Percutaneous non-stenting approach for distal simultaneous multivessel acute coronary occlusions

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein [GP] IIb/IIIa inhibitor and Factor X inhibitor [Rivaroxaban] with full resolution of flow in the distal vessels. Thus, coronary lesions, not amenable to stenting, can be dealt percutaneously, using a combination of old and newer pharmacological agents without stenting

Needle stick injuries: knowledge, attitude, practices [KAP] and frequency of hepatitis B and C among nursing students in Karachi

Objective: The objectives were to determine the Knowledge, Attitude, Practices regarding needle stick injuries [NSI] and frequency of Hepatitis B and C among nursing students at two tertiary care hospitals of Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Department of Medicine, DMC, JPMC and Hilton Pharma, Karachi from January 2014 to June 2014

Materials and Methods: This study was carried out on NSI exposed 214 nursing students from 1[st] year to 4[th] year, visiting their respective hospitals and engaging in clinical activities. A hundred of those students who reported needle stick injuries randomly selected and screened for Hepatitis B surface antigen [HbsAg] and anti-HCV in sera

Results: Approximately thirty four percent [34%] of the students reported to have NSI one time. Out of the 214 students only 143 [66.8%] of the students were aware of the Universal Precaution Guidelines while 71 [33.2%] were unaware of it. After getting NSI only 18.2% reported it to the infection control team while 81.8% failed to report it. Of the 100 students randomly selected for screening, four tested positive for HbsAg and two tested positive for Anti-HCV

Conclusion: Allowing nursing students to practice without prior knowledge of their immune status poses a major risk of acquiring hazardous infections. Prior to practice, students should be ingrained with the universal precaution guidelines and screened for blood borne infections that should be followed up every year

Evaluation of nephrotoxicity by aspirin-clopidogrel combination therapy in patients with acute coronary syndrome

Although aspirin-clopidogrel combination is more useful for acute coronary syndrome [ACS], the renal safety of this combination had not been established. A total 60 patients with ACS were divided into three groups; receiving aspirin, clopidogrel and aspirin-clopidogrel combination. For determination of renal function, serum BUN, creatinine, uric acid, uric acid clearance and GFR were estimated for four months. The study showed that there were no significant [p>0.05] variations in the parameters when used the drugs in combination [aspirin-clopidogrel] compared with the drugs given alone

unusual case of crimean congo hemorrhagic fever: prolonged bleeding with successful recovery

Crimean Congo Hemorrhagic Fever [CCHF] is a tick-borne viral disease with a major reservoir in both domestic and wild animals. In Pakistan, it is endemic largely in rural areas and most cases occur in spring and autumn. Recently, cases are being reported throughout the year, including winter months, with some even from urban areas. Death from CCHF is most likely to occur during the hemorrhagic phase. We report a case presenting from an urban locality in December. Clinical presentation was characterized by a prolonged hemorrhagic phase and a delayed normalization of platelet counts

Prevalence of dental anomalies among orthodontic patients

Dental anomalies are clinically evident abnormalities which can cause various dental problems, which may complicate orthodontic treatment planning. Clinical and radiological inspection play crucial role in identification of various anomalies. This study was carried over the period of 2 years to determine the pattern and distribution of various morphological dental anomalies among orthodontic patients. Demographic details along with detailed medical, dental and family histories were obtained from every patient. In addition to the intraoral examination, study casts and dental panoramic radiograph were also evaluated for dental anomalies causing disturbance in number, size, form, and location of teeth. Patients with syndromes were not included in the study. Out of 520 patients, dental anomalies were present in 83 [16%] patients. Hypodontia was the most prevalent dental anomaly occurring in 37 [7.1%] patients and maxillary lateral incisor was found to be the most commonly missing tooth. Microdontia was second most prevalent dental anomaly observed in 21 [4%] patients with the maxillary lateral incisor being the most commonly affected tooth. Double tooth was rare finding present only in 1 [0.19%] patient. All dental anomalies showed higher prevalence in female patients except for double tooth and transposition which were more prevalent in male patients. . Dental anomalies can lead to disturbance in occlusion. Orthodontists have the responsibility to observe each patient carefully for various dental anomalies and have full knowledge of them as it can help them in planning treatment for these patients and executing them without any complications

Clinician's views on reporting by the radiology department of a tertiary care hospital in Karachi

There are no standard radiological reporting formats therefore reporting varies from person to person. Clinicians are the users of these reports and their satisfaction on reporting can improve the credibility of the radiology department. To obtain clinician's views and assess their satisfaction regarding the current reporting service by the radiology department and to determine ways of improving it. This was a cross sectional study consisting of two main sections. The first section dealt with the existing reporting style while, the second was about the clinician's preferences on the format of reporting. It was a questionnaire based study where senior physicians representing all departments utilizing the services of the radiology department who consented to participate in the study were included. The results were described as frequencies while, percentages and significance was tested using chi square test. Clinicians were unsatisfied with the detail, timeliness and print quality of the reports. However, clarity and correctness were rated high. Computed Tomography scan was the most satisfactory service offered by the radiology department. Substandard film quality was the most common reason given for requesting a repeat investigation. Clinicians supported the idea that radiologists should give recommendations not only for further radiological investigations but also for non-radiological investigation and further referrals. Most clinicians were unaware of normal size of common body organs. There is a need to enhance communication between the clinician and the radiologist to ensure high quality reporting standards

Prospective comparative study to determine the risk of syncope in a dental chair in supine position during administration of local anesthesia

This study was done to compare the incidence of syncope in supine position versus semi supine position during administration of local anesthesia for dental surgery procedures among the local population. One thousand healthy patients presenting for tooth extraction at the Oral and Maxillofacial Surgery Department of Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi from 15th January 2007 to 31st August 2007 were included in this study. Patients were divided into two groups. In Group A patients were administered local anesthetic injection in supine position i.e. with patients head and heart at the same level, while in the Group B patients were administered local anesthesia in semi-supine position. There were 1000 patients requiring tooth extraction under local anesthesia with an age range of 15-47years [Mean 28.31 +/- 8.55years]. It was noted that 135 patients [27%] treated in supine position had pre-syncope symptoms while 245 patients [49%] had pre-syncope symptoms in semi supine position. The difference was statistically significant [P< 0.0001]. No patient fainted in supine position in this study. It was concluded that it was easy to prevent syncope if all patients are placed in a supine position before hand