Multi-resistant Enterococci and Morganella morganii: a rare cause of complicated keratitis

An eighty-five-year-old female presented with preexisting conditions of benign essential hypertension, dyslipidemia, chronic renal failure and diabetes mellitus type 2. She had gastroenteritis, pain and redness in right [blind] eye with corneal decompensation, scarring and right-eye corneal ulcer with hypopyon. Corneal scrapings sent for culture report revealed growth of Morganella Morganii and Enterococci Corneal ulcer was successfully treated with topical and oral antibiotics

Impact of thalassemia major on patients; families in south Punjab, Pakistan

The objectives of this study were to examine the level of awareness of the parents regarding Thalassemia Major; the cost of treatment of Thalassemia Major Patients and the sufferings it brings to the families; the social problems faced by patients' families; to identify the barriers patients' families face in the treatment of Thalassemia child. Descriptive study. Four Thalassemic Centers [i] Thalassemia / Hemophilia Centre, The Children's Hospital and the Institute of Child Health Multan [ii] Fatimid Foundation Multan [iii] Amna Blood Foundation [iv] Minhajul Quran Multan. January-2013 to June-2013. A sample of 500 respondents was drawn from the total population and structured interview schedule was administrated. Data were analyzed and interpreted by using SPSS [Statistical Package for Social Sciences] 19.0 version software. The structured interview was discussed with two experts of the Sociology Department and two Senior Doctors [>8 years' experiences] working in the Thalassemia centers and Government Health Institutions. It was revised to incorporate recommended improvements. Descriptive and inferential statistics were applied to analyze the data that includes: frequency, percent, mean, standard deviations. Data indicated that 100[20.0%] respondents were patients' father while 329[65.8%] were mothers and 71[14.2%] were close relatives. Of the 500 respondents, 306[61.2%] were married to their first cousins, 91[18.2%] of the respondents were married to their second cousins, 34[6.8%] of the respondents married in distance relatives and 69[13.8%] of the respondents married out of family. The study summarized that the health care providers should be encouraged to talk about Thalassemia as a public health problem in Pakistan and should enhance the public awareness to eliminate the Thalassemia in Pakistan

Central retinal artery occlusion in a healthy pregnant woman: a suspected case of susac syndrome

An eighteen-year-old pregnant woman presented with history of acute loss of vision in the right eye for 4 days. Clinical examination revealed central retinal artery occlusion in the right eye. All investigations were normal except MRI brain. MRI report suggested the possibility of acute vasculitis or Susac syndrome; it should be considered in all cases of acute retinal artery occlusions occurring in apparently healthy young females without any precipitating factors. The syndrome may not manifest 'with full clinical triad

Frequency and angiographic characteristics of coronary artery ectasia in patients undergoing coronary angiograms at AFIC and NIHD

To determine the frequency and angiographic characteristics of coronary artery ectasia in the patient population of AFIC and NIHD. Descriptive Study Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jan 2007 to Dec 2011. All coronary angiograms done during the period were included in the study. The reports of coronary angiograms of those patients who were diagnosed to have coronary artery ectasia were left circumflex artery reviewed to assess the distribution of ectasia in different coronary arteries. Concomitant significant coronary artery stenosis left ventricular [LV] systolic function and history of revascularization were also documented. Over the study period, a total of 41,459 patients underwent coronary angiograms. 548 [1.32%] patients were diagnosed to have coronary artery ectasia. Out of these 467 [85.21%] patients were males and 81 [14.78%] were females. Their mean age was 53.7 years. Left anterior descending [LAD] was the coronary artery, most commonly affected by ectasia followed by left circumflex artery [LCx] and Right coronary artery [RCA]. Twenty three patients also had ectasia of left main stem. Four Hundred and three [73.54%] patients also had concomitant occlusive coronary artery disease and 19.52% patients had history of coronary revascularization either by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Coronary artery ectasia is not a benign disorder as it could present as acute coronary syndrome having its own morbidity and mortality

Transcatheter closure of large sized patent ducts arteriosus using the amplatzer duct occluder device

