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BACKGROUND: Device-related thrombus (DRT) following left atrial appendage occlusion (LAAO) can lead to adverse clinical outcomes. DRT rates and outcomes from randomized trials are limited.OBJECTIVES: This analysis investigated the incidence, predictors, and clinical outcomes of DRT following LAAO in the Amulet IDE (AMPLATZER Amulet LAA Occluder Trial) trial.METHODS: Successful implants occurred in 903 patients with an Amulet occluder (dual occlusive mechanism device) and 885 patients with a Watchman device (single occlusive mechanism device). These patients were then followed through 18 months and DRT was assessed by transesophageal echocardiography.RESULTS: The overall incidence of DRT was 3.9% (n = 70) with 3.4% (n = 30) in dual occlusive mechanism device patients and 4.8% (n = 40) in single occlusive mechanism device patients. Most DRTs (n = 19 of 31) were identified early (≤45 days) on the dual occlusive mechanism device, whereas most of the DRTs (n = 31 of 42) were identified late (>45 days) on the single occlusive mechanism device. Strong predictors of DRT included atrial fibrillation at time of procedure (HR: 2.44; 95% CI: 1.42-4.22; P < 0.01), female sex (HR: 1.65; 95% CI: 1.01-2.71; P = 0.04), and older age (HR: 1.04; 95% CI: 1.01-1.08; P = 0.02). There were no stroke events following DRT in the dual occlusive mechanism device group and 3 stroke events following DRT in the single occlusive mechanism device group. Patients with DRT were at a greater risk for cardiovascular mortality compared with non-DRT patients (8.7% vs 3.9%; HR: 2.33; 95% CI: 1.01-5.39; P = 0.04).CONCLUSIONS: Incidence of DRT following LAAO was low. Early DRTs are seen with the dual occlusive mechanism device and late DRTs are seen with the single occlusive mechanism device. Increased cardiovascular mortality risk in patients with DRT should be further investigated. (AMPLATZER Amulet LAA Occluder Trial; NCT02879448).

Exposure to carcinogenic chemicals, Helicobacter pylori infection, and high dietary salt are the risk factors associated with gastric cancer. Mice models of gastric cancer are key to understanding the cancer mechanism, to discerning the role played by different factors, and to determining therapeutic effects of different treatments. The goal has been to find targets which are only expressed with cancer so that they can be targeted specifically without harming normal cells. One such target could be the transferrin receptor, a glycoprotein receptor that is expressed many-folds on rapidly growing cells due to the greater demand of iron. In this study, gastric cancer was developed in mice (BALB/c) with human cancer-associated risk factors by feeding them with tumor-inducing concentration of methyl nitrosourea, dietary salt, and H. pylori along with normal feed and water. Three strategies were adopted to induce gastric cancer; (1) use of N-methyl-N-nitrosourea (MNU) with high dietary salt (NaCl), (2) infection with H. pylori (isolated from human gastric tissue), and (3) use of MNU along with high concentration of NaCl after H. pylori infection. Mice were dissected after induction, and histological study of gastric tissue was done with Hematoxylin and Eosin staining. A diagnostic probe comprising transferrin conjugated with cadmium sulfide quantum dots was prepared and characterized. It was used to study the transferrin receptor overexpression in gastric tissue of cancer-induced mice relative to the normal mice. Mice of group 3 showed the highest rate of the cancer incidence ratio (96%) along with a high expression of transferrin receptors among the three groups. Histochemical studies showed that different types of gastric cancer depend upon the cancer-induction conditions. The mouse model of group 3 has the potential to be used in the future to study the therapeutic effects of cancer medicines, and overexpression of transferrin receptors could be identified through the designed probe to be used as diagnostics.

Background and Objectives: The intention of this study was to compare the histopathological features of helicobacter pylori positive gastritis (HPPG) and helicobacter pylori negative gastritis (HPNG) reported at Department of Pathology, Sahiwal Medical College & Allied Hospitals, Sahiwal, Pakistan. Methodology: It was a descriptive cross-sectional study carried out at Histopathology Section, Department of Pathology, Sahiwal Medical College, Sahiwal. It included all the gastritis cases proven on histopathology on endoscopic biopsies sent from Gastroenterology Department GHAQTH Sahiwal from January 2020 to December 2020. HPPG and HPNG cases were sorted and the data was analyzed with help of SPSS version 20. Chi-square test was used to find p-value and the value of p

