolysis. A total of 200 patients were studied. It was a cross sectional study. Statistical analysis was done using Chi Square test .P value <0.005 was considered statistically significant.

RESULTS:

In this study of 200 cases, the prevalence of arrhythmias was 84%.

The mean age of patients with ST elevation myocardial infarction was 57.01±12.37 years. Occurrence of idioventricular rhythm and monomorphic couplets was significantly more between 41-70 years of age group (p<0.0001).

The prevalence of arrhythmias was 83.09% in males and 85.94% in females. No significant relationship was observed between gender and type of arrhythmia except ventricular tachycardia which was significantly more common in females.

Ventricular premature complexes (VPCs) were observed in 84% cases. Most common arrhythmia in both genders was idioventricular rhythm, followed by nonsustained ventricular tachycardia.

Diabetes, hypertension, tobacco, and alcohol consumption did not increase the risk of arrhythmias in a statistically significant way. Ventricular tachycardia (75%) and sinus tachycardia (58.3%) were more common in anterior wall infarction, but the difference was not statistically significant. Complete heart block (87.5%) and sinus bradycardia (64.7%) were more common in inferior wall infarction, but the difference was not statistically significant. Most common arrhythmia in patients of both anterior and inferior wall MI was idioventricular rhythm followed by nonsustained ventricular tachycardia.

The occurrence of idioventricular rhythm and non sustained ventricular tachycardia was significantly higher between 5-6 hours and first three hours after start of thrombolysis. The occurrence of monomorphic couplets and polymorphic couplets, ventricular bigeminy was significantly higher in first two hours after onset of thrombolysis and decreased thereafter(p<0.0001).

CONCLUSION:

Idioventricular rhythm is the most common arrhythmia after thrombolysis in acute MI. The occurrence of monomorphic couplets and polymorphic couplets, ventricular bigeminy was significantly higher in first two hours after onset of thrombolysis and decreased thereafter.