To assess the results of anterograde transcatheter closure of a large sized patent ductus arteriosus using the Amplatzer Duct Occluder [ADO] device. A case series. Department of Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2005 to December 2007. All patients who underwent transcatheter closure of large sized PDA [4.0 mm], using the Amplatzer Duct Occluder [ADO] device, from January 2005 to December 2007, were included by convenient sampling technique. After the procedure, repeat aortogram was performed to confirm the appropriate position of the ADO and to evaluate for residual shunts. A total of 100 patients had PDA diameter of 4.00 mm. Mean age was 11.73 +/- 10.31 years and there were 37 males and 63 females. Mean PDA diameter was 6.011 +/- 2.078 mm. Forty-nine patients had type 'A', 19 had type 'B', 19 patients had type 'C', 5 had type 'D' and 8 patients had type 'E' PDA. Complete closure was achieved in 70 patients, 26 had trace shunt and 4 patients had small residual shunt immediately after the procedure. However, no patient had residual shunt 24 hours after the procedure. ADO is a highly efficient prosthesis that can be safely applied in most patients with PDA particularly in patients with large sized PDA

Outcome of radiofrequency catheter ablation as a non-pharmacological therapy for idiopathic ventricular tachycardia

To determine the outcome of Radiofrequency Catheter Ablation [RFCA] as a non-pharmacological curative therapy for idiopathic Ventricular Tachycardia [VT] and to identify procedure-related complications. Descriptive study. The Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from February 2001 to October 2008. Ninety eight consecutive patients with idiopathic VT, resistant to drug therapy, who underwent Electrophysiology Studies [EPS] radiofrequency catheter ablation were enrolled. Clinical and electrophysiological variables were recorded and a descriptive analysis was done. Out of the 98 patients, 79 were males [80.6%]. The mean age was 33.29 +/- 11.93 years. Modes of presentation were sustained VT, Repetitive Monomorphic VT [RMVT], Non-sustained VT [NSVT] and Ventricular Premature Beats [VPBs]. Right Ventricular Outflow Tract [RVOT] VT was found in 37 patients, 37 had Idiopathic Left Ventricular Tachycardia [ILVT], 20 had Left Ventricular Outflow Tract [LVOT] VT, and Inflow Right Ventricular Tachycardia [IRVT] was found in 7 patients. Other sites of origin of VT were infrequent. Eight patients had dual morphologies of VT. Atrioventricular Nodal Re-entry Tachycardia [AVNRT] was found in 8 patients. RFCA was successful in abolishing inducible VT in 88 patients. One patient developed complete AV block requiring a permanent pacemaker. Results of this study confirm a high degree of success and safety of radiofrequency catheter ablation as curative therapy for idiopathic ventricular tachycardia

Predictors of fatal outcome in acute myocardial infarction

Myocardial infarction is one of the most common life threatening diagnoses in emergency hospital admissions. Most of the complications occur during the first few hours while the patients are likely to be in the hospital. Although the mortality rate after admission for myocardial infarction has declined significantly over the last two decades but it still remains high. Survival is markedly influenced by age of the patient, presence of different risk factors and complications that patients develop after myocardial infarction. We conducted a study at Armed Forces Institute of Cardiology/National Institute of Heart Diseases [AFIC/NIHD] to document the predictors of mortality in patients with acute myocardial infarction. Patients with first acute myocardial infarction admitted to the hospital from Feb. 2007 to June 2007 were included in the study. It was a descriptive case series study and data was collected on a pre-designed proforma with convenient sampling technique. Patients were assessed clinically with special emphasis on history of typical chest pain and physical examination. Relevant investigations were carried out to establish the diagnosis. Two hundred and fifty cases were assessed. Mean age was 57.94 +/- 14.00 years. Males were 74.4% and Females were 25.6%. Overall in-hospital mortality was 9.2%. Females had a higher mortality [14.06%] as compared to males [7.52%]. Mortality was also related with age of the patient and Diabetes Mellitus. Other features adversely affecting the in-hospital mortality included higher Killip class, anterior wall myocardial infarction and higher peak Creatine Kinase [CK] levels. Mortality was also higher in patients who did not receive thrombolytic therapy for different reasons. Patients with certain risk factors are more prone to develop complications and have a higher mortality rate. Identification of some of these risk factors and timely management of complications may reduce mortality

