Search

Procedural and hospital outcomes of PCI versus CABG among ACS patients with prior history of CABG remains understudied.Percutaneous coronary intervention (PCI) and Coronary artery bypass grafting (CABG) formed the two comparison cohorts. Nationwide Inpatient Sample (NIS) from 2015 to 2020 were analyzed using the ICD-10 coding system. Demographic characteristics, baseline comorbidities, and outcomes such as inpatient mortality, cardiogenic shock, mechanical circulatory support, length of stay (LOS), and cost of hospitalization were compared between the two cohorts.A total of 503,900 ACS hospitalizations with prior history of CABG were identified who underwent PCI and CABG (141650 vs 7715, respectively). Median age was 71 vs 67, with male predominance (74.6% vs 75.4%), Caucasian had the most hospitalizations (79.3% vs 75.1%) in the PCI group compared to patients who underwent CABG. A higher burden of smoking (57.1% v 52.6%, p0.0001) was noted in the CABG group. On adjusted analysis, ACS patients undergoing Redo- CABG had a higher risk of in-hospital mortality (aOR 1.69, CI 1.53-1.87, p0.0001) compared to those undergoing PCI. In addition, Redo-CABG group were more likely to have CS (aOR 1.37, CI 1.26-1.48, p0.0001), MCS devices use (aOR 2.61, CI 2.43-2.80,p0.0001), AKI (aOR 1.42, CI 1.34-1.50, p0.0001) and respiratory failure (aOR 1.39, CI 1.29-1.47, p0.0001) as compared to PCI group.CABG in acute myocardial infarction with prior history of CABG is associated with higher cardiovascular complications compared to PCI. Further exploration and individual-patient level risk assessment is crucial.

Objective: To record the epidemiological, characteristics of Acute hepatitis patients. Study Design. Cross Sectional study. Setting: Government General Hospital Ghulam Muhammad Abad, Faisalabad. Period: March 2019 to 30th of September 2019. Material & Methods: A total of 92 patients included in the study. Patient’s epidemiological characteristics, symptoms and lab results were recorded during hospital stay. Categorical variables were analyzed using Chi-Square and Fissure Exact tests. P value of

Background: Neck fractures of the metacarpal bone can alter optimal hand function. Many surgical fixation techniques are described for this fracture with no robust evidence for the best treatment. Recently developed low profile plates may, however, challenge the preference for K-wires. Low profile plates were found to have lower complications than conventional plates in addition to early range of motion and early return to work. The aim of the present study was to determine the best outcome in patients with unstable fracture neck metacarpals using either multiple K wires or low profile mini-plating. Methods: This prospective randomized controlled study included 37 patients suffering from metacarpal neck fractures. patients were designated as group 1 (AIN group; 18 patients), and the other consecutive patients were designated as group 2 (LPP group; 19 patients). Both groups were treated within the first 48 hours of their injury and followed up for a minimum period of 40 weeks; the maximum period of follow up was 48 weeks. Results: No significant differences were found for PVAS, Q-DASH, TAM, time to radiological union or residual deformities at last follow-up. Grip strength, however, was significantly better in the K-wire group. Operative time and time off work were significantly shorter in the k-wire group. Plate group showed prevalent complications both peri and post-operative hitting 63.2 % of the plate group vs 16.7% in K-wire group. Conclusions: Low profile plates with immediate mobilization paradoxically prolonged operative time, technical demand and disturbing the fracture’s biological environment along with the extra cost were thus not justified by results. Antegrade intramedullary K-wire nailing was superior for the management of unstable metacarpal neck fractures.

