Jawaid Akbar Sial

Bio: Jawaid Akbar Sial is an academic researcher from Chandka Medical College. The author has contributed to research in topics: Percutaneous coronary intervention & Medicine. The author has an hindex of 6, co-authored 37 publications receiving 150 citations.

Severe mitral stenosis with atrial fibrillation--a harbinger of thromboembolism.

Abstract: Objective: To determine the frequency of Left Atrial thrombus in patients suffering from severe mitral stenosis with atrial fibrillation. Methods: A cross sectional descriptive type study was conducted in the Echocardiography department of the National Institute of Cardio Vascular Diseases (NICVD) Karachi from October 1, 2007 to March 17, 2008. A total of 100 consecutive adult patients with severe Mitral stenosis (MS) and Atrial Fibrillation (AF) were included in this study. 12-lead Electrocardiography was done once clinical and echocardiographic features revealed Sever MS. Patients with signs of AF were selected and Transthoracic Echocardiography (TTE) was obtained to detect Left Atrial Thrombus. Transesophageal echocardiography (TEE) was performed whenever thrombus could not be found with TTE and / or nature of the mass could not be confirmed. Results: Among 100 patients studied; there were 52 males and 48 females. TTE was performed in all patients and LA thrombi were detected in 24% patients. TEE was performed in remaining 76% patients and additional 14 patients with LA thrombi were detected in this subgroup. Therefore a total of 38% of the patients with LA thrombi were documented. Among them, 6% had clots in LA body while LA appendage clots were found in 32% of patients. Left atrial dimension was found to be relevant (P-value = 0.004) with the presence of thrombus in patients with severe mitral stenosis associated with atrial fibrillation. Left atrial spontaneous echo contrast (LASEC) was found in 54% of patients but it was not found to be relevant with the presence of LA thrombus (P = 0.75). Conclusion: Left atrial thrombus was present in 38% patients with severe mitral stenosis associated with atrial fibrillation. Larger left atrial diameter is a stronger predictor of presence of LA thrombus (JPMA 60:439; 2010).

Changing trends of infective endocarditis.

Abstract: OBJECTIVE To determine the frequency of culture positive and culture negative endocarditis and type of organisms causing bacterial endocarditis in patients admitted at National Institute of Cardiovascular Diseases (NICVD), Karachi. METHODS This was a cross sectional, descriptive study conducted from 29th March 2006 to 13th October 2006 at National Institute of Cardiovascular Diseases, Karachi. All patients having clinical suspicion of infective endocarditis were admitted and worked up. Seventy five patients having definite infective endocarditis as per Duke Criteria were included. RESULTS There were 55 (70%) males and 20 (30%) females. Mean age of the patients was 23 +/- 8.9 years. Ninety percent of the patients were below 40 years of age. Six patients had prosthetic valve and six were intravenous drug abusers. The commonest signs and symptoms observed were fever, shortness of breath, weight loss, murmur, pallor and splenomegaly. Mitral valve was affected in majority of patients. Blood cultures were positive in 40 (53.3%) cases while 35 (46.7%) cases were culture negative. Nine (22.5%) patients out of 40 culture positive cases and 29 (82.8%) patients out of 35 culture negative cases were using antibiotics before admission. All six intravenous drug abusers showed culture positive endocarditis. Among culture positive cases, staphylococcus group was found in 21 (52.5%) cases while streptococcus group in 11 (27.5%) cases. Coagulase negative staphylococci were found to be the most common organism, that is 14/40 (35%) patients. CONCLUSION Changes in spectrum of organisms causing bacterial endocarditis reported by western researchers do exist in our community. To know the reason behind these changing trends needs further advanced studies and evaluation.

Coronary embolism causing acute myocardial infarction in a patient with mitral valve prosthesis: successful management with angioplasty.

Abstract: A 24-year-old male patient with anterior myocardial infarction, caused by embolization from mitral valve prosthesis due to inadequate anticoagulation is presented. The patient underwent cardiac catheterization within 90 minutes of arrival. Angiography showed total occlusion of the left anterior descending coronary artery (LAD) after the second diagonal branch. Thrombus was extracted with export catheter from LAD, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transoesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with coronary angiography with clot extraction with aspiration catheter (Export XT 6F Medtronic) only, without stenting.

Outcome of primary percutaneous coronary intervention at public sector tertiary care hospital in Pakistan.

Abstract: Objectives To determine the outcome of Primary Precutaneous Coronary Intervention (PCI) in our setup and compare the results with the west. Methods This study was conducted at a tertiary care teaching Hospital (National Institute of Cardiovascular Diseases Karachi, Pakistan) during January 1st, 2008 to December 31st, 2008. A total of 113 patients were enrolled who came with STEMI and agreed to go for Primary PCI. We excluded the patients who had history of Thrombolytic therapy within 24 hours, presented with Non ST-elevation Myocardial Infarction (NSTEMI) and coronary angiogram revealed significant left Main or equivalent disease. All Patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA Inhibitor. After Primary PCI patients were planned to follow at one month, 3 months and 6 months. Primary end point was to document death, MI, CABG and rehospitalization. Results Out of 113 cases, 102 (90.3%) were male and 11 (9.7%) were female, Mean age was 51.2 +/- 11.7 years, 54 (47.8%) patients had Hypertension, 28 (24.8%) were Diabetics and 44 (38.9%) were Smokers. Immediate success was achieved in 111 (98.2%) cases. In hospital mortality was 5.3% (3.5% in cardiogenic shock, 1.7% in non-shock patients). Mean Door to Balloon time remained 98.4 minutes. Twelve patients were lost to follow up. Therefore at 6 months, out of 101 patients, 8 (7.9%) died, 5 (4.9%) underwent Coronary Artery Bypass Graft (CABG) surgery and 5 (4.9 %) had been re-hospitalized either for recurrent myocardial infarction or heart failure. Conclusion Optimal results of primary percutaneous coronary intervention can be achieved for acute STEMI in a developing country at a tertiary care public sector hospital. The results are comparable and nearly similar to the west.

The causative agents in infective endocarditis: a systematic review comprising 33,214 cases

Abstract: Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term "infective endocarditis". All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3 % of studies (N = 57) (and in 55.4 % of studies using Duke's criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and diagnostic strategies.