Objective: The purpose of this study is to observe the prevalence of depression, anxiety and stress among undergraduate MBBS students of Sahiwal Medical College Sahiwal stratified by their gender, class and residences. Study Design: Cross-sectional Survey. Setting: Sahiwal Medical College Sahiwal. Period: 15th March, 2020 to May 15, 2020. Material & Methods: A validated questionnaire was distributed through Whatsapp to different students of all the five MBBS classes. The online survey was done because of countrywide lockdown due to COVID-19 pandemic. Depression Anxiety and Stress Scale (DASS-42) accomplished by 209 students. Results: Depression, anxiety and stress levels of temperate to severe range were found in 48.30, 59.80 and 44.40% of our study group, respectively. Depression was more prevalent in male students (62.50%) while anxiety and stress totals were greater amongst female students (69.40% and 63.60% respectively). First- and final-year students had high prevalence of depression (71.00% and 72.40% respectively) and stress (64.50% and 72.40% respectively) while first year and 2nd year students were more prevalent with anxiety (77.40% and 79.60% respectively) then the others. Hostel residents were found to be high in depression (61.50%) while day scholars were having greater prevalence rates of anxiety and stress (70.40% each). Students who were pleased with their training had lesser depression, anxiety and stress scores than individuals who were not contented. Conclusions: The increased prevalence of depression, anxiety and stress signs amongst college students is disturbing. This displays the necessity for major and ancillary preventive actions, by the improvement of suitable and fitting support facilities for this group.

Objective: To run a comparison between specificity, sensitivity, PPV (positive predictive value) (PPV) & NPV (negative predictive value) of the three varied H. pylori detection methods used in the study. Materials and Methods: It is a retrospective descriptive study that was carried out at Histopathology wing of Pathology Department, Sahiwal Medical College, Sahiwal. It comprised of entire cases of gastritis which were histopathologically proven by using Hematoxylin and Eosin, Giemsa and Immunohistochemical stains on biopsies taken by endoscopy and were sent from Gastroenterology Department Govt. Haji Abdul Qayyum Teaching Hospital, Sahiwal from January 2020 to the month of December 2020. SPSS version 20 was employed to evaluate all the received data. Results: Amongst 95 samples, IHC (Immunohistochemistry) was ranked highest, displaying 100% specificity, 100% positive predictive value and 94.74% sensitivity. The H&E stain followed IHC, displaying 100% and 94.44% specificity and sensitivity respectively. The Giemsa stain was the runner up, displaying 95.65% specificity and 94.12% sensitivity. Conclusions: Histologically, H. pylori infection was associated more with chronic active gastritis as compared with chronic gastritis. The three dissimilar staining methods achieved sensitivity, specificity, positive predictive value and negative predictive values equally well. IHC is a precise method for detection of H.Pylori in gastric biopsies with high sensitivity and specificity. It is suggested to use more than one staining method where H.pylori level is low, it will minimize false-negative rate. Keywords: Helicobacter pylori, Diagnosis, Staining, IHC, H& E, Giemsa

At present time portal hypertension is perceived as one of the complications ofadvanced liver disease. It results in various vascular changes in gastrointestinal tract (GI),including esophageal varices, gastric varices and portal hypertensive gastropathy (PHG). PHGand gastric varices are a common cause of acute as well as chronic bleeding from GI tractwhich resulted in significant mortality among patients. Objectives: To determine the frequencyof gastric vascular changes in various causes of cirrhosis. Study Design: Cross sectional study.Setting: Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad.Period: 1st August 2007 to 31st July 2008. Materials and Methods: Patients of age ≥30 years,with clinical evidence of cirrhosis and without prior treatment of esophagiogastric varices wereincluded in the study. Results: A total of 100 patients were enrolled in the study out of which47 were male and 53 were females with mean age of 53.6 years. The most common type ofcirrhosis was turned out to be Hepatitis C affecting 50% of patients and most of the patientswere in Child class C. Portal hypertensive gastropathy was present in 74% of patients. Amongthem 24.3% have mild changes while severe changes were present in75.7% of patients. Gastricvarices were found in 40% of the patients and the most common type was IGV type I whichwas present in 29(72.5%) of the patients. Correlation of severity of PHG was seen with gradingof esophageal varices, grading of gastric varices and Child class. Conclusion: Frequency ofsevere gastropathy is higher than the mild gastropathy. It is also concluded that gastric vascularchanges are associated with cause of cirrhosis, child class and degree of portal hypertension.

