Percutaneous closure of patent ductus arteriosus under echocardiographic guidance

Percutaneous closure of patent ductus arteriosus [PDA] is done in the cardiac catheterization laboratory, usually under fluoroscopic and angiographic guidance. The aortogram is used for assessing PDA size and shape the pre-device implantation. Additionally, post-device aortograms are applied for the assessment of device position, profile and residual shunt. Angiograms expose patient to radiation and possible untoward effects of contrast media. Recently, transthoracic echocardiography has been utilized to guide in PDA closure to avoid radiation exposure as well as contrast material. On two occasions, we were obligated by special circumstances to close the PDA under echocardiography guidance. First case was a 6-month baby girl with mild signs of heart failure having moderate size PDA. She underwent device closure under transthoracic echocardiogram as the angiographic system had stopped working during the procedure. Second case was a 6-year girl, weighting 16-kg with chronic renal failure. She had moderate size PDA closed by device under transthoracic echocardiographic, guidance avoiding the use of contrast agent due to chronic renal failure

Evaluation of furazolidone, sulfadimidine and amprolium to treat coccidiosis in beetal goats under field conditions

Coccidiosis is a protozoal and occasionally fatal diarrheic disease of goats imposing heavy economic losses to farming community. This study aimed to evaluate the efficacies of Furazolidone, Sulfadimidine and Amprolium against coccidiosis in Beetal goats. Twenty-four [24] Beetal goats naturally infected with coccidiosis were randomly divided into four groups of 6 [A-D]. Goats in groups A, B and C were treated orally with Furazolidone [10mg/Kg], Sulfadimidine [100mg/Kg] and Amprolium [55mg/Kg], respectively for 7 days. Goats in-group D served as positive control. Oocysts per gram [OPG] of feces counts of individual goats in each group were performed on Days; 0 [pre-treatment] 7, 14 and 21 [post-treatment]. OPG counts amongst goats in all groups at day 0 were not significant [P>0.05]. On days 7, 14 and 21, OPG values decreased significantly [P<0.05] in groups A, B and C compared to group D. The efficacy of Furazolidone, Sulfadimidine and Amprolium was 98.6, 98.0 and 99.6 percent, respectively on Day 21 [end of trial]. Statistically, the efficacies of three drugs were not significantly different [P>0.05]. In conclusion, Furazolidone, Sulfadimidine and Amprolium are well-tolerated and any one of these may be recommended to effectively treat coccidiosis in Beetal goats

Frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS], before the surgery, at discharge and at six months follow up

Introduction: Depression is much frequent in patients undergoing CABGS. However, severity was reduced post operatively. Counseling and psychosocial interventions can play an important role in recovery and functionality of patients

Objective: To compare the frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS] before the surgery, at discharge and at six months follow up

Design: Prospective, observational study conducted from Dec 2008 to Dec 2009

Setting: National Institute of Cardiovascular Diseases [NICVD] Karachi

Methods: One hundred and thirty four [134] patients of 18+ years old who were consecutively listed for first time CABGS were included in the study after fulfilling the inclusion and exclusion criteria and addressing the ethical issues. ICD-10 criteria to diagnose and Hamilton Rating Scale for Depression [HAM-D] were applied to assess the frequency and severity of depressive disorder respectively. Results were analyzed using SPSS version 17.0

Results: One hundred and thirty four [134] patients undergoing CABGS fulfilled the criteria for Depressive disorder. One hundred and thirteen [84.3%] were male and 21 [15.7%] were female with age range 33 to 75 years [mean 53.7 +/-SD 8.57]. Preoperatively 132 [98.5%] patients and postoperatively 108 [80.6%] patients were depressed. At 6 months follow up which was available in 73 patients, only 12 [16.4%] were found depressed. Both genders were almost equally affected. Surprisingly age, ethnicity, education and co-morbids did not show a significant role

Conclusion: Depression is commonly reported before and after cardiac surgery procedures and it significantly influences the quality of life of the patients undergoing CABGS. The consequences can increase morbidity and mortality

Psychosocial risk factors of myocardial infarction and adverse effects of streptokinase in public sector hospitals

This study investigated the psychosocial risk factors of myocardial infarction and time related adverse effects of administration of streptokinase on short-term morbidity and mortality in patients with ST-segment-elevation myocardial infarction [STEMI]. One hundred patients with STEMI treated with streptokinase in the hospital setting were prospectively enrolled in the study. The primary outcome parameter was the incidence of major adverse cardiac events. During hospital stay the psychosocial and demographic risk factors were also investigated. The overall mortality rate was similar in both groups and it was not significant. [5.7% vs 14.5%; P = 0.18]. The number of recurrent chest pain was significantly higher in the group 2 compared to the group 1 [25% vs 62.5%; P = .01]. The number of hypotesion was significantly higher in the group 1 as compared to the group 2 [30.7% vs 6.2%; P = .009]. The demographic and psychosocial risk factors were recorded. The early intravenous administration of streptokinase in the hospital setting leads to a reduced rate of major cardiovascular events compared to delayed administration beyond 2 hours. However, mortality rates were not significantly affected. Secondary prevention should be targeted on modifiable demographic, dietary, and psychosocial risk factors of STEMI

