Waheed A. Sahibzada

Lanzhou Veterinary Research Institute

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Muhammad Hafizullah

Syiah Kuala University

Muhammad Arabi

National Guard Health Affairs

Inayat Ullah

Lady Reading Hospital

Palwasha Sahibzada

Behman Hospital

Aziz Gul Mufti

Mahmood Ul Hassan

Hayatabad Medical Complex

Shahab Ud Din

Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology

Gangaiah Natarajan

Bharathiar University

Taslim Akhtar

University of Sargodha

Farhat Abbas

Aga Khan University

Cooperative Institutions

Hazara University

Einstein Medical Center Philadelphia

Lady Reading Hospital

Hayatabad Medical Complex

Deborah Heart and Lung Center

Temple University

Behman Hospital

The University of Agriculture, Peshawar

Government College University, Faisalabad

National University of Medical Sciences

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The impact of hyperglycaemia on morbidity and mortality of acute coronary syndromes and acute myocardial infarction.

Journal of Ayub Medical College Abbottabad (2009)

Palwasha Sahibzada Ambreen Khan Waheed A. Sahibzada

Background: Though diabetes and hyperglycaemia are well known risk factors for morbidity and mortality associated with Coronary Heart Disease, there are no studies published from Pakistan on the impact of non-diabetic hyperglycaemia on these indices. The present study was undertaken to fill the gap in knowledge related to this aspect of hyperglycaemia in Pakistani patients. Methods: We studied 166 patients admitted to our coronary care unit from May 2008 to March 2009 with acute coronary syndrome and acute myocardial infarction. The patients were divided into three groups (a) Diabetic group (b) Impaired glucose group and (c) Normal glucose group according to the American Diabetic Association criteria. Results: It was observed that with increasing level of hyperglycaemia there was an increase in the mortality, with a p -value of 0.058. Hyperglycaemia was also associated with impaired left ventricular function and clinical evidence of left ventricular failure. Insulin therapy was under utilized and may have contributed to increased morbidity and mortality. Keywords: Coronary artery syndromes, Myocardial infarction, Diabetes mellitus, Hyperglycaemia

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Changing Pattern of Infective Endocarditis

Pakistan Heart Journal (2012)

Karamat Ali Shah Shahab Uddin Muhammad Hafizullah Muhammad Arabi Inayat Ullah

Introduction: Bacterial endocarditis or better called Infective endocaxditis which was first described by Osler (1) and Horder (2) remains one of the most serious complications of heart disease. It was a fatal disease till the introduction of Penicillin when the mortality fell from almost 100% to around 30% where it has generally stayed(3), though lower figures have been quoted from some major centres (4) in recent years. Patients and Methods: It was a prospective study convering all patients suspected of infective endocarditis admitted to cardiology unit, P.G.M.1./’%Rj-j from January 1985 to November, 1987. It was a prospective study covering all patients suspected of infective endocarditis admitted to cardiology unit, P.G.M.I./L.R.H. from January 1985 to November, 1987. Results: A total of 65 proformas were collected. Out of which only 45 were accepted with most probable Infective Endocarditis. 20 cases were discarded, as they proved to be non-endocarditic. Discussion: The mean age of 19 years for our patients was extremely low which was even lower than 31 year of pre-antibiotic era (6).In last 2-3 decades the mean age has steadily increased to 57 years (6,7) because of increase longevity and falling incidence of rheumatic heart disease.Blood cultures were positive in only 10 cases (22%). Out of which two cases of citobacter and Micrococcus were most probably contaminants while the rest 8 cases grew the same bacteria in at least two sets. This was in sharp contrast to other studies where the causative organisms were isolate d from 90% to 98% of cases (9, 12).We wish to thank Dr. Tasleem Akhtar, Director, PMRC, Peshawar and her lab oratory staff who kindly helped us in providing the blood culture facilities.

Infective Endocarditis

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Total Cholesterol and High Density Lipoprotein Cholesterol in Myocardial Infarction Patients and Controls.