To compare the improvement of dilatation among patients receiving intralesional steroid injection with dilatation versus dilatation alone for the management of corrosive ooesophageal strictures.The randomized controlled trial was conducted at Mayo Hospital, Lahore, Pakistan, from November 10, 2014, to November 10, 2015, and comprised patients of either gender aged 15-50years who had corrosive ooesophageal stricture. They were randomised into 2 groups by using the lottery method. In the dilatation group, only endoscopic dilation was done, while in the combination group, intralesional triamcinolone injection was injected followed by dilatation. Follow-up endoscopic dilatation was done every two weeks. Data was analysed using SPSS 21.There were 60 patients randomised into two groups of 30(50%) each. The overall mean age was 32.58±10.58 years and the male-to-female ratio was 1.7:1. At baseline, in dilatation group, the mean stricture length was 23.30±2.28cm while in combination group, it was 24.23±3.06cm. In dilatation group, the mean stricture length was 11.20±3.09cm while in combination group, it was 5.33±3.09cm (p=0.0001)..oesophageal Combination group was more effective than the dilatation-alone group.

Objective: The purpose of this investigation was to characterize clinical variables and angiographic distribution of coronary atherosclerosis to classify patients with de novo left main (LM) disease in a real-world population presenting for coronary angiography. Background: Limited quantitative and angiographic published data exist that provide detailed quantitative information to classify potential target population for elective LM percutaneous coronary intervention (PCI) and guide development of dedicated LM PCI platforms. Methods: Medical history and clinical presentation were prospectively collected on 177 consecutive patients with LM stenosis ≥50% by coronary angiography. Blinded quantitative coronary angiography (QCA) was performed on all LM stenoses to classify LM-A (ostial), LM-B (nonostial, non-bifurcation), and LM-C (bifurcation involvement). QCA was performed on the left anterior descending (LAD), left circumflex (LCx), and right coronary arteries (RCA) and branches (≥2.5 mm) to identify lesions with ≥60% stenosis or occlusion. Results: No differences in baseline clinical history or presentation discriminated the distribution patterns of LM stenosis. QCA revealed 66% of LM stenoses were LM-C. Mean LM reference vessel diameter was 4.65 mm and average lesion length was 11.12 mm. Around 88.7% of patients had at least one lesion ≥60% in a major epicardial artery and 32.2% of patients had RCA chronic total occlusion. Right-to-left coronary collateralization was only identified in patients with obstructive stenosis in the LAD or LCx in addition to the LM stenosis. Conclusion: Dedicated LM stent platforms may need to be developed to accommodate larger vessel size and bifurcation distributions. A majority of patients with LM stenosis will require adjunctive epicardial vessel PCI to achieve complete anatomic revascularization.

Background: The long-term prognostic implication of post-procedural hematocrit drops in patients undergoing cardiac catheterization outside the clinical trial setting is not well defined. Methods: Data was prospectively collected from 12,661 patients undergoing diagnostic or interventional cardiac catheterization between July 1998 and July 2006. Patients were divided into three cohorts based upon the degree of hematocrit change: drop greater than 6, drop between 3 and 6, and drop less than 3. In-hospital major adverse events, 30-day mortality, and long-term all-cause mortality were recorded. Results: Patients with larger reductions in hematocrit were more likely to be older, female, and have a higher baseline hematocrit, present with acute myocardial infarction, develop cardiogenic shock, require emergent catheterization, develop retroperitoneal bleeds and large hematomas, receive transfusions, have longer index hospitalizations, develop subacute stent thrombosis, and have higher 30-day and long-term mortality. An increase in long-term mortality was observed with progressive hematocrit drop. This finding is largely driven by early (30 day) mortality, as trends were no longer significant after rezeroing mortality. Hematocrit drop was not an independent risk factor for 30-day mortality. Transfusion and low baseline hematocrit were identified as independent predictors of near and long-term mortality. Conclusions: Periprocedural bleeding, defined by hematocrit drop, is associated with increased near-term and long-term mortality in patients undergoing diagnostic and therapeutic cardiac catheterization procedures. Long-term mortality is largely driven by up front 30-day mortality. Hematocrit drop was not an independent predictor for near-term mortality. Transfusion and low baseline hematocrit were independent predictors for near and long-term mortality. © 2009 Wiley-Liss, Inc.