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Home > Outcomes in Patients With Acute Coronary Syndromes at the Aga Khan University Hospital, Nairobi

Outcomes in Patients With Acute Coronary Syndromes at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Varwani, Mohamed Hasham

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728056273

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Background: As the prevalence of cardiovascular diseases in Sub-Saharan Africa rises, coronary artery disease, with its acute presentations, is being increasingly recognized in Kenyans and treated at tertiary level hospitals. It is just over a decade since the introduction and wide availability of modern cardiology services, including interventional cardiology in Kenya. Following an acute coronary syndrome (ACS), patients remain at high risk of death and other adverse events such as heart failure, recurrent myocardial infarction, stroke, and bleeding. Local and regional data on long-term outcomes following ACS are lacking. These data are important to clinicians for prognostication and to health care planners for resources allocation. Objectives: The objectives of this study were to determine the in-hospital and long-term outcomes of patients following the treatment of Acute Coronary Syndromes. Specific objectives included determining in-hospital, 30-day and one-year mortality of ACS patients, and the rates of several non-fatal adverse outcomes including reinfarction, heart failure and cardiogenic shock, revascularization, stroke, major bleeding and re-hospitalization due to specific major adverse events. Methods: The study was a retrospective chart review of ACS admissions during a two year period (2012-2013) for all acute coronary syndrome admissions. Data on patient characteristics, treatment, and inpatient and short-term outcomes were obtained from the patients’ medical records. Telephone interviews were conducted to determine long-term results. Results: A total of 230 patients were included in the analysis. Of these, 101 had a diagnosis of STEMI, 93 suffered an NSTEMI, and 36 had UA. Males accounted for 81.7% of the patients, and the mean age was 60.5 years. Delayed presentation was common with more than 35% of patients taking longer than 24 hours to arrive. Coronary angiography was performed in 85.2% of the patients. The in-hospital mortality was 7.8% (14.9% for STEMI and 2.3% for NSTE-ACS), the mortality at 30 days and one year was 7.8% and 13.9% respectively. The most common in-hospital non-fatal adverse outcome was heart failure, occurring in 40.4% of STEMI and 16.3% of NSTE-ACS. Readmission rate due to recurrent MI, stroke or bleeding at one year was 6.6%. Conclusion: In our cohort, in-hospital, 30 day and one year mortality following acute coronary syndromes remains high, particularly for STEMI. Delayed presentation to hospital following the onset of symptoms appears to be an important contributing factor.
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مولانابدر الدین علوی

مولانا بدر الدین علوی
افسوس ہے کہ گذشتہ مہینے مولانا بدرالدین صاحب علوی سابق استاد عربی مسلم یونیورسٹی نے وفات پائی مرحوم استاد العلماء مولانا لطف اﷲ صاحب علی گڑھی کے تلمیذ رشید اور مولانا حبیب الرحمن خاں شروانی مرحوم کے ہمدرس تھے، ان کی پوری زندگی درس و تدریس اور علم و ادب کی خدمت میں گذری مسلم یونیورسٹی سے ریٹائر ہونے کے بعد گھر پر عربی کے شایقین کو درس دیتے تھے، انھوں نے عرصہ ہوا المختار بن شعر بشار بن برد پر اور اس کی شرح لابی الطاہر اسمٰعیل بن احمد التجیبی بڑے اہتمام سے تصحیح و تحشیہ کے ساتھ شائع کیا اﷲ تعالیٰ اس شیدائے علم کی مغفرت فرمائے۔
(شاہ معین الدین ندوی،مارچ ۱۹۶۵ء)

زیارت قبر رسولﷺ،جمہور اور شیخ ابن تیمیہ Sheikh Ibn-e-Taymiyyah’s Distinction on the issue of the traveling to visit the tomb of the Holy Prophet ﷺ

Shaykh-ul-Islam Ahmad bin Abdul Haleem alias Ibn Taymiyya (661-728 AH) is one of the great personalities whose far-reaching effects of his thoughts and opinions have been felt in every age. The issues, on which Allama Ibn Taymiyya has a different opinion, are the result of his such research as well as liquidation, wisdom, Ijtihad and continuous consideration as well as deliberation which have been based on Quran and Sunnah, the interaction of companions and speculation. In his Ijtihadi issues, there is a collection of evidence and proofs related to the Quran and Sunnah. Most of Ibn Tamiya’s dissent is of a jurisprudential and principled nature. Some of these dissents are against the consensus of the Ummah. Some are against the religion of the four Imams, some differences are contrary to Hanbali School of thought itself and some differences are against the majority of scholars. Allama Ibn Taymiyya also has such differences in which he looks unique and distinguished from the whole Ummah. One of them is related to the pilgrimage to the tomb of the Holy Prophetﷺ. According to Islamic scholars, traveling to visit the tomb of the Holy Prophet Muhammad ﷺ is permissible and rewarding. The majority of scholars agree on this. Ibn Tamiya’s position and the difference is that if he did not intend to offer prayers in the Holy Prophet's Mosque during this pilgrimage, then it is not permissible according to most of the scholars and imams, nor has it been commanded. According to the command of the Holy Prophet ﷺ, the reason behind this is that only three mosques should be packed, namely Masjid al-Haram, Masjid al-Nabawi, and Masjid al-Aqsa. After the Prophet of Islam, there is room for disagreement with the words and deeds of everyone in Islamic thought. Almost all the great scholars have disagreed with this position and have refuted it with arguments. But their other religious and national services cannot be ignored based on this distinction. In the article under discussion, Ibn Tamiya’s position and his arguments will be critically examined in light of the views of other scholars of the ummah.

