Experience with permanent pacemaker implantation at Mayo Hospital, Lahore

Permanent pacemaker implantation procedure was started at Mayo Hospital, Lahore in March, 1978. Till December 31st 1998 nine hundred and sixty six permanent pacemakers had been implanted in this institution. 53% patients were males and 47% patients were females. 55% patients were between 50-70 years old. The youngest patient was only six months old while maximum age of the patients implanted with permanent pacemaker was ninety nine years old. 92% patients had fist implant while 6% patient had second implant and 2% patient had third implant. 84% patients had complete heart block, 5.5% patients had sick sinus syndrome, 2.7% patients had symptomatic second degree heart block, 2.6% patients had congenital heart block

To study the risk factors for hepatitis C in cirrhotic patients

The purpose of the study was to evaluate predisposing risk factors for the development of Hepatitis C in cirrhotic patients who tested positive for Hepatitis C. Twenty three cirrhotic patients who tested positive for hepatitis C were included in the study. All were questions about possible risk factors resulting in infection with Hepatitis C. 4 patients [17.3%] gave a history of previous blood transfusion, 5 [20.8%] had a previous history of jaundice, 5 [20.8%] had a history of needle stick injury in the past. No patient gave a history of surgery and no history of contact with a jaundiced patient was available. 1 patients [4.35%] who also gave history previous blood transfusion, gave a history of contact with multiple partners. In 9 cases [39.1%] no cause could be established. This shows that in a significant number of cases the mode of transmission of Hepatitis C still remains a grey area

Pregnancy with previous mitral valve replacement

Mitral valve replacement has changed many lives of patients with severe mitral stenosis who were doomed due to severe haemodynamic complications. Successful pregnancy outcomes are now numerous. The study was carried out at Services hospital involving 7 pregnant patients with mitral valve replacement, as regards to its antepartum, intrapartum and postpartum management. The study showed the incidence to be 0.2% of all deliveries. StarrEdwards was the most common [71.5%] prosthetic valve with good haemodynamic outcomes. Five [71.5%] patients remained in NYHA class II, showing the efficacy of valvular surgery and I. Five [71.5%] patients ended in vaginal delivery of healthy infants and 2 [28.5%] had evacuation. Six [85.7%] patients received anticoagulants. Oral warfarin was used in all of these six cases throughout the first trimester. One [14.3%] of these patients ended in spontaneous abortion. One [14.3%] patient had blighted ovum and intravenous heparin was replaced for warfarin 24 hours before evacuation at 12 weeks of gestation. The remaining 4 [57%] patients continued warfarin through second trimester, and replaced by subcutaneous heparin at 34 weeks in 3[42.8%] patients and at 36 weeks in one [14.3%] patient. Coagulation monitoring, which was carried out in only 3 [42.8%] cases, revealed ineffective thromboprophylaxis. Ampicillin and gentamycin was given intravenously at start of labour and then 8 hourly for 48 hours in 6 [85.7%] patients. Antenatal antibiotic prophylaxis was provided only to 1 [14.3%] patient by benzathaine penicillin [penidure-LA, Wythe] 1.2 x 106 units per month. Diuretics, digoxin and beta blockers were prescribed according to individual requirements of patients. Two patients developed pulmonary oedema treated effectively in the intensive care unitI.C.U. There was no mortality in this study. A concerted effort by all the concerned specialities in patients management is necessary to ensure safe outcome. The role of subcutaneous instead of intravenous heparin for prophylaxis in pregnancy should be evaluated by further studies