Serial Electrocardiograms-An Unsung Hero

This case report describes a patient in their 60s with diabetes and hypertension who presented to the emergency department with retrosternal chest pain.

Procedural complications associated with percutaneous mitral balloon valvotomy: A systematic review

BACKGROUND

As Percutaneous mitral balloon valvotomy (PMBV) remains the keystone in treating mitral stenosis, we conducted this review to elucidate the cumulative frequency and predictors of complications following PMBV and their occurrence in various patient populations.

AREAS COVERED

We searched digital databases for relevant studies covering complications of PMBV and retrieved articles using the Medical Subject Heading (MeSH) keywords.

EXPERT OPINION

A total of 37 articles (8 RCTs, 7 nonrandomized clinical trials, 22 observational studies) were selected for qualitative analysis. A total of 11,803 patients undergoing PMBV among 37 studies were included, with a mean success rate of 84.54%. The most common complication was mitral regurgitation (8.2%) followed by an atrial septal defect (2.4%). Other relevant complications like stroke, pericardial tamponade, rupture of mitral leaflets, and conduction abnormalities were present in <1% of the patients.

Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above)

Introduction

Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD.

Methods

A case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography.

Results

Patients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35–1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS.

Conclusion

IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country

BACKGROUND

Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor-patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor-patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan.

MATERIALS AND METHODS

The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data.

RESULTS

The study revealed four emerging themes: (1) Lack of doctor-patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients' concern with their improvement in health and doctor's demeanor.

CONCLUSION

The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.

Effect of moderate learning style-teaching mode mismatch on academic performance among 2nd year medical students in Pakistan

INTRODUCTION

The vagueness surrounding "learning style-teaching mode mismatch" makes its effects uncertain. This study tried to tackle that controversy by comparing and assessing the effect of different learning styles on performance in physiology examination when teaching mode was somewhat different than learning preferences of the 2^nd year medical students.

METHODS

A total of 102 2^nd year medical students participated in this study. Honey and Mumford learning style questionnaire was used to categorize the participants into one of the four learning styles (activist, reflector, theorist, and pragmatist). Many teaching modes were used in the medical college. The first professional theory and practical physiology scores of these 102 students of University of Health Sciences were obtained online. Learning styles were compared with physiology scores and age using one-way analysis of variance and post hoc statistical analysis and between males and females by using Chi-square test.

RESULTS

Pragmatists had the lowest total physiology score (P < 0.001), while theorists had the highest total physiology scores (P < 0.001). Activists and reflectors had scores in between pragmatists and theorists, and there was no statistical difference between these two styles of learning (P = 0.9). No student scored below 60%.

CONCLUSION

This study demonstrated that the effect of moderate teaching-learning mismatch is different for different learners. Theorists excelled as they had the highest physiology score, while pragmatists lagged in comparison. Reflectors and activists performed better than pragmatists but were worse than theorists. Despite this, none of the students scored below 60%. This shows that a moderate learning style-teaching mode mismatch is not harmful for learning.

In vitro effectiveness of triterpenoids and their synergistic effect with antibiotics against Staphylococcus aureus strains

OBJECTIVES

The aim of this study is to evaluate the effect of four triterpenoids such as oleanolic acid, ursolic acid, cycloastragenol, and beta-boswellic acid alone and in combination with antibiotics against Staphylococcus aureus strains.

MATERIALS AND METHODS

Sixteen clinical strains of S. aureus from infected wounds were isolated. Eight were methicillin-sensitive S. aureus (MSSA), and the other eight were methicillin-resistant S. aureus (MRSA). The activity was also seen in reference S. aureus American Type Culture Collection™ strains. The activity of all the triterpenoids and antibiotics against S. aureus was evaluated by broth microdilution method. The effectiveness was judged by comparing the minimum inhibitory concentrations (MICs) of the compounds with antibiotics. The combination of antibiotics with compounds was evaluated by their fractional inhibitory concentrations (FIC).

RESULTS

Against both clinical and reference MSSA strains, none of the compounds exhibited comparable activity to antibiotics vancomycin or cefradine except for ursolic acid (MIC 7.8 μg/ml). Against MRSA, all compounds (MIC 16-128 μg/ml) showed lesser activity than vancomycin (MIC 5.8 μg/ml). Among triterpenoid-antibiotic combinations, the most effective were ursolic acid and vancomycin against clinical strain MSSA (FICS 0.17). However, overall, different combinations between triterpenoids and antibiotics showed 95%-46% (P < 0.05) reduction in MICs of antibiotics compared to when antibiotics were used alone. Cefradine, a drug not suitable for treating MRSA (MIC = 45 μg/ml), showed a remarkable decrease in its MIC (87% P< 0.01) when it was used in combination with oleanolic acid or ursolic acid in both clinical and reference strains.

CONCLUSION

The tested triterpenoids are relatively weaker than antibiotics. However, when used in combination with antibiotics, they showed remarkable synergistic effect and thus can help in prolonging the viability of these antibiotics against S. aureus infections. Furthermore, reduction in MIC of cefradine with oleanolic acid indicates their potential use against MRSA.