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Research Publications (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/216

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Author: search.filters.author.Rmaih, Wafaa

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    The characteristics and outcomes of patients undergoing percutaneous balloon pulmonary valvuloplasty in the paediatric population
    (The Society of Medical Laboratory Technologists of South Africa, 2013-06) Adam, Jamila Khatoon; Govender, S.; Hoosen, E. G. M.; Amod, A.; Rmaih, Wafaa
    Background The immediate results along with short term and medium term results of percutaneous balloon pulmonary valvulo-plasty (PBPV) for the treatment of pulmonary stenosis (PS) have been well documented in literature. On the other hand the results on long term follow up are few. The purpose of this study was to document the immediate, short and long term results of PBPV and, to analyse the characteristics and outcomes of patients who have undergone PBPV at Inkosi Albert Luthuli Central Hospital (IALCH) Department of Paediatric Cardiology in Durban South Africa. Methods The study comprised of 30 patients (20 females/67%, 10 males/33%) with isolated congenital pulmonary stenosis who underwent PBPV from June 2005 to June 2012. Their age ranged from 23 days to 11 years. Patients underwent clinical examination, angiography (Pre and post PBPV) and echocardiography on the day after the procedure, at 6 months and at one year. The difference in clinical examination and diagnostic findings were described over the above three time periods. Results The results were categorized as “excellent” when the Peak Transvalvular systolic gradient (PTSG) was reduced by more than 50mmHg after the procedure, “good” when the PTSG was reduced by 25-50mmHg and “poor” when the PTSG was less than 25mmHg. The mean pre PBPV pullback systolic pressure between the main Pulmonary Artery (MPA) to right ventricular outflow tract (RVOT) was 20.2±7.60 mmHg to 78.1±27.78 mmHg. The mean pre PBPV systolic pullback pressure gradient between the MPA to RVOT was 60.03±32.10. The mean post PBPV pullback systolic pressure between the MPA to RVOT was 20.13±8.22 mmHg to 48.13±24.47 mmHg. The mean post PBPV pullback systolic pressure gradient between the MPA to RVOT was 28.73±23.21 The mean±SD initial echocardiographic gradient was 110.1±35.58 mmHg. The mean±SD echocardiographic gradient the day after PBPV was 54.37±26.53 mmHg (excellent), the mean±SD echocardiographic gradient at the 6 months follow-up was 54.9±28.10 mmHg (excellent) and the mean±SD echocardiographic gradient at the one year follow-up was 53.2±32.27 mmHg (excellent). Patients with Mild Pulmonary stenosis 9/30(30%) showed mean±SD reduction in the gradient between pre-procedure echocardio-graphic findings and at one year follow-up by 41.30±20.10 mmHg (good). Patients with moderate pulmonary stenosis 9/30(30%) showed post PBPV with a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 70.92±24.90 mmHg (excellent). Patients who presented with severe pulmonary stenosis [12/30(40%)] showed a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 81.21±35.85 mmHg (excellent). Procedural complications included pulmonary regurgitation occurring in 16/30(53%) of patients and tear of a leaflet occurring in one patient 1/30(4%). The remaining 13/30(43 %) presented with no procedural complications. Conclusion In this study Percutaneous Balloon Pulmonary Valvuloplasty as a treatment option of pulmonary stenosis in children showed excellent immediate, short and long term results.
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    An assessment of Erythropoietin levels in haemodialysis patients in Addington Hospital Durban, South Africa
    (Research India Publications, 2013) Adam, Jamila Khatoon; Benjamin, Sherilene Cheryl; Assounga, A. G.; Rmaih, Wafaa
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    The predictive value of proBNP levels to determine the presence and severity of coronary artery disease in patients with a positive or inconclusive exercise stress test
    (Medical Technology SA, 2012-06) Adam, Jamila Khatoon; Pearce, A.; Naidoo, N.; Rmaih, Wafaa
    Background Several clinical studies have shown increased levels of N Terminal-Pronatriuretic Peptide (NT-proBNP) during epi- sodes of coronory ischaemia. Consistent with this observation, both Brain Natriuretic Peptide (BNP) and NT-proBNP correlated to severity, location, and extent of angiographic coronary artery disease (CAD). The main objective of this study was to identify the possible value of NT-proBNP level which indicates CAD. Methods Sixty patients with signs and symptoms of CAD were recruited for this study. They were divided into two groups; Group A, consisted of thirty patients with a positive Exercise Stress Test (EST) and Group B, consisted of thirty patients with an inconclusive EST. After the EST, all patients from both groups were required to have a NT-proBNP blood test, a left and right coronary angiogram and a left ventriculogram. Results Post EST NT-proBNP levels, in both groups, increased in the presence of CAD (p<0.001). For the positive EST group, the area under the ROC curve was 0.975 (p<0.001). A cut- off value of 120 pg/ml was identified with the highest sensitivity (95.7%) and specificity (100%). For patients in the inconclusive EST group, the area under the ROC curve was 0.912 (p<0.001). A cut-off value of 85 pg/ml was identified with the highest sensitivity (87.5%) and specificity (86.4%). Conclusion EST is relatively inaccurate at predicting CAD in patients with inconclusive ESTs. The need for an additional tool, such as NT-proBNP measurements post inconclusive EST is warranted in the determination of the presence of CAD.
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    Two year clinical outcomes after sirolimus-eluting stent implantation for the treatment of coronary artery disease
    (Medical Technology SA, 2012) Adam, Jamila Khatoon; Dyer, Robby B.; Harrypaul, Ashika; Rmaih, Wafaa
    Background Coronary artery stents are known to reduce rates of restenosis after coronary stenting, but it is uncertain how long this benefit is maintained. Clinical data has raised concerns that drug-eluting stents are associated with increased rates of late stent thrombosis, death or myocardial infarction. Objectives To evaluate the safety and reliability of sirolimus-eluting stents in real-world practice out to two years. Methods From January 2008 to June 2008, 30 patients were enrolled in the study after implantation of one or more sirolimus-eluting stents. We evaluated clinical follow-up information for up to two years after the implantation of Cypher® Select stents in 30 patients with 35 lesions. Results Mean patient age was 62.33 +/- 10.99 years, 7 percent were diabetic and 30 percent presented with acute myocardial infarctions. The procedure’s success rate was 100 percent for the sirolimus-eluting stent implantation, and follow-up rates were 100 percent. Mean total stent length was 22.32 +/- 6.63 mm, with 13 percent receiving more than one stent. Two year freedom from mortality, myocardial infarction, target vessel revascularization and stent thrombosis was 100 percent. Dual antiplatelet therapy was taken by 100 percent at 1 month, 53 percent at 6 months, 40 percent at 1 year and 0 percent of patients at 2 years. The rate of survival free of myocardial infarction, bypass surgery and repeated angioplasty for stented lesions was 100% at two years. Conclusions Treatment of lesions with sirolimus-eluting stents is associated with a sustained clinical benefit two years after device implantation.