Prolonged oral cyanide effects on feed intake, growth rate and blood parameters in rabbits

Twelve adult rabbits bred locally were divided into two equal groups of 6; experimental and control groups. Rabbits in the experimental group were orally dosed with KCN at 3mg/kg body weight for 40 consecutive days. Members in control group were given placebo [distilled water] for the same period. Animals in both groups were offered feed at 90gm/kg/day while ample drinking water was available ad lib. Feed consumption and body weight of rabbits in both the groups were recorded. Blood samples were also drawn to determine various hematological parameters. Statistical analysis revealed a non-significant difference of total and daily feed intakes in rabbits of experimental and control groups. Whereas the feed efficiency of rabbits in the experimental group were significantly reduced [P<0.05] compared to controls. Likewise a significant decrease in body weight gain of rabbits in experimental group [P<0.05] was observed. A non-significant difference [P>0.05] was observed in leukocyte count, differential leukocyte count and platelets of rabbits in both the groups. Erythrocyte count, hemoglobin concentration, packed cell volume and mean corpuscular hemoglobin were significantly decreased in treated rabbits. It was concluded that chronic cyanide intake had a deleterious effect on feed efficiency, growth rate and blood components of rabbits

Molecular Characterization of Legionellosis Drug Target Candidate Enzyme Phosphoglucosamine Mutase from Legionella pneumophila (strain Paris): An In Silico Approach

The harshness of legionellosis differs from mild Pontiac fever to potentially fatal Legionnaire's disease. The increasing development of drug resistance against legionellosis has led to explore new novel drug targets. It has been found that phosphoglucosamine mutase, phosphomannomutase, and phosphoglyceromutase enzymes can be used as the most probable therapeutic drug targets through extensive data mining. Phosphoglucosamine mutase is involved in amino sugar and nucleotide sugar metabolism. The purpose of this study was to predict the potential target of that specific drug. For this, the 3D structure of phosphoglucosamine mutase of Legionella pneumophila (strain Paris) was determined by means of homology modeling through Phyre2 and refined by ModRefiner. Then, the designed model was evaluated with a structure validation program, for instance, PROCHECK, ERRAT, Verify3D, and QMEAN, for further structural analysis. Secondary structural features were determined through self-optimized prediction method with alignment (SOPMA) and interacting networks by STRING. Consequently, we performed molecular docking studies. The analytical result of PROCHECK showed that 95.0% of the residues are in the most favored region, 4.50% are in the additional allowed region and 0.50% are in the generously allowed region of the Ramachandran plot. Verify3D graph value indicates a score of 0.71 and 89.791, 1.11 for ERRAT and QMEAN respectively. Arg419, Thr414, Ser412, and Thr9 were found to dock the substrate for the most favorable binding of S-mercaptocysteine. However, these findings from this current study will pave the way for further extensive investigation of this enzyme in wet lab experiments and in that way assist drug design against legionellosis.

PEFR, FEF25-75 and MVV In Type-1 Diabetic Male And Their Relationships With HbA1c.

Background: Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to microvascular, macrovascular and neuropathic diseases which affect eyes, kidneys, heart, blood vessels and also lungs. So, there may be a relationship between type-1 diabetes and reduced lung function. Objectives: To observe PEFR, FEF25-75 and MVV and their relationship with HbA1c in type- 1 diabetic male in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka between 1st January and 31st December 2009. A total 30 type-1 diabetic male subjects, age 18-30 years were taken as study group. Another 30 apparently healthy age, sex, BMI and socioeconomic status matched non-diabetic persons were also included as control. For assessment of lung function PEFR, FEF25-75 and MVV of all the subjects were measured by a digital spirometer. Again, to observe glycemic control serum blood glucose and glycosylated hemoglobin (HbA1c) levels of diabetic patients were also measured by usual laboratory technique. Data were analyzed by unpaired‘t’ test and Pearson’s correlation coefficient test. Results: PEFR (p<0.001), FEF25-75 (p<0.001), and MVV (p <0.001) were significantly lower in type-1 diabetic patients in comparison to those of apparently healthy non-diabetic male. Again, their PEFR (p < 0.05), FEF25-75 (p>0.05), and MVV (p<0.05) were negatively correlated with HbA1c. Conclusion: The lung functions were lower in type-1 diabetic male in comparison to those of non-diabetic counterpart and this reduction is mainly due to poor glycemic control.

