Bashir Hanif - Academia.edu (original) (raw)

Papers by Bashir Hanif

JPMA. The Journal of the Pakistan Medical Association, 2013

To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardi... more To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock. The retrospective study was conducted at the Tabba Heart Institute, a private-sector facility in Karachi. It reviewed the medical records of 56 consecutive patients between January 2009 and June 2011 with acute ST elevation myocardial infarction complicated by cardiogenic shock and subjected to primary percutaneous coronary intervention. The primary end point was in-hospital mortality and its predictors. SPSS 14 was used for statistical analysis. The mean age of the study patients was 63 +/- 11.7 years; 38 (68%) were male; 32 (57%) were hypertensive; and 39 (69%) were diabetic. Most infarcts were anterior in location (n = 36; 64%). Besides, 33 (59%) required ventilatory support. Intra-aortic balloon pump was placed in 30 (54%), and 33 (59%) patients had multivessel coronary artery disease. In-hospital mortality occurred in 26 (46%). Multiva...

CVD Prevention and Control, 2009

To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LV... more To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of ≤ 40% in patients with first anterior ST Elevation Myocardial Infarction (STEMI). Study Design: Case series. Place and Duration of Study: At the Tabba Heart Institute, Karachi, from May to November 2008. Methodology: Consecutive patients presenting with first anterior STEMI were studied. Troponin-I concentration was measured by MEIA (microparticle enzyme immunoassay) method and LVEF was visually assessed. Analysis of relation between troponin-I levels and LVEF by the Receiver-Operator Characteristic (ROC) curve was performed to determine the cut off values of troponin-I in identifying LVEF of ≤ 40% in patients, who had received streptokinase or undergone primary Percutaneous Coronary Intervention (PCI). Results: Out of the 90 patients studied, 50 patients received streptokinase and the remaining 40 patients underwent primary PCI. Mean age was 54.6 ± 9 years and 82% were male. Troponin-I levels of > 63.5 ng/ml predicted LVEF of ≤ 40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-I levels of > 87.5 ng/ml predicted LVEF < 40% with a sensitivity of 86% and specificity of 100%. Conclusion: Troponin-I concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF ≤ 40% in patients treated with either streptokinase or primary PCI respectively for first anterior STEMI. Troponin-I can be used as a non-imaging tool to identify patients with LVEF ≤ 40% who need early aggressive therapy.

CVD Prevention and Control, 2009

Methods: Medical records of 104 consecutive patients presented in our hospital between January 20... more Methods: Medical records of 104 consecutive patients presented in our hospital between January 2006 to December 2007 with acute ST elevation myocardial infarction (STEMI) and treated with primary PCI as a mode of reperfusion were reviewed. The primary end point was in ...

Clinical Cardiology, 2000

JPMA. The Journal of the Pakistan Medical Association, 2012

The case of a 55 years old, hypertensive, obese female is presented, who came to the emergency de... more The case of a 55 years old, hypertensive, obese female is presented, who came to the emergency department with inferoposterior ST segment elevation myocardial infarction (STEMI) with right ventricular infarction. After thrombolytic therapy, she reperfused but had anginal symptoms on minimal activity. The patient underwent coronary angiogram which showed aneurysmal right coronary artery (RCA) with 60% stenosis and thrombus in mid portion and distal bifurcation of RCA with TIMI III distal blood flow. Left main coronary artery was normal. Left anterior descending (LAD) and Left circumflex (LCX) arteries were also aneurysmal and non obstructive. The patient was started on intravenous heparin and warfarin in view of aneurysmal coronary arteries and large thrombus burden. The patient was discharged home in one week and is doing well at follow up.

JPMA. The Journal of the Pakistan Medical Association, 2011

The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for la... more The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent transthoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week.

Journal of the College …, 2009

OBJECTIVE: To determine the serum levels of troponin-I in identifying left ventricular ejection f... more OBJECTIVE: To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of <or= 40% in patients with first anterior ST Elevation Myocardial Infarction (STEMI). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: At the ...

