Objective— To examine variants at the 9p21 locus in a case-control study of acute myocardial infarction (MI) in Pakistanis and to perform an updated meta-analysis of published studies in people of European ancestry. Methods and Results— A total of 1851 patients with first-ever confirmed MI and 1903 controls were genotyped for 89 tagging single-nucleotide polymorphisms at locus 9p21, including the lead variant ( rs1333049 ) identified by the Wellcome Trust Case Control Consortium. Minor allele frequencies and extent of linkage disequilibrium observed in Pakistanis were broadly similar to those seen in Europeans. In the Pakistani study, 6 variants were associated with MI ( P <10 −2 ) in the initial sample set, and in an additional 741 cases and 674 controls in whom further genotyping was performed for these variants. For Pakistanis, the odds ratio for MI was 1.13 (95% CI, 1.05 to 1.22; P =2×10 −3 ) for each copy of the C allele at rs1333049 . In comparison, a meta-analysis of studies in Europeans yielded an odds ratio of 1.31 (95% CI, 1.26 to 1.37) for the same variant ( P =1×10 −3 for heterogeneity). Meta-analyses of 23 variants, in up to 38 250 cases and 84 820 controls generally yielded higher values in Europeans than in Pakistanis. Conclusion— To our knowledge, this study provides the first demonstration that variants at the 9p21 locus are significantly associated with MI risk in Pakistanis. However, association signals at this locus were weaker in Pakistanis than those in European studies.

Background— Evidence is sparse about the genetic determinants of major lipids in Pakistanis. Methods and Results— Variants (n=45 000) across 2000 genes were assessed in 3200 Pakistanis and compared with 2450 Germans using the same gene array and similar lipid assays. We also did a meta-analysis of selected lipid-related variants in Europeans. Pakistani genetic architecture was distinct from that of several ethnic groups represented in international reference samples. Forty-one variants at 14 loci were significantly associated with levels of HDL-C, triglyceride, or LDL-C. The most significant lipid-related variants identified among Pakistanis corresponded to genes previously shown to be relevant to Europeans, such as CETP associated with HDL-C levels (rs711752; P <10 −13 ), APOA5/ZNF259 (rs651821; P <10 −13 ) and GCKR (rs1260326; P <10 −13 ) with triglyceride levels; and CELSR2 variants with LDL-C levels (rs646776; P <10 −9 ). For Pakistanis, these 41 variants explained 6.2%, 7.1%, and 0.9% of the variation in HDL-C, triglyceride, and LDL-C, respectively. Compared with Europeans, the allele frequency of rs662799 in APOA5 among Pakistanis was higher and its impact on triglyceride concentration was greater ( P -value for difference <10 −4 ). Conclusions— Several lipid-related genetic variants are common to Pakistanis and Europeans, though they explain only a modest proportion of population variation in lipid concentration. Allelic frequencies and effect sizes of lipid-related variants can differ between Pakistanis and Europeans.

In GUSTO trial, deaths and non-fatal strokes were 6.9% for accelerated TPA, 7.7% for SK with subcutaneous heparin and 7.9% for SK with IV heparin. Other international trials have reported complication rates from 3.7% to 10.7% (1,2,3,5,6). In our own practice we do observe immediate benefits with SK therapy. However, more frequent rehospitalizations for post-MI Angina, re-infarction and OUTCOME OF THROMBOLYTIC AND NONTHROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION

OBJECTIVE:To compare morbidity, in hospital mortality and benefits of Streptokinase (SK) therapy and NonStreptokinase (non-SK) therapy in acute myocardial infarction patients.METHODS:Retrospective review of the medical record of 300 patients with all types of acute MI admitted in our CCU between Nov. 2000-April 2001.RESUTLS:Out of 300 patients, 210 (70%) were male and 90 (30%) were female. 150 (50%) were given SK therapy and 150 (50%) did not receive SK therapy because they did not qualify. Mean age was 55 years. The success of SK therapy was judged indirectly through non-invasive measures. LIMITATIONS: This data is from a hospital which does not have invasive or PCI facilities, hence it was totally dependant on non-invasive measures. However, this might help in patient management in our society where most hospitals/CCUs do not have invasive facilities.CONCLUSION:The overall survey shows that not only mortality was improved in SK group but also patients had less complications, early pain relief and shorter hospital stay. However, due to higher earlier event rate in SK group, these patients should preferably be referred to a facility having interventional support.

OBJECTIVES: To see the incidence, prevalence and common presentation of different types of cardiomyopathies in patient presenting with congestive heart failure (CHF). SETTING: This study was carried out at Cardiology Department of Liaquat University Hospital Hyderabad over a period of 9 months from August 2001 to April 2002. METHODOLOGY: This descriptive case series study included 200 patients who presented with congestive heart failure or angina. Detailed history of all patients was taken, systemic examination done. After appropriate investigations a diagnosis of all cases was made and patients were treated accordingly. All the parameters studied were noted and compiled later on. RESULTS: Dilated cardiomyopathy was seen in 140 cases, ischemic cardiomyopathy in 38 cases and hypertrophic cardiomyopathy in 22 cases. While no case of restrictive cardiomayopathy was seen in this study. CONCLUSION: Ischemic cases are more common in our society than western world because of inadequate awareness and lack of facilities in rural areas. It was also noted that males of older age group suffer more from congestive heart failure due to cardiomyopathy than females.

A study is described of the kinetics of reactions in which the complexes trans-IrX(CO)(PPh3)2, where X = Cl, Br, and I, are used for the catalytic homogeneous hydrogenation of olefinic bonds. Catalytic activity is enhanced in coordinating solvents such as dimethylacetamide. The rate law is complex, showing between zero and first order in each of iridium, substrate, and hydrogen concentrations, and the mechanisms proposed show the importance of a dissociation step in making available a coordination site on the transition metal complex. The dependence of rate on the halogen followed the order I > Br > Cl. Quite remarkably, traces of oxygen in the system enhance the hydrogenation rate considerably.