Methemoglobinemia in an elderly patient with glucose-6-phosphate dehydrogenase deficiency: a case report

Glucose-6-phosphate dehydrogenase [G6PD] deficiency is an X-linked genetic disorder characterized by low levels of the G6PD enzyme. It is present worldwide but with more prevalence in the Middle East and the Mediterranean areas. We report a case of severe hemolysis due to G6PD deficiency manifesting as methemoglobinemia in a 70 year old Omani male never known to have any previous hemolytic episodes or previously diagnosed of G6PD deficiency.

Infective endocarditis of the aortic valve caused by Pseudomonas aeruginosa and treated medically in a patient on haemodialysis

Infective endocarditis [IE] in patients on dialysis is a serious infection with a high mortality rate. It is usually caused by Gram positive bacteria with Gram negative organisms being relatively rare as a cause. Recommended treatment usually involves surgical valve replacement and the extended use of antibiotics. Successful treatment with antibiotics alone is rare. We report a case of IE caused by Pseudomonas aeruginosa in a patient on dialysis treated solely with antibiotics

Diagnostic value of electrocardiographic T wave inversion in lead aVL in diagnosing coronary artery disease in patients with chronic stable angina

The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease [CAD] remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina. Electrocardiograms [ECGs] of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded [66 patients]. The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists. T wave inversion in aVL was identified in 89 ECGs [46.8%] with definite ischemic Q-ST-T changes in different leads in 97 ECGs [50.8%]. Stand alone aVL T wave inversion was found in 27 ECGs [14.1%] while ischemic changes in other leads with normal aVL were identified in 36 ECGs [18.8%]. The incidence of CAD was 86.3%. Single, two-and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery [LAD] lesions [Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001]. This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding