Browsing by Author "Sayami, A"
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Publication Decrease in Mean Platelet Volume after percutaneous transvenous mitral commissurotomy in patients with Rheumatic Mitral Stenosis(Institute of Medicine, 2017) Thapa, S; Shrestha, A; Gajurel, RM; Poudel, CM; Shrestha, H; Khanal, R; Bhatta, YD; Sayami, AAbstract Introduction: Rheumatic mitral stenosis (RMS) is associated with increased thromboembolic events, especially in the presence of concomitant atrial fibrillation. Mean platelet volume (MPV) is the marker of platelet activity as larger platelets are hemostatically active and have more propensity of thrombosis. It has also been reported that percutaneous transvenous mitral commissurotomy (PTMC) attenuates platelet activity. We aimed to investigate whether PTMC decreases MPV in patients with RMS. Methods: In the present study, MPV was measured in 39 patients with RMS in sinus rhythm just before and one month after PTMC. Thirty four, sex and age-matched, apparently healthy controls were used for comparison. Mitral valve area (MVA), mean diastolic gradient across mitral valve (MDG) and pulmonary artery systolic pressure (PASP) were measured using transthoracic echocardiography and mean left atrial (LA) pressure measured during the procedure. Results: As compared to apparently healthy controls, patients with RMS had higher MPV (11.51±1.46 v. 9.6+0.75l, p<0.001). All patients with RMS underwent successful PTMC. One month after the procedure, LA diameter, MVA, MDG, PASP and LA pressures were reduced significantly (p< 0.001). The final mean platelet volume measured in patients with RMS undergoing PTMC measured after one month also had significant reduction when compared with the initial mean MPV (11.51±1.46 vs 9.55 1.11 0.001). Conclusions: As compared to apparently healthy controls, patients with RMS have higher MPV reflecting increased platelet activity, and PTMC is associated with a significant decrease in MPV one month after the procedure. Keywords: Mean platelet volume, percutaneous transvenous mitrl commissurotomy, rheumatic mitral stenosisPublication Endothelial dysfunction in patients with coronary artery disease in tertiary level teaching hospital(Institute of Medicine, 2017) Poudel, CM; Poudyal, RR; Sayami, AAbstract Introduction: Endothelial Dysfunction is a pathological condition characterized by reduction of bioavailability of vasodilators, in particular, nitric oxide whereas endothelium-derived contracting factors are increased resulting in an impairment of endothelium- dependent vasodilation. ED can be assessed by Brachial Artery Flow Mediated Dilatation (BAFMD). The study is to determine the prevalence of endothelial dysfunction in patients with coronary artery disease. Methods: A total of 150 adult patients above 18 years both male and female diagnosed as CAD both stable and acute were enrolled. All patients were undergone ultrasound assessment of brachial artery diameter. Brachial artery flow mediated dilatation (BAFMD) was calculated as percentage increase in diameter from the baseline and after sphygmomanometer cuff inflation. BAFMD <10% was considered abnormal, signifying ED. Results: Overall, the prevalence of ED determined by abnormal flow mediated dilatation of brachial artery (FMD<10%) in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively. Eight risk factors analyzed were male sex, diabetes mellitus, hypertension, smoking, family history of CAD, age, hypercholesterolemia and low high density lipoprotein (HDL). When correlating the cardiovascular risk factors with ED, diabetes mellitus (p=0.031), smoking (p=0.026), and age >45yrs in male and >55yrs in female (p=0.013) was found to be statistically significant on univariate analysis by logistic regression. When undergoing multivariate analysis, age (p= 0.012) and smoking (p= 0 .024) were significantly associated with ED. Conclusion: Overall the prevalence of ED in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively. Keywords: Endothelial dysfunction, Coronary artery disease Prevalence, Brachial artery flow mediated dilatationPublication Outcome of Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients Presenting with Cardiogenic Shock(Institute of Medicine, 2016) Anil, OM; Sayami, A; Nepal, R; Jaiswal, S; Bhattarai, NAbstract Introduction: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction (MI). Cardiogenic shock can occur in both ST elevated MI (STEMI) and non-ST elevated MI (NSTEMI). In these patients primary percutaneous coronary intervention (PCI) has better outcome and decreased in-hospital mortality compared to thrombolysis, if performed in time. Methods: This is a retrospective observational study conducted at Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal from September 2012 to December 2014. Patients who presented with acute myocardial infarction and cardiogenic shock and underwent primary PCI were enrolled in this study. Records from cath lab, Coronary Care Unit (CCU) and discharge notes were reviewed and analyzed. Results: A total of 22 patients were enrolled in this study. The mean age of the study population was 61.5±11.5 years and 73% of the participants were male. Four patients were intubated in the emergency department, three received cardiopulmonaryresuscitation (CPR) and one patient received electrical cardio version on presentation. Triple vessel disease was the most common finding and left anterior descending (LAD) artery was the commonest culprit vessel. Procedural success was 91%. In-hospital mortality was 31.2% in the entire study population. Ventilator associated pneumonia and severe sepsis was seen in 5 out of 7 cases that died. Conclusion: Initial outcome of primary PCI performed in patients with acute MI in cardiogenic shock at our centre is encouraging. In-hospital mortality in patients with acute MI complicated by cardiogenic is high. Primary PCI improves outcome in these patients and should be performed as an initial strategy. Keywords: Acute Myocardial Infarction, Primary Percutaneous Coronary Intervention, Cardiogenic shock, Outcome