Transcatheter treatment of lutembacher's syndrome

Lutembacher`s syndrome is a rare combination of atrial septal defect [ASD] and rheumatic mitral stenosis. Traditionally, this condition is treated surgically. We present a case of Lutembacher`s syndrome that was successfully treated with percutaneous transcatheter mitral commissurotomy [PTMC] using the Inoue balloon. Closure of ASD was successfully achieved with an Amplatzer atrial septal occluder under transthoracic echocardiogram [TTE] guidance without general anesthesia

Device closure of residual postsurgical atrial septal defect by transcatheter technique

Surgical closure of an Atrial Septal Defect [ASD] and transcatheter closure of ostium secundum ASD is an established form of therapy in selected patients. Only a few cases have been reported in literature when transcatheter closure of ASD was achieved successfully in a patient with residual postsurgical ASD. It is less invasive, avoids thoracotomy, requires short hospital stay, yet, hemodynamic benefits, similar to surgery, can be achieved. It may also be considered the procedure of first choice in postsurgical residual atrial septal defect. Present case report describes the technique in a 14 years old girl with residual ostium secundum ASD

Cutaneous leishmaniasis; clinical response of intralesional meglumine antimoniate in the treatment

The aim of study was to evaluate clinical response of Intralesional Meglumine Antimoniate [MA] in the treatment of Cutaneous Leishmaniasis [CL]. A case control interventional prospective study Scouts Hospital Wana, from Feb 2003 to Dec 2004. A total number of sixty patients were included in the study on the basis of demonstration of LT bodies in the slit skin smears and skin biopsies. These patients were randomly distributed in three groups. Group 1 constituted 20 patients who received 0.5 ml [42.5 mg of MA] in each lesion six days a week for a total number of 15 injections. Group II included 20 patients who received o.5 ml [42.5 mg of MA] in each lesion on alternate days for a total number of 15 injections. Group III included 20 patients, who were unwilling for treatment due to personal reasons and were used as a control group. Patients were then observed on 30 days and followed up at 3 and 6 months. In group I over all cure rate was found to be, 12 of 20 [60% patients. In group II 17 of 20 [85%] patients and in group III spontaneous healing was found in 3 of 20 [15%] patients. Intralesional administration of pentavalent Antimonial compound [Meglumine Antimoniate] is an effective method of treatment in cutaneous Leishmaniasis

Early in-Hospital re-infarction after thrombolysis for acute myocardial infarction [AMI] in AFIC/NIHD Rawalpindi

This study was designed to determine the frequency and variables of in-hospital re-infarction after streptokinase in patients with first acute ST segment elevation myocardial infarction [AMI], hospitalized in CCU of AFIC/NIHD from Feb 2002 to July 2002. Of 200 consecutive patients of AMI who received streptokinase, 73% [n = 146] were males and 27% [n = 54] were females, mean age was 55.5 years [29-81]. Frequency of in-hospital re-infarction documented in this study was 6.5% [n = 13] a median time of 2.5 days [1-6] after thrombolysis. Patients with re-infarction had higher in-hospital mortality within ten days of hospitalization [30.77% versus 7.5% without re-infarction; P = .01]. Median time to death after re-infarction was 3 days [2 - 10] with 50% of deaths occurring within 48 hours of re-infarction. Rates are comparable with previously conducted large-scale studies [GUSTO I/III and TAMI study]. Advanced age, diabetes mellitus, hypertension, increasing killip class > at the time of admission, fluctuation in heart rate and hyperilipidaemias were the most important predictors /variables associated with higher in-hospital re-infarction and subsequent increased morbidity and mortality. Improved treatment, preventive strategies and early detection of re-infarction should be an important goal of AMI management. Repeat thrombolysis and early revascularization where possible in selected cases can decrease the cardiac mortality and morbidity