JPMA. The Journal of the …, 2010

To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) an... more To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis &amp;amp;amp;amp;amp;amp;gt; or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. Out of 230 patients, in 111 patients with cTnI levels &amp;amp;amp;amp;amp;amp;lt; or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels &amp;amp;amp;amp;amp;amp;gt; 10 folds ULN, 23 (19.3%) had single vessel, 37 (31.1%) had two vessel and 55 (46.2%) had three vessel significant CAD. The results suggest that there was an insignificant association between the cTnI levels and single vessel, two vessel and the overall CAD extent (p = 0.35, p = 0.21 and p= 0.13 respectively), however there was a statistically significant association between the cTnI levels and three vessel CAD (p &amp;amp;amp;amp;amp;amp;lt; 0.04). Higher cTnI levels are associated with an increased proportion of severe three vessel CAD involvement. Prompt identification and referral of this patient subset to early revascularization strategies would improve clinical outcomes.

JPMA. The Journal of the Pakistan Medical Association, 2010

To determine the doppler derived mean gradients of St Jude mechanical prosthesis in early postope... more To determine the doppler derived mean gradients of St Jude mechanical prosthesis in early postoperative period in patients undergoing valve replacement at a tertiary care cardiac centre. Medical records of 190 consecutive patients who underwent 233 mitral, aortic or dual (mitral and aortic) valve replacement by St Jude bileaflet mechanical prosthesis at Tabba Heart Institute, between March 2006 to December 2008 were reviewed. Doppler derived mean gradients were assessed predischarge and recorded. There were 98 (51.5%) males and 92 (48.5%) females in the study cohort. The mean age was 40 +/- 14 years. Of the total, 101 (53%) had mitral, 46 (24.2%) had aortic and 43 (22.6%) patients had dual valve replacement. Doppler derived mean gradient was assessed across 144 mitral and 89 aortic St Jude mechanical prosthesis. Doppler derived mean gradient for St Jude mitral prosthesis was 3.5 mm Hg and for St Jude aortic prosthesis was 10.2 mm Hg. The study determines baseline gradients across mitral and aortic St Jude mechanical prosthesis in our population. These can be used as reference gradients to assess St Jude prosthetic valve function in patients who did not have early postoperative doppler assessment.

JPMA. The Journal of the Pakistan Medical Association, 2009

American journal of infection control, 2012

We describe a comprehensive surveillance system involving infection control practitioners, surgeo... more We describe a comprehensive surveillance system involving infection control practitioners, surgeons, administrative staff, and patients aimed at improving the postdischarge surveillance of surgical site infections. The system was able to detect 22 infections out of 538 procedures, 95% of which were detected during the postdischarge period.

American Journal of Infection Control, 2012

We describe a comprehensive surveillance system involving infection control practitioners, surgeo... more We describe a comprehensive surveillance system involving infection control practitioners, surgeons, administrative staff, and patients aimed at improving the postdischarge surveillance of surgical site infections. The system was able to detect 22 infections out of 538 procedures, 95% of which were detected during the postdischarge period.

Cardiovascular …, 2009

... e Dow University of Health Science, Karachi, Pakistan. f Ittefaq Hospital and Institute of He... more ... e Dow University of Health Science, Karachi, Pakistan. f Ittefaq Hospital and Institute of Heart Diseases, Lahore, Pakistan. g Mayo Hospital and King Edward Medical University, Lahore, Pakistan. h Armed Forces Institute of Cardiology, Rawalpindi, Pakistan. ...

The American Journal of Cardiology, 2009

Background: In-stent restenosis (ISR) is considerably reduced in the drug-eluting stent (DES) era... more Background: In-stent restenosis (ISR) is considerably reduced in the drug-eluting stent (DES) era but occurs in 2%-15% of cases. The optimal approach to the treatment of DES restenosis is not clearly defined. We have studied outcomes following additional DES implantation for DES restenosis.