Impact of Omeprazole, Rosuvastatin and Clopidogrel on the Pharmacokinetics of Cefixime in Healthy Adult Human Subjects

The aim of the present study is to evaluate the pharmacokinetics (PK) parameters of the cefixime in the local healthy human volunteers and to study the influence of its PK on the co-administration with omeprazole; rosuvastatin and clopidogrel on the pharmacokinetic of cefixime. The study was designed in three stages. In first stage of study, reverse phase high performance liquid chromatography (RP-HPLC-UV) method for the analysis of cefixime was developed and validated. In the second stage PK of cefixime was established in local healthy human volunteers while in the third stage potential drug-drug interaction of cefixime with concurrent administration of omeprazole, rosuvastatin and clopidogrel was investigated. A novel isocratic, simple, economic, precise, selective, and reproducible RP-HPLC-UV method of determination of cefixime and cefdinir (I.S) in human plasma was developed and validated. The cefixime was separated on a Supelco Discovery HS C 18 (150 x 4.6 mm, 5 μm) analytical column, fixed with Perkin Elmer C 18 (30 x 4.6 mm, 10 μm) guard cartridge. The methanol/acetonitrile (50/50 v/v):0.05% trifluoroacetic acid (19:81 v/v) was used as mobile phase. The flow rate was adjusted at 2.0 ml.min -1 . The temperature of the column was fixed at 50̊C and sample was injected using 20 μl loop and the eluents were monitored at a 285 nm. Sample preparation was based on a simple extraction procedure consisting of deproteination and extraction with 3 parts of 6% TCA solution (aqueous) followed by volume make up with the mobile phase. Separation of cefixime and cefdinir were achieved within 4 min. The present method demonstrated good values for specificity/selectivity, linearity (0.004-5.0 μg mL -1 ; r 2 >0.999 f), recovery I Abstract (>96% for cefixime), precision (%RSD <2.2 for cefixime), sensitivity (limit of detection: 1 ng mL -1 and lower limit of quantification: 4 ng mL -1 , stability of solutions, and robustness. The method was efficiently applied to a pharmacokinetic study in healthy adult volunteers. The PK study of cefixime in healthy human volunteers (n = 20) was conducted using single dose, open label study design. A strict inclusion and exclusion criterion was adopted. The physical, biochemical and hematological examination of every individual were conducted. Each individual volunteer was orally administered cefixime capsule (400 mg) with full glass of water (Ca ᴝ 250 ml) and blood samples were collected at preset time intervals and analyzed using HPLC. The plasma drug concentration was calculated and various PK parameters were calculated using PK summit ® a PK software. The mean ± SD of C max , T max AUC , AUC and AUMC of cefixime was 3.54 ± 0.55mg.ml -1 , 32.54 ± 5.81μg-hml -1 , 32.49 ± 5.99 μg-hml -1 and 246.67 ± 58.57 μg-h*h ml - 1 respectively. While the mean ± SD of Cl, Vd and MRT were 192.71 ± 31.46 ml/h/kg, 1200.13 ± 364.47 ml/kg and 7.23 ± 0.85h . The Pharmacokinetic analysis using non- compartment model for cefixime was also studied and the mean ± SD AUC , MRT, Cl and Vd were 33.492 ± 5.99 mg.ml -1 , 7.320 ± 0.853 h, 12270.252± 1958.550 ml/h/kg and 76485.611 ± 23318.799 ml, respectively. The present data reveal that most of the PK parameters of cefixime found in study are not significantly different from reported values in other nations and no need to adjust the dose under normal conditions. II Abstract The PK drug-drug interaction studies were carried out with same group of volunteers (n = 20) which participated in PK study with a wash out period of 3 weeks. Same protocol was adopted for inclusion and exclusion of volunteers. The single dose, two periods, two sequences, open labeled with wash out period of one week between the two interaction studies was designed. The plasma drug concentrations of cefixime following oral administration of cefixime (400 mg) alone and with simultaneous administration of omeprazole (40 mg) were investigated. The concentration of cefixime in plasma samples following simultaneous administration of cefixime (400 mg) and omeprazole (40 mg) capsule were calculated. The different PK parameters were determined to investigate interaction between cefixime and omeprazole. The C max of cefixime was significantly