Cardiology Commons^™

Pseudocystic Myxoid Liposarcoma Of The Posterior Chest Wall - A Rare Case Report, Saad Shakil, Sareema Eman Akhtar, Mahum Zaidi, Rizwan Ajmal, Abdulla K. Alsubai, Rahul Ramtohul, Absam Akbar, Aysa Tabassi, Aylin Tabassi, Talal Almas

Medical College Documents

Introduction and importance: Liposarcoma (LPS) is a common soft-tissue sarcoma predominantly diagnosed in adults, arising from malignant adipose cells. Among its various subtypes, myxoid LPS (MLPS) stands out as the second most frequent, accounting for ~30% of all LPS cases. This particular subtype typically manifests in males between the ages of 40 and 50 and is commonly found in the lower extremities. Although rare, MLPS may also occur in the head, neck, and infrequently in the back. Chest wall LPS cases are also sparsely reported.
Case presentation: In this report, we present a case of MLPS in a 69-year-old male …

Methodological Analysis Of A Community-Based Training Initiative Using The Epis Framework: An Ongoing Initiative To Empower 10 Million Bystanders In Cpr And Bleeding Control, Asma Altaf Hussain Merchant, Sheza Hassan, Mirza Noor Ali Baig, Huba Atiq, Sana Mahmood, Adil H. Haider, Zia Ul Haq, Deeba Shehnaz, Rizwan Naseer, Junaid Razzak

Medical College Documents

Background: Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yielded positive results in high-income countries, the same has not been replicated in low and middle-income countries (LMICs) due to resources constraints. This article describes a replicable implementation model of a nationwide program, aimed at empowering 10 million bystanders with basic knowledge and skills of hands-only cardiopulmonary resuscitation (CPR) and bleeding control in a resource-limited setting.
Methods: Using the EPIS …

Effectiveness Of Non-Invasive Respiratory Support Strategies In Patients With Covid-19: A Systematic Review And Meta Analysis, Vinesh Kumar, Umair Arshad Malik, Reshman Kumari, Berkha Berkha, Vijay Kumar, Manoj Kumar, Simran Simran, Suman Suman, Bushra Nasim

Medical College Documents

Background: The effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established.
Methods: A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was …

The Impact Of The Covid-19 Pandemic On The Career Choice Of Medicine: A Cross-Sectional Study Amongst Pre-Medical Students In Pakistan, Raisa Saleh, Russell Seth Martins, Muhammad Saad, Asad Saulat Fatimi, Manzar Abbas, Inaara Akbar, Hamzah Jehanzeb, Shamila Ladak, Shamama Kaleem, Sarah Nadeem

Medical College Documents

Background: The COVID-19 pandemic has significantly affected the lives of healthcare workers due to the frontline nature of their work. Their hard work and sacrifice have forged new perceptions of healthcare workers. These changes may potentially influence students' interest in medicine. This study explores how the COVID-19 pandemic has affected premedical students' decisions to pursue medicine as a career.
Methods: A cross-sectional study using a self-designed online questionnaire was carried out amongst pre-medical students across Pakistan.
Results: A total of 1695 students from 93 public and private schools filled in the survey. After the onset of the COVID-19 pandemic, significantly …

Statins: Masked Anti-Epileptic Warriors, Govinda Khatri, Priya Kotak, Ayush Kumar, Mohammad Mehedi Hasan

Medical College Documents

No abstract provided.

Protocol For A Cluster Randomised Controlled Trial Of Secondary Distribution Of Hepatitis C Self-Testing Within The Context Of A House-To-House Hepatitis C Micro-Elimination Programme In Karachi, Pakistan, Sonjelle Shilton, Dania Ali, Alyia Hasnain, Adeel Abid, Jessica Markby, Muhammad S. Jamil, Niklas Luhmann, Pamela Nabeta, Stefano Ongarello, Saeed Hamid