Atrioventricular and interventricular groove and septal extension of right sinus of Valsalva aneurysm: a rare cause of complete heart block

A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block

Bidirectional ventricular tachycardia of unknown etiology

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. Hiselectrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up [of 6 months] he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored

In vitro evaluation of vincristine and fluconazole combination against Candida

Infections associated with cancer are a major scourge and cause of substantial morbidity and mortality in cancer patients. The aim of present study was to appraise the in vitro activity of anticancer agent vincristine and antifungal fluconazole alone and in combination against Candida spp. Results were interpreted in terms of fractional inhibitory concentration index [FICI]. Antifungal activity of fluconazole showed marked synergism when used in combination with vincristine, with FICI ranging from 0.25-0.5 against different Candida spp. Although, the use of vincristine with fluconazole is always disputed due to its side effects including decreased peristalsis, but the present research can help to perform suitability analysis of fluconazole use in life threatening invasive candidiasis associated with cancer patients. In addition, the synergism in antifungal activity after using with vincristine also warrants further research in the direction of minimizing adverse reaction associated with combined use of fluconazole and vincristine

FVC, FEV1 And FEV1/FVC% In Type-1 Diabetic Male And Their Relationships With HbA1c.

Background: Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to micro and macrovascular diseases which affect eyes, kidneys, heart, blood vessels, nerves and also lungs. There may be a relationship between type-1 diabetes and reduced lung function. Objectives: To observe FVC, FEV1, FEV1/FVC % and their relationship with HbA1C in type-1 diabetic male in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka from January to December 2009. A total number of 60 male subjects, from 18-30 years of age was taken and was divided into control and study groups. Among them study group was consisted of 30 type-1 diabetic male patients. Control group was consisted of 30 apparently healthy age, sex, BMI and socioeconomic status matched non-diabetic subjects. All the subjects belonged to lower socio-economic status. For assessment of lung function, FVC, FEV1, FEV1/FVC % of all the subjects were measured. All of theses tests were done by spirometric method by using a digital Spirometer. Again, to observe glycemic control of blood, glycosylated hemoglobin (HbA1c) levels of diabetic patients were also measured by usual laboratory technique. Data were analyzed by Independent-Samples ‘t’ test and Pearson’s correlation coefficient test as applicable. Results: FVC (p <0.001), FEV1 (p < 0.001), and FEV1/FVC% (p < 0.05) were significantly lower in type- 1 diabetic patients in comparison to those of apparently healthy non-diabetic male. Again FVC and FEV1 had significant (p < 0.001) negative correlation but FEV1/FVC% had non-significant positive correlation with HbA1c. Conclusion: Impairment of some lung functions may be found in type-1 diabetic male which may be due to poor glycemic control.

Infective endocarditis: a rare cause of acute coronary syndrome

This is a case report of a 26 years old female who presented in emergency with sudden onset of chest heaviness and dyspnoea. She had suffered a stroke in the past and was treated with anti-tuberculous medication. Her ECG revealed STelevation myocardial infarction and thrombolysis was performed but was unsuccessful. Further workup during in-hospital stay revealed evidence of infective endocarditis and Streptococcus species were isolated. She was started on penicillin and gentamycin with good recovery. This case presented a management problem during initial presentation as there was insufficient data on thrombolysis during such situation. It is also a diagnostic problem as the initial picture was dominated by acute coronary syndrome. There is need to develop consensus based on expert opinion about management in such situations

Adult basic life support: an updated summary from the recent guidelines on cardiopulmonary resuscitation [CPR]

Sudden cardiac death is the most prevalent yet preventable clinical problem. It is estimated to cause 300,000 to 400,000 deaths annually with 63% cardiac deaths. The most important determinant of survival among these patients is the prompt and effective delivery of basic life support at the site or by the first bystander. Although there has been a decline in overall cardiovascular morbidity and mortality but the incidence of sudden deaths from cardiovascular causes has remained constant. In the current era the basic life support not only includes cardiopulmonary resuscitation [CPR] but defibrillation has also been added by using automated external defibrillators. The latest guidelines for CPR published in 2010 by the American Heart Association [AHA] have made substantial changes to the basic life support strategy. The conventional stepwise approach A-B-C has been changed to C-A-B. This mandates the decrease in time to deliver first compression. Look, listen and feel has been omitted to avoid unnecessary delay of the chest compressions. The pulse check parameter has also been diminished for healthcare providers. This article is a review of management of CPR. It scrutinizes current practices and data supporting the use of CPR.

