Bidirectional ventricular tachycardia of unknown etiology

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. Hiselectrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up [of 6 months] he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction [MI] due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation

Are antibiotics needed for common throat infections?

Ever fuelling antibiotic use and resulting resistance is still prevalent in our society most commonly prescribed for throat infections. However community acquired throat infections are known to be caused mostly by viruses, therefore it was of interest to determine the incidence of bacterial species grown from infected throats and whether the character of these isolates indicated antibiotic intervention to control ever increasing antibiotic resistances. Prospective Study. At a private Lab and Diagnostic Centre, Karachi, Pakistan during Jan 2010 to July 2011. The isolates from 362 patients of all ages presenting with RTI were cultured and identified using standard protocol. Antibiotic sensitivity of these isolates was checked using 23 drugs and the Kirby-Bauer disc diffusion method at a private lab in Karachi. In addition, to know the perspective of ENT specialists regarding the antibiotic resistance, rate of their prescriptions and the drugs they prescribe, 30 questionnaires were also collected. Among the 362 isolates Pneumococci were most commonly seen [35.34%] followed by Staphylococcus aureus [23.01%] and notable Klebsiella pneumoniae [14.5%]. The ENT physicians interviewed commonly prescribed any of 20 antibiotics, most often Amoxicillin, Amoxiclav or even the injectables Cefotaxime, Ceftriaxone for pharyngitis. In our study, among others, the isolates were most sensitive to Cefotaxime [91.2%], Ceftriaxone [91.0%] and Amoxiclav [80.4%] followed by Penicillin [71.0%] Erythromycin [43.1%] and Cefixime [30.7%] were less effective. Pneumococci and Staphylococci were most often isolated from infected throats; these were likely part of residential flora accompanying infecting respiratory viruses, the drug therapy was hence superfluous and essentially harmful