Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease
Shazia Nazar, Erum Afaq, Shayan Zufishan, Nahida Baigam, Ghazala Masood Farrukh and Sumera Mustafa
Abstract: Background: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease.
Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC.
Results: : Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI > 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%.
Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease..
Received: April 19, 2023
Revised: June 15, 2023
Accepted: June 19, 2023
doi.org/10.21089/njhs.82.0051
Assessment of Segmental Hepatic Fat Distribution using Magnetic Resonance Proton Density Fat Fraction MR-PDFF in Non-alcoholic Fatty Liver Disease (NAFLD)
Muhammad Salman Rafique, Ayesha Ayub, Ahmad Karim Malik, Tahir Malik, Sana Kundi and Abdullah Saeed
Abstract: Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant.
Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD).
Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver.
Conclusion: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%). Received: April 10, 2023
Revised: May 24, 2023
Accepted: May 26, 2023
doi.org/10.21089/njhs.82.0057
Benefits of Ferric Carboxymaltose Administration for Enhanced Hemoglobin Levels in Urban Population of Sindh: BOFERIN® Observational Study
Jahanara Ainuddin, Nasreen Majid, Azra Aslam, Raheel Sikander, Sarmad Iqbal and Syed Saad Hussain
Abstract: Background: : Iron deficiency anemia is a major public health issue in developing countries, especially among women of reproductive age. Anemia is a major public health problem in women of reproductive age in rural Pakistan and a large proportion of women were found to have low levels of serum iron.
Materials and Methods: A multicenter observational cohort study was conducted at Karachi & Hyderabad from 8th February 2022 to 30th April 2022. Women with low hemoglobin level and age 18-45 years were included in this study. Patients were grouped according to 1-week assessment and 3-week assessment of hemoglobin concentration. A single dose of a generic substituent ferric carboxymaltose (Boferin®) was administered to the patients over 15 minutes infusion. Baseline hemoglobin levels were compared at 1 week and 3 weeks after administration of Ferric Carboxymaltose.
Results: A total of 104 patients were enrolled in this study. The mean hemoglobin levels at baseline were 9.22 ± 0.175 g/dl and 7.55 ± 0.329 g/ dl for 1-week and 3-week, respectively. The mean hemoglobin increases after 1 week and 3 week was reported as 1.4211± 0.169 g/dl (p< 0.001) and 2.321± 0.335 g/dl (p< 0.001) respectively. Only three patients presented with mild to moderate adverse effect which included abdominal discomfort and nausea. Conclusion: This is a first in class study has shown statistically significant increase in hemoglobin at 1-week and 3-week interval with minimal side effects. It is concluded that Boferin® is efficacious in increasing hemoglobin levels in patients with iron deficiency anemia with its safety being documented in pregnant Pakistani population as well.
Received: November 21, 2022
Revised: April 19, 2023
Accepted: April 20, 2023
doi.org/10.21089/njhs.82.0062
Barriers and Beliefs Related to Covid-19 Vaccine in a Rural Area of Peshawar, Pakistan
Abdul Adil Khan, Syed Imran Gillani, Qazi Haris Wadan and Syed Ibne Ali
Abstract: Background: After the corona virus outbreak, a new challenge has presented itself in the form of vaccine hesitancy, a decision which stems from personal beliefs and perceptions, which may lead to the prevalence of a disease that can otherwise easily dealt with.
Objective: This study aimed to determine the barriers and beliefs related to COVID-19 vaccine in a rural area of Peshawar, Pakistan.
Materials and Methods: An analytical cross-sectional study was conducted from May 2021 to October 2021 on a population from rural areas of Peshawar with a non-probability convenience sampling technique. An interview based self-administered questionnaire was used with questions regarding beliefs and about the COVID-19 vaccine as well as their vaccination status. An SPSS software was used to analyze the data for descriptive as well as inferential statistics.
Results: A total of 526 people from the rural area participated in our study with 73% males (n = 384) and 27% females (n = 142). Only 23.6% got vaccinated voluntarily, 8% agreed that there was enough information available regarding the vaccine to trust, around 17.5% agreed the vaccine does not cause adverse reactions, only 15.6% believed that the vaccine had no unknown side effects, 22.1% trusted the vaccine to be effective in combating the coronavirus while 54.4% believed it to be a conspiracy.