Posterior spinal fixation with pedicle screws and rods system in thoracolumbar spinal fractures

To determine the effectiveness of posterior spinal fixation in maintaining the stability of spine and to determine mortality in 6 months after posterior spinal fixation. Quasi experimental study. Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi and Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2006 to April 2009. Fifty patients with unstable thoracolumbar spinal fractures from T7 - L4 were included. All the patients were operated by posterior approach using pedicle screws and rods. Effectiveness of the fixation was measured at 6 months postoperatively in terms of relief of pain and improvement in mobility using Oswestry disability index, range of motion of spine using Schobar Test/sign, reduction in deformity by measuring Cobb angle, local kyphosis angle [LKA], thoracolumbar angle, anterior and posterior vertebral heights [AVH and PVH respectively], evidence of union was made using plain radiographs and by computer assisted measurement using " OSIRIS " software. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts. Twenty-eight patients were operated within first week. In 38 patients, 4 screws were used and in 12 patients, 8 screws were used with 2 rods. Pain and disability showed improvement, with mean 71.98% score pre-operatively to 44.96% mean at last visit [p = 0.001]. Mean range of motion increased 0.5 - 2 cms postoperatively in all directions [p = 0.001]. Mean kyphosis angle, Cobb angle and thoracolumbar angle improved postoperatively. Anterior and posterior vertebral body heights increased postoperatively with resultant decrease in anterior vertebral body compression. Ninety six percent patients showed signs of postoperative union on last visit and only 3 people died of unrelated causes till last visit. Posterior spinal fixation with pedicle screws and rods is an effective surgical technique in maintaining stability of spine by improvement in pain and mobility, range of motion of spine, correction of deformity and bone union

Adult basic life support: update from the recent guidelines on cardiopulmonary resuscitation

Sudden cardiac death is the most prevalent yet preventable clinical problem. It is estimated that about 300,000 to 400,000 deaths occur annually due to cardiovascular causes with 63% occurring due to sudden cardiac deaths. The most important determinant of survival among these patients is the prompt and effective delivery of basic life support at the site or by the first bystander. Although there has been a decline in overall cardiovascular morbidity and mortality but the incidence of sudden deaths from cardiovascular causes has remained constant. Currently the basic life support not only includes cardiopulmonary resuscitation but also defibrillation using automated external defibrillators. The latest guidelines for cardiopulmonary resuscitation published in 2010 by the American Heart Association [AHA] have made substantial changes to the basic life support strategy. The conventional stepwise approach A-B-C has been changed to C-A-B. This mandates the decrease in time to deliver first compression. Look, listen and feel has been omitted to avoid unnecessary delay of the chest compressions. The pulse check parameter has also been diminished for healthcare providers. This review covers the management of cardiopulmonary resuscitation, and scrutinizes current practices and data supporting the use of CPR

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction [MI] due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation

Comparison of the two methods of percutaneous K - wire fixation in displaced supracondylar fracture of humerus in children

To compare the effectiveness and safety of fractures treated by percutaneous medial-lateral cross K-wire fixation and 2-lateral K-wire fixation. Randomized controlled trial was conducted from January 2008 to July 2009 in Orthopedics unit of Hayatabad Medical Complex Peshawar. A total of 50 patients of displaced supracondylar fracture of humerus presenting between age 1-12 years were randomly allocated in two groups of 25 patients in each group and were subjected to medial lateral cross K wire fixation and 2 lateral K wire fixation. Mean age of patients was 7.02 +/- 2.25 years.72% of patients with carrying-angle loss was excellent results and 28% good results. The mean loss of elbow flexion and loss of elbow extension were 8.38° +/- 3.10 and 7.26° +/- 3.22 respectively. In Patients with med-lat cross K-wire fixation group 72% were excellent results and 28% good results, while similar results were found in 2-lateral K- wire fixation group. The 4% iatrogenic ulnar nerve injuries occurred with the med-lat cross K-wire fixation group, while no neurological injury occurred with 2 lateral K wire fixation with p value of 0.312. Hence, there was no significant difference in the incidence of ulnar nerve injury between the two groups of patients. Both techniques appear to be effective, 2 lateral K-wire fixation is as effective in term of stability as medial-lateral cross K- wire fixation but with less chance of iatrogenic ulnar nerve injury

Device entrapment: a rare complication of percutaneous coronary intervention

Device entrapment is a rare complication of percutaneous coronary intervention. It has hazardous potentials for the patient. Emergent cardiac surgery is the only option after failure of retrieval devices. We have described here a case of a 55 years old male. During percutaneous coronary intervention, the balloon inflated only partially at its ends and entrapped in the lesion along with the stent. Multiple attempts at inflation failed and the patient developed severe chest pain for few minutes. Surgery was contemplated but final attempt at inflation was successful and the patient stabilized. It was an emergent situation and could have led to fatal outcome, although this patient escaped narrowly from any fatal outcome

Pulmonary atresia with hypoplastic right ventricle and large subaortic ventricular septal defect

A neonate is presented with a very rare association consisting of pulmonary atresia with large ventricular septal defect but additionally, combined with a hypoplastic right ventricle and well developed pulmonary arteries. The management strategy is described

Salmonella typhi infection: a rare cause of endocarditis

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis