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Application Of Euroscore To Predict Risk Of Mortality After Coronary Artery Bypass Grafting In Pakistani Population

by Ali Naeem (2014-VA-780) | Dr. Muhammad Hassan Mushtaq | Dr. Ammar Hameed Khan | Dr. Mamoona Chaudhry | Dr. Muhammad Nasir.

Material type: book Book; Literary form: not fiction Publisher: 2016Dissertation note: Coronary artery bypass surgery has become the standard of care for advanced coronary artery disease. It is one of the most audited and closely monitored operations in the history of surgery. Morbidity and mortality associated with this operation is also very closely monitored by surgeons, hospitals, professional bodies and governments at large. Based on the preoperative clinical information available about patients preparing to undergo coronary artery bypass surgery various predictive models for assessment of mortality risk have been developed over the last two decades in various regions across the world. Euro SCORE is one such predictive model which can accurately predict the risk of mortality for large groups of patients for the population in which it was developed. A large number of Pakistanis and nationals from South East Asian countries reside in different European countries and form part of the population on which this score has been developed and validated. We intend to find out the predictive accuracy of this model in our patients living in Pakistan. Euro SCORE accurately predicts operative mortality in patients from Pakistani population. This study will be conducted at the Department of Cardiac Surgery Shalamar Hospital Lahore. One hundred consecutive patients admitted to hospital for coronary artery bypass surgery will be enrolled in study. A total of 18 variables as included in EuroSCORE (Appendix 1) will be collected and entered into database. The expected mortality risk will be calculated by the EuroSCORE Calculator software (http://www.euroscore.org/). Actual or observed mortality and morbidity will also be recorded. Statistical analysis will be performed using SPSS version16. Continuous numerical data will be presented as mean ± Standard deviation, the Student t test will be used to compare means of normally distributed data. The qualitative data will be analyzed using chi square test. The relationship of the observed and the expected rates of mortality will be assessed using ROC curves for the accuracy of prediction of the Euro-SCORE. This study will indicate how accurately Euro SCORE can predict the risk of mortality after coronary artery bypass grafting in our population and more over it may indicate other patient related variables that can contribute to operative mortality other than Euro SCORE. Availability: Items available for loan: UVAS Library [Call number: 2713-T] (1).

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Comparative Evaluation Of “Onlay” Versus “Intraperitoneal Onlay” Novel Polyester Meshplasty In Ventral Hernia Of Rabbits

by Bilal Ahmed Shah (2010-VA-196) | Dr. Hamad Bin Rashid | Dr. Ayesha Safdar | Dr. Mamoona Chaudhry.

Material type: book Book; Literary form: not fiction Publisher: 2017Dissertation note: Polyester (Polyethylene terephthalate) is hydrophilic material works with the body’s natural systems to improve tissue integration while reducing negative foreign material response. Polyester offers extremely lower pain intensity and less foreign body reaction. The purpose of designated research was to compare the efficacy of two placement techniques “Onlay” versus “Intraperitoneal Onlay” polyester meshplasty for the treatment of ventral hernia. Polyester is a non-absorbable mesh. Polyester mesh is not available in Pakistan and was acquired from a local healthcare company in Dubai, United Arab Emirates. Polyester mesh is available with brand name of (Parietex®, Covidien, France). The experimental study was conducted on 24 (twenty four) healthy rabbits presented for massive ventral hernia repair. All rabbits were thoroughly examined to rule out any other anomaly before the study. The rabbits were allocated into two different groups, viz. group-A and group-B with 12 rabbits in each group respectively. All treatments were administered intramuscularly using 1 ml insulin syringe. The “Onlay Polyester Meshplasty” (Parietex®, Covidien) a placement technique that was used for the treatment of ventral hernia in group-A. The rabbits of group-B were treated with “Intraperitoneal Polyester Meshplasty” (Parietex®, Covidien) placement technique. Ventral herniorhaphy was performed in both groups using Polyester mesh with two different placement techniques. The surgery was performed at Surgery Section, Department of CMS, UVAS, Lahore for 3 months duration (including adaptation and postoperative period). Both techniques were compared on the basis of postoperative complications (wound healing, pain evaluation, hematoma, seroma and abscess formation), inflammatory responses and adhesion formation after application of mesh fixation. SUMMARY 47 During the experiment, it was observed that “Onlay Polyester Meshplasty” resulted in a prominent pain sensation, persistent inflammatory reaction, proliferating fibroblast, more granulating tissue, macrophages appearance, increased connective tissue thickness and proliferating collagen fiber. It was observed that “Intraperitoneal Polyester Meshplasty” resulted in less pain sensation, no foreign body reaction, no neutrophil appearance and rare granulating tissue. “Intraperitoneal Polyester Meshplasty” showed remarkable advantages over “Onlay Polyester Meshplasty” in terms lower pain level, reduced size seroma and extremely less scar tissue formation. Based upon all the findings it was concluded that “Intraperitoneal Polyester Meshplasty” placement technique is safer and more effective in terms of post-operative complications and outcomes. Availability: Items available for loan: UVAS Library [Call number: 2809-T] (1).

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