Age (year)

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JPMA. The Journal of the …, 2010

To determine the safety and success of transradial coronary angiography and angioplasty in a Paki... more To determine the safety and success of transradial coronary angiography and angioplasty in a Pakistani population. This was a prospective study on 264 consecutive patients undergoing transradial coronary angiography (TRCAG) and angioplasty (TRCAP) at Tabba Heart Institute, Karachi between November to December 2008. All patients enrolled in the study underwent Allen&amp;amp;#39;s test to ensure dual arterial supply to the hand. Modified Allen&amp;amp;#39;s test was performed only when Allen&amp;amp;#39;s test was abnormal. Patients were excluded from the study if they had abnormal Allen&amp;amp;#39;s and modified Allen&amp;amp;#39;s test, were on haemodialysis or had abnormal serum creatinine level. The main outcome measures were success rate and complications of TRAG and TRCAP. The mean age was 57 +/- 11.08 years with 199 (75.4%) males and 64 (24.6%) females. A total of 182 (76.3%) coronary angiographies and 82 (76.8%) coronary angioplasties were preformed from the trans-radial route in the study period. Overall procedural success rate was 94% for TRCAG with mean procedure time of 23.74 +/- 6.26 minutes and mean fluoroscopy time of 5.65 +/- 2.3 minutes. The success rate for TRCAP was 93.6% with mean procedure time of 62 +/-10.6 minutes and mean fluoroscopy time of 15.78 +/- 8.90 minutes. Only 1 patient had mild forearm haematoma and asymptomatic radial artery occlusion occurred in 4 (1.5%) study patients. Trans-radial artery cannulation is a safe and successful route for performance of coronary procedures. It can be used as an acceptable alternate to transfemoral approach.

jpma.org.pk

To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and ... more To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and coronary revascularization. A cross-sectional study was conducted on 416 patients admitted in Tabba Heart Institute, Karachi from December 2010 to May 2011. Patients admitted with diagnosis of acute myocardial infarction (AMI) or who underwent elective coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) procedures were offered cardiac rehabilitation (CR). Out of these, patients who enrolled in 6 weeks outpatient CR programme were followed for number of CR sessions and their socio-demographic and clinical data were collected. Data was analyzed by Statistical Package for Social Sciences (SPSS) software, version 15.0. Chi-square test was applied to test association between categorical variables and Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test for continuous variables. Out of 416 patients identified, only 151 patients (36.2%) enrolled and attended the CR programme. Of the 151 attendees, 111 (73.4%) patients subsequently completed more than 6 weeks of outpatient CR programme. We found significant association between CR attendance and easy access to the programme, elective CABG procedure, employment status, presence of diabetes or hypertension and baseline level of exercise (all p…

JPMA. The Journal of …, 2010

To determine the association of prolonged ST segment depression after an exercise test with sever... more To determine the association of prolonged ST segment depression after an exercise test with severity of coronary artery disease. A cross sectional study of 100 consecutive patients referred to the cardiology laboratory for stress myocardial perfusion imaging (MPI) conducted between April-August 2008. All selected patients were monitored until their ST segment depression was recovered to baseline. ST segment recovery time was categorized into less and more than 5 minutes. Subsequent gated SPECT-MPI was performed and stratified according to severity of perfusion defect. Association was determined between post exercise ST segment depression recovery time (&amp;amp;amp;amp;amp;amp;amp;amp;lt;5 minutes and &amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes) and severity of perfusion defect on MPI. The mean age of the patients was 57.12 +/- 9.0 years. The results showed statistically insignificant association (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) between ST segment recovery time of &amp;amp;amp;amp;amp;amp;amp;amp;lt;5 minutes and &amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes with low, intermediate or high risk MPI. Our findings suggest that the commonly used cut-off levels used in literature for prolonged, post exercise ST segment depression (&amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes into recovery phase) does not correlate with severity of ischaemia based on MPI results.