decreased from 3.545 ± 0.552 μg.ml -1 to 2.648 ± 0.356 mg.ml -1 whereas t max was non-significantly increase to 3.964 ± 0.118 to 4.00 ± 00 h. The decrease in AUC AUC ∞ and were also observed from 37.67 ± 3.77 μg-h ml -1 to 27.25 ± 5.94 μg-h ml - 1, 34.03 ± 5.496 μg-h ml -1 to 22.629 ± 5.99 μg-h ml - 1 and 435.415 ± 48.37, to 234.32 ± 52.43 μg-h*h/ml, respectively. The mean ± SD of Cl and Vd were reduced and MRT was increased from 192.71 ± 31.46 ml/h/kg to 188.70 ± 36.62, 1200.13 ± 364.47 to 1756.439 ± 900.81 ml/kg and 7.46 ± 4.55 h to 11.444 ± 5.42. The Pharmacokinetic analysis using non-compartment model for cefixime with simultaneous administration of omeprazole was also studied that also showed similar alteration in PK of cefixime following simultaneous administration of cefixime and III Abstract omeprazole. The alteration in drug plasma profile by changes in bound and un-bound fraction mainly affects the changes in the Cl and Vd. The change in the Cl and Vd will also alter the Vss and AUC. Similar protocol was adopted to study the PK drug drug interaction between the cefixime and rosuvastatin. Single oral dose of cefixime capsule (400 mg) alone and in combination with rosuvastatin (40 mg) were administered in healthy human volunteers (n = 20) using two periods, two sequence, open labeled, cross over design with washout period of 7 days between two treatments. Concurrent administration of cefixime with rosuvastatin significantly decreased C max , AUC and AUC ∞ of cefixime from 3.79 ± 0.69 mg.ml -1 to 2.88 ± 0.33 mg.ml -1 , 33.79 ± 6.22 μg.h ml -1 to 27.89 ± 3.80 μg.h ml -1 and from 29.06 ± 4.99 μg.h ml -1 to 25.01 ± 6.15 μg.h ml -1 , respectively. Similarly the Cl, MRT, and Vd also decreased significantly from 194.67 ± 54.23 to ± 42.48 ml/h/kg, 9.80 ± 5.22 to 8.65 ± 4.59 h and from 1435.24 ± 398.26 to 1246.21 ± 500.38 ml/h/kg, respectively. The non-compartment model analysis of the data for cefixime with co-administration with rosuvastatin showed significant decrease in AUC , and Cl from 33.49 ± 5.99 to 31.37 ± 3.89 mg.ml -1 , 12653.44 ± 7246.82 to 11893.69 ± 2761.52 ml/h/kg, respectively. while the MRT and Vd were also significantly decreased from 9.21 ± 1.21 to 8.49 ± 2.36 h and 97221.61 ± 33215.21 to 82341.41 ± 29368.67 ml. The decrease in the parameters may be due to the use of same class of transporter (SLC) both cefixime and rosuvastatin may either compete for same transporter or rosuvastatin may inhibit the transporter responsible for the transport of the cefixime across the G.I.T. membrane. IV Abstract The PK drug-drug interaction study of cefixime (400 mg) with clopidogrel (150 mg) was carried out with in healthy human volunteers (n= 20) using two period, two sequence, open labeled, cross over design with one week washout time between treatment periods. Various PK parameters like C max , T max , AUC, AUMC, MRT, t 1⁄2 β, Cl, Vd and t 1/2 β etc were calculated for cefixime single oral dose of cefixime following single oral dose of cefixime (400 mg capsule) alone and concurrent administration with clopidogrel (150 mg tablet). The data showed the decrease in the C max of cefixime from 3.35 ± 0.538 mg.ml -1 to 3.13 ± 1.13 mg.ml -1 . Whereas AUC , AUC and MRT of cefixime were also decreased from 37.67 ± 21.97 μg-h ml -1 to 32.97 ± 6.44 μg-h ml -1 , 34.04 ± 22.65 to 30.974 ± 3.664 and from 7.462 ± 5.22 h to 7.213 ± 3.198h, respectively. Moreover, non- compartment PK model was applied for cefixime with co-administration with clopidogrel was studied and the mean ± SD AUC , and Cl were decreased 41.27 ± 23.67 to 35.42 ± 6.90 mg.ml -1 , 12653.44 ± 7246.46 to 11627.21 ± 1930.77 ml/h/kg, respectively. While the MRT and Vd was decreased from 7.33 ± 0.86 to 6.96 ± 1.49 h and 76485.61± 23318.79 to 97295.95 ± 21281.29 ml, respectively. The t 1/2 β of cefixime changed from 3.64 ± 1.88 h to 6.96 ± 1.49 h with simultaneous administration of clopidogrel. The reason of alteration may be due to that; clopidogrel may competitively displace cefixime from protein and re-distribution of cefixime that may result in changes of PK parameters. The oral concurrent administration of the clopidogrel and cefixime is considered to be safe. The drug-drug interaction between the cefixime and clopidogrel may be classified as moderate type of drug-drug interaction." xml:lang="en_US