Conclusion: Vaccine hesitancy was quite profound which was caused by the amalgamation of many negative beliefs based on claims that had no sound basis. A great confusion surrounds the COVID-19 vaccine for the people of the rural area who are concerned about various aspects of the vaccine.
Received: April 03, 2023
Revised: June 14, 2023
Accepted: June 19, 2023
doi.org/10.21089/njhs.82.0067
Experience of Physical Examination as a Primary Tool for Surgical Access Planning in Hemodialysis Patients
Waqar Ahmed Memon, Javed Altaf Jat, Pooran Mal, Adeel Hyder Arain, Taimoor Ahmed Jatoi, Ahsan Ali Arain and Ansar Ahmed
Abstract: Background: Understanding the importance of pre-operative assessment is something nephrologists are probing for years to avoid any post-operative complication and AVF failure.
Objective: To assess the physical examination as primary tool as compared to Ultrasound Doppler in assessment of AVF planning in hemodialysis patients.
Materials and Methods: This was a Retrospective, Cross-sectional study. Secondary data was collected from the Urology Department of Liquate University of Medical and health sciences, Jamshoro starting from October 2021 to October 2022. For physical examination, both the arterial and venous circulation were evaluated. Arterial patency, pulse amplitude and Allen’s test were recorded. After collection of data, statistical Package for Social Science (SPSS) version 17. 0 statistical software was used for analysis.
Results: A total of 105 participants with mean age of 42.9 ± 13.9 years, 78 (74.3%) males and 27 (25.7%) females were included. The physical examination findings indicated facial swelling as the most frequently reported sign in with 59 (56.2%) of patients, followed by generalized body edema reported in 22 (21%) of participants. The estimated analysis of Allen’s test indicated good results with a mean of 12.4 ± 2.8 seconds in all patients, indicating good blood flow of the ulnar artery. The mean duration of hemodialysis was 55.2 ± 23.4 days before AVF, while central venous line duration was 57.2 ± 20.5 days. After 6 days fistula maturation was assessed, while mean fistula maturation duration was 44 ± 7.1 days.
Conclusion: To monitor functioning, the Physical Examination of vascular access is convenient, straightforward, and cost-effective. Physical examination (PE) has been validated with diagnostic techniques for detecting stenosis.
Received: April 04, 2023
Revised: June 14, 2023
Accepted: June 15, 2023
doi.org/10.21089/njhs.82.0075
Validation of MRI Quantification of Liver Fat, Keeping CT Liver Attenuation Index (LAI) as Gold Standard
Faryal Ijaz, Samina Khan, Muhammad Salman Rafique, Sana Kundi, Tahir Malik and Ahmad Karim Malik
Abstract: Background: Non – Alcoholic Fatty Liver Disease (NAFLD) is emerging as a considerable health problem in patients visiting gastroenterology clinics. It is of crucial importance to evaluate the extent of hepatic steatosis in potential candidates for living donor liver transplantation (LDLT) to ensure donor safety as well as optimum graft regeneration.
Objective: To validate the MRI quantification of liver fat keeping CT liver attenuation index as gold standard.
Materials and Methods: : This cross-sectional study was carried out in the department of Diagnostic Radiology, Pakistan Kidney and Liver Institute and Research Centre from 10th October, 2022 to 10th December, 2022. We determined the sample size using WHO sample size calculator. The MR fat fraction sequence was acquired as a part of the obligatory MRCP in 70 potential liver donors who undertook CT abdomen. Liver Attenuation Index (LAI) and MR fat fraction were determined separately by two radiologists who were blinded to each other. LAI was calculated as: Mean liver attenuation – mean splenic attenuation. MRI fat fraction from seven areas of liver were taken and their mean calculated to determine the percentage of liver fat. SPSS version 20 was employed for statistical analysis and Pearson’s Correlation was applied.
Results: Among the 70 donors 42 were males and 28 were females (M: F= 1.5: 1). The hepatic fat fraction values on MR were correlated with the liver attenuation index on CT using a two – tailed Pearson correlation test. The results showed a very strong negative correlation between the two; the lower the LAI, the higher the MR fat fraction (Pearson correlation coefficient r = -0.932, p<0.05). Conclusion: Strong correlation was found between MRI estimation of liver fat and CT LAI fat estimation. MRI is safer than CT as it does not involve ionizing radiation, is quicker to perform, and hence can be recommended as future method of choice.
Received: April 01, 2023
Revised: June 05, 2023
Accepted: June 07, 2023
doi.org/10.21089/njhs.82.0080