PurposeThis study explores the best strategies for regional economic development to attract highly skilled populations, regardless of whether the region is a multisector or unisector economic hub. It also determines the development variables affecting the success of integrated regional economic hubs to achieve spatial equality, enhance economic productivity and attain environmental sustainability.Design/methodology/approachIn addition to a qualitative analysis, this study employed quantitative techniques using SPSS software. This allowed amplification of the most significant explanatory variables affecting the weaknesses and strengths of economic hubs.FindingsThe results highlight approaches that can be used to achieve socio-economic sustainability in regional hubs. These include multisectors or main centralised hubs (smart economic regional capital), which provide new services to regions and act as a unidevelopment sector or as a regional, economic capital.Research limitations/implicationsThe study analyses the effect of economic strategies and integration of natural resources and the required core services in regional economic development.Practical implicationsCase studies of successful economic hubs are discussed. The most important services proposed in such hubs promote human development and increase the standard of living.Social implicationsIntegration between the hubs in a region is fundamental to attracting direct investments that can benefit the local population.Originality/valueThe results could help governments, economists and planners implement multisector developmental hubs to achieve sustainable development.

Background: Carpal tunnel syndrome is the most common type of peripheral nerve entrapment; it affects females more than males; it may be idiopathic or secondary to other disorders especially diabetes mellitus. Carpal tunnel syndrome mostly affects manual workers and may be bilateral or unilateral and mainly affects the dominant hand. Carpal tunnel syndrome has characteristic symptoms and signs including paresthesia and pain along median nerve distribution, these symptoms are usually accompanied by positive provocative tests. Electrodiagnostic studies remain the cornerstone in the diagnosis of CTS. Carpal tunnel syndrome can be treated conservatively by activities of daily living instructions, splints, medical treatments as neurotropic drugs and NSAIDs and local steroid injection. Also, it can be treated by surgical decompression in severe cases. Aims: The aim of this study was to evaluate local steroid injection in the treatment of CTS. Twenty-one patients with mild and moderate CTS were included in this study. Patients and Methods: This was a prospective study included 21 patients with symptoms and signs of mild to moderate CTS attending the outpatient clinic of orthopedic Department, Tanta University Hospitals in the period between February 2019- January 2020. 1 ml Triamcinolone was used with 2 ml lidocaine. Patient’ hand was rested on towel roll flexed about 30 to 45 degrees and injection was done according to landmarks. Night splint was described for 3 days after injection. Results: In regards to clinical assessment; there was a significant clinical improvement after injection and follow-up period as compared to before injection. In regards to electrophysiological assessment; there was a significant improvement in NCS after injection. Conclusion: Local steroid injection is an effective treatment and recommended as a therapeutic tool in the management of idiopathic mild to moderate CTS.

Background: Tibial pilon fractures are relatively uncommon injuries, representing only 1% of all fractures of the lower limb and 5% to 10% of those of the tibia. Frequent comminution and the thin soft-tissue envelope in the area make the treatment of these fractures challenging. The tibial pilon is characterised by a total absence of muscle coverage and marginal vascularity. Therefore, even moderate trauma often results in extensive soft-tissue damage. Objective: The aim of this present study was to evaluate the arthroscopic assisted (Ilizarov) ring external fixation of distal tibial intra articular (pilon) fractures. Patients and methods: This was a prospective study conducted between February 2012, April 2015 on thirty patients with closed, and Gustilo Types I & II open fractures of pilon fractures of the distal tibia who were admitted to Zagazig University Hospitals. During a period of two years, all cases were treated by Ilizarov fixators with or without limited internal fixation and assessment of intra-articular reduction tibial plafond by arthroscopy. Results: Nineteen patients had right-sided injury, eleven patients had left sided injury and one patient had bilateral injury. At the time of injury, the youngest patient was 19 years old and the oldest was 6o years. The results in relation to pain as distributed according to the fracture. It is noted that the excellent results were with type I & II fracture, while the fair and poor results were with type II and III fracture. Conclusion: The present study provided information on the use and the role of ankle arthroscopy in assisting and evaluation (the value, advantages, techniques of ankle arthroscopy and ring external fixators) of distal tibial intra- articular reduction after pilon fracture. The study showed that this technique might be a good method to manage the pilon fractures.

Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time. Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included. Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia. Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.