JPMA. The Journal of the Pakistan Medical Association, 2013

To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardi... more To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock. The retrospective study was conducted at the Tabba Heart Institute, a private-sector facility in Karachi. It reviewed the medical records of 56 consecutive patients between January 2009 and June 2011 with acute ST elevation myocardial infarction complicated by cardiogenic shock and subjected to primary percutaneous coronary intervention. The primary end point was in-hospital mortality and its predictors. SPSS 14 was used for statistical analysis. The mean age of the study patients was 63 +/- 11.7 years; 38 (68%) were male; 32 (57%) were hypertensive; and 39 (69%) were diabetic. Most infarcts were anterior in location (n = 36; 64%). Besides, 33 (59%) required ventilatory support. Intra-aortic balloon pump was placed in 30 (54%), and 33 (59%) patients had multivessel coronary artery disease. In-hospital mortality occurred in 26 (46%). Multiva...

CVD Prevention and Control, 2009

To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LV... more To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of ≤ 40% in patients with first anterior ST Elevation Myocardial Infarction (STEMI). Study Design: Case series. Place and Duration of Study: At the Tabba Heart Institute, Karachi, from May to November 2008. Methodology: Consecutive patients presenting with first anterior STEMI were studied. Troponin-I concentration was measured by MEIA (microparticle enzyme immunoassay) method and LVEF was visually assessed. Analysis of relation between troponin-I levels and LVEF by the Receiver-Operator Characteristic (ROC) curve was performed to determine the cut off values of troponin-I in identifying LVEF of ≤ 40% in patients, who had received streptokinase or undergone primary Percutaneous Coronary Intervention (PCI). Results: Out of the 90 patients studied, 50 patients received streptokinase and the remaining 40 patients underwent primary PCI. Mean age was 54.6 ± 9 years and 82% were male. Troponin-I levels of > 63.5 ng/ml predicted LVEF of ≤ 40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-I levels of > 87.5 ng/ml predicted LVEF < 40% with a sensitivity of 86% and specificity of 100%. Conclusion: Troponin-I concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF ≤ 40% in patients treated with either streptokinase or primary PCI respectively for first anterior STEMI. Troponin-I can be used as a non-imaging tool to identify patients with LVEF ≤ 40% who need early aggressive therapy.

CVD Prevention and Control, 2009

Methods: Medical records of 104 consecutive patients presented in our hospital between January 20... more Methods: Medical records of 104 consecutive patients presented in our hospital between January 2006 to December 2007 with acute ST elevation myocardial infarction (STEMI) and treated with primary PCI as a mode of reperfusion were reviewed. The primary end point was in ...

Clinical Cardiology, 2000

JPMA. The Journal of the Pakistan Medical Association, 2012

The case of a 55 years old, hypertensive, obese female is presented, who came to the emergency de... more The case of a 55 years old, hypertensive, obese female is presented, who came to the emergency department with inferoposterior ST segment elevation myocardial infarction (STEMI) with right ventricular infarction. After thrombolytic therapy, she reperfused but had anginal symptoms on minimal activity. The patient underwent coronary angiogram which showed aneurysmal right coronary artery (RCA) with 60% stenosis and thrombus in mid portion and distal bifurcation of RCA with TIMI III distal blood flow. Left main coronary artery was normal. Left anterior descending (LAD) and Left circumflex (LCX) arteries were also aneurysmal and non obstructive. The patient was started on intravenous heparin and warfarin in view of aneurysmal coronary arteries and large thrombus burden. The patient was discharged home in one week and is doing well at follow up.

JPMA. The Journal of the Pakistan Medical Association, 2011

The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for la... more The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent transthoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week.

Journal of the College …, 2009

OBJECTIVE: To determine the serum levels of troponin-I in identifying left ventricular ejection f... more OBJECTIVE: To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of <or= 40% in patients with first anterior ST Elevation Myocardial Infarction (STEMI). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: At the ...