Medical College Documents

Background: Globally, just 21% of the estimated 58 million people living with hepatitis C virus (HCV) know their status. Thus, there is considerable need to scale-up HCV testing if the World Health Organization (WHO) 2030 hepatitis elimination goals are to be achieved. HCV self-testing may assist with this; however, there are currently no data on the real-world impact of HCV self-testing. With an estimated 5% of the general population living with HCV, Pakistan has the second highest HCV burden in the world. This study aims to evaluate the acceptability and impact of home delivery of HCV self-testing for secondary distribution …

Etiology, Clinical Characteristics, And Outcome Of Infective Endocarditis: 10-Year Experience From A Tertiary Care Center In Pakistan, Sara Salim Ali, Imran Ahmed Qureshi, Ahmed Ayaz, Ainan Arshad, Awais Farhad, Bushra Jamil, Muhammad Rizwan Sohail

Medical College Documents

This study was conducted to assess the clinical characteristics, causative agents, complications, and outcomes of infective endocarditis (IE) among patients presenting to our tertiary care center over the last decade. This retrospective cohort study included all adult patients admitted to the Aga Khan University Hospital with the diagnosis of IE over a ten-year period from 2010 to 2020. Outcomes variables included complications during hospitalization, surgical intervention, mortality, and length of stay. We identified a total of 305 cases out of which 176 (58%) were males and 129 (42%) were females. The mean age of the patients was 46.9±18.8 years. 95 …

Efficacy And Safety Of Direct Oral Anticoagulants With And Without Aspirin: A Systematic Review And Meta-Analysis, Talal Almas, Adeena Musheer, Arooba Ejaz, Fahd Niaz Shaikh, Anousheh Awais Paracha, Fizza Raza, Maryam Sarwar Khan, Fahad Masood, Faiza Siddiqui, Muhammad Hasnain Mankani

Medical College Documents

Background: Various anticoagulant therapies are prescribed to patients under physicians' discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin.
Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized controlled …

Epidemiology, Clinical Ramifications, And Cellular Pathogenesis Of Covid-19 Mrna-Vaccination-Induced Adverse Cardiovascular Outcomes: A State-Of-The-Heart Review, Talal Almas, Sarah Rehman, Eyad Mansour, Tarek Khedro, Ali Alansari, Jahanzeb Malik, Norah Alshareef, Vikneswaran Raj Nagarajan, Abdulla Hussain Al-Awaid, Reema Alsufyani

Medical College Documents

The coronavirus disease 2019 (COVID-19) has overwhelming healthcare systems globally. To date, a myriad of therapeutic regimens has been employed in an attempt to curb the ramifications of a severe COVID-19 infection. Amidst the ongoing pandemic, the advent and efficacious uptake of COVID-19 vaccination has significantly reduced disease-related hospitalizations and mortality. Nevertheless, many side-effects are being reported after COVID-19 vaccinations and myocarditis is the most commonly reported sequelae post vaccination. Majority of these diseases are associated with COVID-19 mRNA vaccines. Various studies have established a temporal relationship between these complications, yet the causality and the underlying pathogenesis remain hypothetical. In …

Radial Artery Coronary Bypass Grafting: Surgical Outcomes Of An Unexplored Innovation In A Developing Country, Russell Seth Martins, Laiba Masood, Mabrooka Kazi, Mishal Gillani, Ayesha Sadiq, Hina Inam, Saulat Fatimi

Medical College Documents

Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial artery coronary artery bypass graft patients in a tertiary-care setting.
Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary artery bypass grafting for coronary artery disease involving two or more vessels. The subjects were approached for the use of their radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay >9 days. Multivariable logistic regression was used to identify …

The Kardashian Index Of Cardiologists: Do More Social Media Followers Mean More Citations Or Merely Celebrity Status In Academia?, Talal Almas, Maheera Farooqi, Vikneswaran Raj Nagarajan, Muhammad Ali Niaz, Absam Akbar, Yohan Porus Irani, Jung Hur, Josef Finsterer

Medical College Documents

No abstract provided.