Pakistan Heart Journal (2012)

Waheed A. Sahibzada Zahoor Ahmad Taslim Akhtar

INTRODUCTION: Atherosclerotic Coronary heart disease has reached epidemic proportions in ‘the developed countries of the Western world where mortality from it is approximately 1000 per 100,000 population (1). The prevalence of the disease in the tropical countries including Pakistan was thought to be low (2,3,4). However, the hospital admissions from Coronary Heart Disease, appear to have increased dramatically over the past few decades (5,6); even more disconcerting is the relatively high proportion of young individuals, less than forty years of age, afflicted by the disease. METHODS: All patients who presented to the Coronary Care unit of Khyber Hospital Peshawar and who were diagnosed as having Myocardial Infarction were included in the study. The diagnosis of Myocardial Infarction was made the basis of at least two of the following Criteria: 1) the presence of typical constricting chest pain, at least half an hour in duration. 2) Elevation of serum Enzymes CPK, SGOT LDH 3) Typical EGG changes of Acute Myocardial Infarction Q waves, QS complex and ST and T wave changes. Cigarette smoking and other forms of tobacco use were also looked at in the control and patient population. RESULTS: Age: The mean age of the patient group was 53.9 ± 10.3 years: of the total number of 82 cases there Were ten (12.2%) aged 40 years OR less: 54 (65.8%) in the 41 - 60 years age group and 18 (22%) in the over sixty group. As is apparent from figure 1 the age distribution is similar to other reported series where the majority y of patients falls in the middle aged category (7). Also fairly significant proportions fall in the less than 40 years bracket. DISCUSSION: p A review of available hospital admission data indicates that the number of admissions from CAD is increasing (5,6). No clear reason has emerged from the limited number of studies. Total cholesterol of 206 mgs% in the patient group and 209 mgs% in the present study would rule against this being a significant contributory factor.

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Effect of Diabetic Status on Morbidity and Mortality following Acute Myocardial Infarction

Journal of Postgraduate Medical Institute (2011)

Farhat Abbas Taufiq Ahmad Mufti Muhammad Hafizullah Waheed A. Sahibzada Kiramat Ali Shah

The morbidity and mortality from acute myocardial infarction (AMI) is high in diabetics. This may be due to more extensive myocardial damage as diabetics have more severe coronary artery disease (CAD). This short term propective study evaluated the clinical course of AMI in diabetic patients. Patients admitted with AMI were assessed for glycemic status, clinical events and left ventricular function on echocardiography. Fifty diabetic and sixty non diabetic patients were enrolled. the baseline characteristics were well matched. More diabetic patients were in killip calss II and III [(56% vs 21%) P< 0.05] class IV [(12% VS 6%) p=NS] and had higher mortality [14% function assessed on echocardiography LVFs 20 + 8% VS 25 + 5%) P< 0.05]. diabetics had higher fasting glucose [(164 + 68 vs 90 + 13mg/dl) p<0.001] and higher fructosamine level [(445 + 152 vs 226 + 50 micro mol/l) p< 0001). Diabetes was consideree adequately controlled in 12 patients against 38 patients with fructosamine level [(250 + 25 vs 494 + 168 micro mol / l) p< 0.001) and fasting glucose [(105 + 12 vs 175 + 25 mg/dl) p< 0.01]. Heart failure was more common in uncontrolled diabetics than controlled diabetics [(70% vs 34%) p< 0.05] but there was no difference in mortality. Diabetic status in general and uncontrolled diabetes in particular is associates with higher morbidity and left vetricular dysfunction.

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Myocardial metabolic studies in prolapsing mitral leaflet syndrome.

Circulation (1975)

Gangaiah Natarajan Fred K. Nakhjavan D. Kahn S. Yazdanfar Waheed A. Sahibzada

Patients with prolapsing mitral leaflet syndrome (PML) frequently have chest pain of undetermined etiology. Twenty-three patients with PML underwent cardiac hemodynamic, angiographic, and metabolic studies. The latter were performed during control spontaneous heart rate and tachycardia by right atrial pacing. Myocardial supply-demand ratio (DPTI:SPTI) was estimated from the planimetric integration of the diastolic area (diastolic pressure time index = DPTI) and systolic area (systolic pressure time index = SPTI) of the central aortic pressure. Chest pain during pacing occurred in five patients. In two patients, it was associated with ST depression typical of ischemia on the electrocardiogram. Myocardial lactate abnormalities (lactate production or less than 10% extraction) occurred in seven patients during pacing tachycardia and was present in two patients during control state. DPTI:SPTI ratio during control state was 1.22 (+/- 0.07 SE) and decreased to 0.85 (+/- 0.05 SE) during pacing tachycardia. It is concluded that the myocardial lactate abnormalities in PML, which were present in approximately 30% of the patients in the present series, are most likely due to myocardial hypoxia. Whether or not the hypoxia is secondary to "small vessel disease" is not elucidated by this study.