JPMA. The Journal of the …, 2010

To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) an... more To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis &amp;amp;amp;amp;amp;amp;gt; or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. Out of 230 patients, in 111 patients with cTnI levels &amp;amp;amp;amp;amp;amp;lt; or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels &amp;amp;amp;amp;amp;amp;gt; 10 folds ULN, 23 (19.3%) had single vessel, 37 (31.1%) had two vessel and 55 (46.2%) had three vessel significant CAD. The results suggest that there was an insignificant association between the cTnI levels and single vessel, two vessel and the overall CAD extent (p = 0.35, p = 0.21 and p= 0.13 respectively), however there was a statistically significant association between the cTnI levels and three vessel CAD (p &amp;amp;amp;amp;amp;amp;lt; 0.04). Higher cTnI levels are associated with an increased proportion of severe three vessel CAD involvement. Prompt identification and referral of this patient subset to early revascularization strategies would improve clinical outcomes.

JPMA. The Journal of the Pakistan Medical Association, 2010

To determine the doppler derived mean gradients of St Jude mechanical prosthesis in early postope... more To determine the doppler derived mean gradients of St Jude mechanical prosthesis in early postoperative period in patients undergoing valve replacement at a tertiary care cardiac centre. Medical records of 190 consecutive patients who underwent 233 mitral, aortic or dual (mitral and aortic) valve replacement by St Jude bileaflet mechanical prosthesis at Tabba Heart Institute, between March 2006 to December 2008 were reviewed. Doppler derived mean gradients were assessed predischarge and recorded. There were 98 (51.5%) males and 92 (48.5%) females in the study cohort. The mean age was 40 +/- 14 years. Of the total, 101 (53%) had mitral, 46 (24.2%) had aortic and 43 (22.6%) patients had dual valve replacement. Doppler derived mean gradient was assessed across 144 mitral and 89 aortic St Jude mechanical prosthesis. Doppler derived mean gradient for St Jude mitral prosthesis was 3.5 mm Hg and for St Jude aortic prosthesis was 10.2 mm Hg. The study determines baseline gradients across mitral and aortic St Jude mechanical prosthesis in our population. These can be used as reference gradients to assess St Jude prosthetic valve function in patients who did not have early postoperative doppler assessment.

JPMA. The Journal of the Pakistan Medical Association, 2009

American journal of infection control, 2012

We describe a comprehensive surveillance system involving infection control practitioners, surgeo... more We describe a comprehensive surveillance system involving infection control practitioners, surgeons, administrative staff, and patients aimed at improving the postdischarge surveillance of surgical site infections. The system was able to detect 22 infections out of 538 procedures, 95% of which were detected during the postdischarge period.

American Journal of Infection Control, 2012

We describe a comprehensive surveillance system involving infection control practitioners, surgeo... more We describe a comprehensive surveillance system involving infection control practitioners, surgeons, administrative staff, and patients aimed at improving the postdischarge surveillance of surgical site infections. The system was able to detect 22 infections out of 538 procedures, 95% of which were detected during the postdischarge period.

Cardiovascular …, 2009

... e Dow University of Health Science, Karachi, Pakistan. f Ittefaq Hospital and Institute of He... more ... e Dow University of Health Science, Karachi, Pakistan. f Ittefaq Hospital and Institute of Heart Diseases, Lahore, Pakistan. g Mayo Hospital and King Edward Medical University, Lahore, Pakistan. h Armed Forces Institute of Cardiology, Rawalpindi, Pakistan. ...

The American Journal of Cardiology, 2009

Background: In-stent restenosis (ISR) is considerably reduced in the drug-eluting stent (DES) era... more Background: In-stent restenosis (ISR) is considerably reduced in the drug-eluting stent (DES) era but occurs in 2%-15% of cases. The optimal approach to the treatment of DES restenosis is not clearly defined. We have studied outcomes following additional DES implantation for DES restenosis.

