European Journal of Cardiovascular Medicine

Background: Coronary chronic total occlusions (CTOs) refer to 100% blockages that result in no blood flow (TIMI grade 0) in the affected segment and have lasted for a confirmed or estimated duration of at least three months. Microcatheter overuse can cause fatigue, leading to entrapment or detachment, while balloons and stents are prone to entanglement in calcified or stented areas. This study evaluated the outcomes and feasibility of performing CTO PCI without the use of microcatheters, focusing on guidewire type ,techniques , assessing the impact on procedural success, complications and overall patient outcomes. Method: This retrospective observational study utilized data collected from PNA Shifa Hospital Karachi, including all the adult patients (18 or above) of CTO PIC procedures from 2018 to 2024 performed with and without using microcatheters. Result: The chi-square test applied to the pre-and post-dilation outcomes revealed no statistically significant differences between procedures with or without microcatheters. The p-value was >0.05 indicating that the use of microcatheters had no impact on the success of the dilation and excellent results were achieved in both groups. Conclusion: Microcatheters make the procedure more successful in many CTO-PCI cases, especially in challenging anatomies. This study's findings and supporting literature suggested that alternative strategies can be equally effective in achieving favorable outcomes, depending on the operator's expertise and the specific lesion characteristics.

Background: Over 41 million people live with HIV. With 12% of them still unaware of their status, untreated mental illness in this population leads to non-adherence, higher viral loads, increased immunosuppression, morbidity, mortality, and transmission risk. Methods: It is a cross-sectional study in 100 individuals aged 18-65 years who were diagnosed as HIV positive. Prevalence of depression and other psychiatric comorbidities, were diagnosed with ICD10, and screening and severity of psychotic and affective symptoms assessed with BPRS and HDRS scales.  Results: Prevalence of psychiatric morbidity was 33%, including 12% depressive disorder. Mean duration of HIV illness in those depressed was longer, than those with no psychiatric morbidity, but depression was negatively associated with CD4 count. BPRS scores were found to have a negative correlation with CD4 count and duration of HIV illness.  Conclusion: Persons with HIV need regular screening for early management of psychiatric morbidities. Strategies for good healthcare support system, especially for women, may result in potentially higher QOL outcomes. Facilitating access to care including mental health should be made a priority for this vulnerable population.

Background: Hyponatremia, defined as serum sodium <135 mEq/L, is a frequent electrolyte disturbance in critically ill patients and has been associated with prolonged ICU stay, mechanical ventilation, and increased mortality. This study aimed to determine the prevalence, severity, and etiological profile of hyponatremia in Medicine ICU (MICU) patients and to assess its association with clinical outcomes. Methods: A total of 177 critically ill patients aged 18 years and above admitted to the MICU were enrolled in the study. Serum sodium levels were measured on admission, and hyponatremic patients were categorized by severity (mild, moderate, severe) and volume status (euvolemic, hypovolemic, hypervolemic). Clinical data, comorbidities, treatment details, ventilator requirements, and outcomes were analyzed using standard statistical tests. Results: The mean age of patients was 52.99±12.6 years, with slight male predominance (52.5%). Hyponatremia was present in 63 patients (35.6%), with 18.1% severe, 11.3% moderate, and 6.2% mild cases. Hypervolemic hyponatremia was most common (50.8%), followed by hypovolemic (38.1%) and euvolemic (11.1%). Congestive cardiac failure (25.4%) and chronic kidney disease (20.6%) were leading etiologies. Ventilator support was required in 49.1% of patients, with mean duration of 8.6±2.9 days. Mortality occurred in 21.5% of cases. While the overall presence of hyponatremia was not significantly linked to mortality (p=0.111), increasing severity showed a strong association with adverse outcomes (p=0.048) and prolonged ventilation (p=0.004). Conclusion: Hyponatremia was a common electrolyte disturbance among MICU patients, with severe cases showing higher mortality and prolonged ventilation. Hypervolemic hyponatremia, mainly due to cardiac and renal causes, was most frequent. Early recognition and severity-based management are crucial for improving outcomes in critically ill patients

Background: Hypokalemia associated with hypertension is an important clinical clue to secondary hypertension, particularly primary hyperaldosteronism. Early identification of the underlying cause facilitates targeted treatment and reduces cardiovascular morbidity. The present study was undertaken to evaluate the clinical presentation, laboratory profile, and etiological spectrum of patients presenting with hypokalemia associated with hypertension. Methods: This hospital-based observational cross-sectional study included 80 adult patients with hypertension and serum potassium levels <3.5 mEq/L recruited over 18 months at a tertiary care teaching hospital. Demographic characteristics, clinical features, blood pressure, laboratory investigations, hormonal profile, electrocardiographic findings, and final diagnoses were recorded. Data was analyzed using SPSS version 22.0, with p<0.05 considered statistically significant. Results: The majority of patients were aged 41–60 years (51.3%) with male predominance (57.5%). Fatigue (70.0%), muscle weakness (61.3%), and headache (55.0%) were the most frequent presenting symptoms. Stage 2 hypertension was most common (41; 51.3%) and mild hypokalemia was predominant (39; 48.7%). Mean serum potassium was 2.91±0.42 mEq/L, and 76.3% of patients had spot urine potassium-to-creatinine ratio ≥15 mEq/g. The mean aldosterone-to-renin ratio was elevated (31.6±12.8). U waves were the most common electrocardiographic abnormality (45.0%). Primary hyperaldosteronism was the leading diagnosis (42.5%), followed by renovascular hypertension (22.5%). Patients with primary hyperaldosteronism had significantly higher mean aldosterone–renin ratio (42.8±10.6) than other groups (p<0.001). Conclusion: Hypokalemia in hypertensive patients frequently indicates an underlying secondary cause, particularly primary hyperaldosteronism, and may be associated with significant target-organ damage. Early clinical, biochemical, hormonal, and ECG evaluation is essential for timely diagnosis and prevention of cardiovascular and renal complications.