Cardiac index

10.1161/01.cir.52.6.1105

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Detection of Escherichia coli and total microbial population in River Siran water of Pakistan using Emb and Tpc agar

African Journal of Microbiology Research (2018)

Waheed A. Sahibzada Aalia Gul Sahibzadi F. Sana Kibrea Tayba Saleem Adila

There is an increased ratio of gastrointestinal diseases in the area of Mansehra, Pakistan, which depends on the Siran River for drinking. These diseases drew our attention to analyze the microbial population. For detection of Escherichia coli and other microbial population, samples were collected from different regions of Mansehra, Pakistan. Two samples were collected from each site for proper detection of microorganisms and repeated the process 5 times. The microbial counts were performed using total plate count agar (TPC) and eosin methylene blue (EMB). The samples were cultured on EMB and TPC agar at 370C for 24 h. The findings revealed that Baffa and Bajna had high microbial count confirmed by EMB and TPC. To this end, we confirmed that Siran River has high microbial count. The E. coli detection in water indicates the fecal contamination and the presence of E. coli in water makes the water unfit for drinking. Key words: Escherichia coli, eosin methylene blue, total plate count, drinking water.

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10.5897/ajmr2018.8955

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Prevalence of Coronary Artery Disease in Rural Areas of Peshawar

Journal of Postgraduate Medical Institute (2005)

Mahmood Ul Hassan Zahid Aslam Awan Adnan Mahmood Gul Waheed A. Sahibzada Muhammad Hafizullah

To see the prevalence of coronary artery disease in rural areas of Peshawar above the age of 30 years. They were interviewed according to performa by trained interviewer. Fasting blood was taken for sugar and serum cholesterol. ECG was done of every subject. height, weight, BMI and blood pressure were recorded. Diagnosis of CAD was made both on the rose questionnaire and ECG criteria according to the minnesota code. The most prevalent risk factors for CAD in rural area in Peshawar were physical inactivity, obesity, hypertention and diabetes mellitus. Coronary artery disease risk factors, i.e. iage > 40 years, hypertension, diabetes mellitus, hypercholesterolemia and physical inactivity were significantly associated with CAD in rural population. CAD was more prevalent in females as comapred to males, through not statistically significant. Male gender, smoking and increase body mass index did not turn out to be important risk factors for CAD in rural area in our study.

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Haemodynamic Effects of Captopril in Congestive Cardiac Failure Due to Rheumatic Heart Disease

Journal of Postgraduate Medical Institute (2011)

Muhammad Hafizullah Waheed A. Sahibzada

Rheumatic heart disease is a leading cause of congestive cardiac failure. Besides conventional therapy ACE Inbibitors have been found useful in patients with congestive cardiac failure. This study was conducted in 13 patients with CCF due to RHD to see the acute hemodynamic effects of an ACE inhibitor captopril, Captopril 25mg was orally administered and heamodynamic changes were recroded at fixed intervals. The pulmonary wedge pressure dropped by 21 % p <.001. Cardiac index improved by 8 % p <.01. Captopril has a beneficial effect in patients with CCF because of lowering of preload and afterload with little effect on cardiac output and heart rate.

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Coronary risk Factors Estimation in Different Regions of Pakistan

Journal of Postgraduate Medical Institute (2011)

Waheed A. Sahibzada

Ischemic heart disease is a leading cause of death all over the world. The major risk factors for athrerosclerosis are hypertension, diabetes mellitus, smoking and hypercholesterolaemia. This study comprising 2201 subjects conducted in four citis of the mean cholesterol in hypertensive and nomotensive group was 192 + 51.0 and 174 + 54mg% respectively. the mean cholesterol value of lower socioeconomic group was 172 + 52.9mg% and higher socioeconimic group was 191 + 53.8mg%. Value in children was found to be 146 + 30.55mg% among boyes and 148 + 31.9mg% among girls. Mean cholesterol values vary in different cities. Large scale surveys are required to define the risk factors so that a well orchestrated drive can be planned accordingly.

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Changing Pattern of Infective Endocarditis

Journal of Postgraduate Medical Institute (2011)

Syed Karamat Ali Shah Shahab Ud Din Muhammad Hafizullah Muhammad Arabi Inayat Ullah

Forty five indoor patients of infective Endocarditis admitted during 1985-87 with mean age of 19 years are being reported. 37 patients (82%) had pre-existing rheumatic valualar lessions and 8 patients (18%) had underlying congenital heart disease. Two patients had prosthetic valve endocarditis while right-sided endocarditis was found in 8 cases (18%). Fever, anaemia, clubbing splenomegaly and microscopic haematuria were the common features. Portal of entry could not be established in an case.

Infective Endocarditis

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