Age (year)

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JPMA. The Journal of the …, 2010

To determine the safety and success of transradial coronary angiography and angioplasty in a Paki... more To determine the safety and success of transradial coronary angiography and angioplasty in a Pakistani population. This was a prospective study on 264 consecutive patients undergoing transradial coronary angiography (TRCAG) and angioplasty (TRCAP) at Tabba Heart Institute, Karachi between November to December 2008. All patients enrolled in the study underwent Allen&amp;amp;#39;s test to ensure dual arterial supply to the hand. Modified Allen&amp;amp;#39;s test was performed only when Allen&amp;amp;#39;s test was abnormal. Patients were excluded from the study if they had abnormal Allen&amp;amp;#39;s and modified Allen&amp;amp;#39;s test, were on haemodialysis or had abnormal serum creatinine level. The main outcome measures were success rate and complications of TRAG and TRCAP. The mean age was 57 +/- 11.08 years with 199 (75.4%) males and 64 (24.6%) females. A total of 182 (76.3%) coronary angiographies and 82 (76.8%) coronary angioplasties were preformed from the trans-radial route in the study period. Overall procedural success rate was 94% for TRCAG with mean procedure time of 23.74 +/- 6.26 minutes and mean fluoroscopy time of 5.65 +/- 2.3 minutes. The success rate for TRCAP was 93.6% with mean procedure time of 62 +/-10.6 minutes and mean fluoroscopy time of 15.78 +/- 8.90 minutes. Only 1 patient had mild forearm haematoma and asymptomatic radial artery occlusion occurred in 4 (1.5%) study patients. Trans-radial artery cannulation is a safe and successful route for performance of coronary procedures. It can be used as an acceptable alternate to transfemoral approach.

jpma.org.pk

To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and ... more To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and coronary revascularization. A cross-sectional study was conducted on 416 patients admitted in Tabba Heart Institute, Karachi from December 2010 to May 2011. Patients admitted with diagnosis of acute myocardial infarction (AMI) or who underwent elective coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) procedures were offered cardiac rehabilitation (CR). Out of these, patients who enrolled in 6 weeks outpatient CR programme were followed for number of CR sessions and their socio-demographic and clinical data were collected. Data was analyzed by Statistical Package for Social Sciences (SPSS) software, version 15.0. Chi-square test was applied to test association between categorical variables and Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test for continuous variables. Out of 416 patients identified, only 151 patients (36.2%) enrolled and attended the CR programme. Of the 151 attendees, 111 (73.4%) patients subsequently completed more than 6 weeks of outpatient CR programme. We found significant association between CR attendance and easy access to the programme, elective CABG procedure, employment status, presence of diabetes or hypertension and baseline level of exercise (all p…

JPMA. The Journal of …, 2010

To determine the association of prolonged ST segment depression after an exercise test with sever... more To determine the association of prolonged ST segment depression after an exercise test with severity of coronary artery disease. A cross sectional study of 100 consecutive patients referred to the cardiology laboratory for stress myocardial perfusion imaging (MPI) conducted between April-August 2008. All selected patients were monitored until their ST segment depression was recovered to baseline. ST segment recovery time was categorized into less and more than 5 minutes. Subsequent gated SPECT-MPI was performed and stratified according to severity of perfusion defect. Association was determined between post exercise ST segment depression recovery time (&amp;amp;amp;amp;amp;amp;amp;amp;lt;5 minutes and &amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes) and severity of perfusion defect on MPI. The mean age of the patients was 57.12 +/- 9.0 years. The results showed statistically insignificant association (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) between ST segment recovery time of &amp;amp;amp;amp;amp;amp;amp;amp;lt;5 minutes and &amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes with low, intermediate or high risk MPI. Our findings suggest that the commonly used cut-off levels used in literature for prolonged, post exercise ST segment depression (&amp;amp;amp;amp;amp;amp;amp;amp;gt;5 minutes into recovery phase) does not correlate with severity of ischaemia based on MPI results.