paradigm shift: the new novel oral anticoagulation agents

Atrial fibrillation [AF] is the most common arrhythmia and represents one-third of the arrhythmia-related hospital admissions in the developed countries

Embolic strokes associated with AF are more severe and disabling

Thrombo-embolic stroke prevention is a major goal in treatment of AF and Warfarin has successfully served this purpose for many years

Drug-drug interaction and regular monitoring with Warfarin pose a significant challenge where health care system has limited resources; and lack of a well-structured health system, hinders regular International Normalized Ratio [INR] monitoring. Novel oral anticoagulants [NOACs] have opened up a new exciting chapter in the field of anticoagulation in non-valvular atrial fibrillation [NVAF]. This review discussed the landmark trials that led to the development of NOACs and explored the potentials of these new agents with simultaneous comparison of Warfarin

Juvenile hyaline fibromatosis

Juvenile hyaline fibromatosis is a rare, autosomal recessive disease. We report a 4-year-old female born of first-degree consanguineous marriage, presenting with gingival hyperplasia, nodular swellings involving the both pinna and right ankle joint. She had contractures of elbows, knees and shoulder joints, restricting the movements of these joints. Cutaneous examination revealed erythematous papules and plaques involving the nape of neck and the perianal region. Histological examination revealed deposition of PAS positive amorphous eosinophilic hyaline material with scattered intervening fibroblast like cells resembling chondroid cells. The patient was diagnosed as a case of Juvenile hyaline fibromatosis based on characteristic clinical and histopathological findings

Influence of size of tympanic membrane perforation on outcome of myringoplasty

The objective of this study was to determine the influence of size of central tympanic membrane perforation on outcome ofmyringoplasty. Descriptive-Interventional Study. ENT Department PNS SHIFA Karachi. The study was completed in seventeen months from 22nd August 2009 to 22nd Jan 2010. The study consists of 60 cases. Non-Probability Convenience Sampling. After obtaining informed consent sixty patients undergoing myringoplasty at PNS SHIFA Karachi during the study period fitting the inclusion criteria were selected. Patients were examined and the size of tympanic membrane perforation was recorded. Perforation up to two quadrents was labeled as small perforation, three quadrents as large perforation and four quadrents labeled as subtotal perforation. The patients were managed by myringoplasty using Endaural incision with underlay technique to place the graft harvested from Temporalis fascia under General Anesthesia. All surgeries were performed by second author [senior consultant surgeon]. After undergoing myringoplasty patients were followed in ENT OPD on 2nd week to check the status of ear after removal of BIPP and eight weekly interval to check complete healing of graft for final result.:After 8wks 100% [n=20] patients with small perforation, 85% [n=17] with large perforation and 60% [n=12] with subtotal perforation had perfect healing and graft was intact. Smaller perforations have a greater chance of healing after surgery

Ectomesenchymal chondromyxoid tumour of the tongue: Variant of myoepithelioma or a separate entity

We present the case of a 75 year old lady who presented with a non-healing ulcer over the left lateral tongue. Subsequent histology showed presence of ectomesenchymal chondromyxoid tumour of the tongue. The aim of this case report is to record in literature an extremely rare tumour of the oral cavity and to generate discussion on its controversial histogenesis

Patients' perspective in orthognathic surgery

A two-year retrospective audit was conducted at the Ipswich hospital to record patients' perspective in orthognathic surgery. The aim of this study was to assess and improve system already in place for treating these patients. Audit was conducted in form of a questionnaire. Approximately 50% patients responded. Clinical data was collected and analysed. A literature search was performed to find similar studies. Most of the patients sought treatment for functional and/ or aesthetic reasons. Most of the patients were informed adequately about various associated complications, however most of the patients would have appreciated a written hand out. Even though surgery was associated significant morbidity, most of the patients were satisfied with overall outcome. In order to establish a successful orthognathic practice, it is paramount to take into account all aspects of patients' perspective

Cutaneous leishmaniasis in N.W.F.P.

To know the frequency of cutaneous leishmaniasis in patients admitted in dermatology department, Lady Reading Hospital Peshawar. Material and This study was conducted at department of Dermatology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2002 to 31st May 2002. Criteria for admission was multiple and ugly non-healing ulcers. This study does not include those cases seen in outpatients department. Patients diagnosed as cutaneous leshmaniasis were analyzed. During the study period, 306 patients were admitted in Dermatology unit Lady Reading Hospital, Peshawar. This included 167 male patients and 139 female patients. Out of 167 male patients, 16 patients were confirmed cases of Cutaneous Leishmaniasis making 9.6% of total male admissions. Out of these 16 patients, 6 patients belonged to the urban population of N.W.F.P and 10 patients belonged to the rural/ border areas of N.W.F.P. So urban to rural ratio of frequency in males is 37.5% to 62.5% respectively. Out of 139 female admitted patients 6 patients were confirmed cases of Cutaneous Leishmaniasis making it 4.3% of total female admissions. Among these female patients 2 patients belonged to urban population while 4 patients belonged to border/rural areas of N.W.F.P. Urban to rural frequency in females is 33.3% to 66.6% respectively. We conclude that Cutaneous Leishmaniasis is an emerging health problem of our country and immediate steps need to taken for its control

2-Year retrospective audit and critical analysis of orbital floor fractures operated in national maxillofacial unit st. james's hospital, dublin

The purpose of the study was to compare our practice with peer practice. Over all ourpractic, similar to peer practice. However, there are certain areas where there are differences and further studies are required to evolve consensus

This is a 2 year retrospective audit and critical analysis of the operative management of orbital floor fractures in our unit. The total number of patients operated was 64. We examined various aspects of orbital floor fractures including cause of injury .associated injuries, clinical features, investigations performed, number of patients in which ophthalmic opinion was taken, ophthalmic findings, duration between injury and operation, reconstructive techniques and results

Angina bullosa haemorrhagica: a case report

We present a case of an 80 years old patient who was referred to accident and emergency department of the Ipswich hospital with a bleeding blister on the soft palate. It was diagnosed as Angina bullosa haemorrhagica. Itis a relatively uncommon yet important condition to recognize, as misdiagnosis can cause unnecessary alarm and lead to over treatment