Development Of Stress-Induced Cardiomyopathy After Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Saad Ahmed Naved, Sadiq Shoukat Parpia, Huma Shoukat Ali

Medical College Documents

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. …

Off-Label Use Of Direct Oral Anticoagulants In Patients Receiving Surgical Mechanical And Bioprosthetic Heart Valves, Ankur Kalra, Sajjad Raza, Baqir Hasan Jafry, Harley E. King, Joseph A. Lahorra, Lars G. Svensson, Samir R. Kapadia

Medical College Documents

This cohort study assesses direct oral anticoagulant use in patients with surgical prosthetic heart valves in the United States and evaluates differences in preoperative and postoperative profiles in patients discharged while receiving direct oral anticoagulant vs warfarin.

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Comparison Of Figure Of Eight And Traditional Simple Wire Closure Method To Prevent Dehiscence After Sternal Closure, Aleezay Asghar, Khawaja Muhammad Talha, Muneer Amanullah, Syed Shahabuddin

Medical College Documents

Objective: To investigate significant differences, if any, between figure of-eight method and simple wire closure technique in reducing the incidence of infectious and non-infectious sternal dehiscence in patients undergoing sternal closure.
Methods: The systematic review was conducted in the Cardiothoracic Surgery Department at Aga Khan University from 1st December 2015 to 13th December 2017. The review was registered with PROSPERO, the International Prospective Register of Systematic Reviews. Pubmed, Cochrane Library (Wiley) and Scopus databases were searched for articles published up to December 13, 2017. The search was limited to randomised control trials, clinical trials, retrospective cohort studies, journal analyses, systematic …

Direct True Lumen Versus Conventional Cannulation For Acute Type-A Aortic Dissection, Asra Wahid, Syed Shahabuddin, Muhammad Muneer Amanullah, Shiraz Hashmi, Shahid Ahmed Sami

Medical College Documents

Acute type-A aortic dissection is a surgical emergency and has a high rate of short-term mortality. Aortic dissection is highly under-reported in Pakistan. With the technological developments in its management, arterial cannulation technique of direct true lumen cannulation has emerged with improved outcomes. We aimed to compare the mortality and morbidity outcomes between direct true lumen and conventional cannulation techniques for arterial access in patients with acute type- A aortic dissection under a single-centre retrospective review from 2007 to 2017. Mean age of the participants was 43.3±11.6 vs 45±12.4 years with males being dominant in both groups. Frequency of overall …

Major Septal Defects: Comparative Study Of Down Syndrome And Non-Down Syndrome Infants, Before And After Surgery, Saleha Aziz, Maaha Ayub, Laiba Masood, Muneer Amanullah, Rukhsana Hameed, Shiraz Hashmi, Waris Ahmad

Medical College Documents

Objective: To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan.
Methods: We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded.
Results: In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower …

Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery: A Surgical Certainty, Ayesha Butt, Muhammad Muneer Amanullah, Mehnaz Atiq Ahmed, Asif Hasan, Waris Ahmad

Medical College Documents

This study aims to assess the clinical presentation and the outcomes of a surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was carried out on the charts of six patients admitted for ALCAPA surgery at Aga Khan University Hospital, Karachi from March 2017 to May 2018.Dyspnoea, palpitation, poor feeding, fatiguability, pallor and a murmur of mitral regurgitation were the main presenting features. The pre-operative median left ventricular ejection fraction (LVEF) was 64%. Coronary reimplantation was performed in all the patients with a mitral valve repair being done in only …

An Atypical Case Of Silent Aortic Dissection In A Peritoneal Dialysis Patient: A Case Report And Review Of Literature., Waqas Javed Siddique, Ali Arif, Mohammad Harisullah Khan, Maryam Khan, Muhammad Owais Hanif, Muhammad Junaid Mehboob, Muhammad Aslam, Ayesha Aslam, Hasan Arif, Sandeep Aggarwal

Medical College Documents

Objective: Unusual clinical course

Background: Aortic dissection presents with acute chest or back pain and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.

Case Report: A 53-year-old African American male presented with progressively worsening exertional dyspnea and orthopnea for 3 days without any history of chest pain. His chest x-ray showed mild pulmonary edema. He was admitted with a diagnosis of heart failure. Bedside echocardiogram revealed severe aortic regurgitation and concern for possible aortic dissection. Computed tomography …