Nail as a foreign body in a neonate, an unusual presentation at an unusual age

Children are prone to ingest substances due to their exploratory nature and tendency to put everything in the mouth. Commonly ingested foreign bodies are coins, batteries and buttons. Foreign body ingestion in neonates is a very rare presentation and always needs important consideration as it can be a part of child abuse and can lead to serious life threatening consequences

Association between symptoms and frequency of arrhythmias on 24-hour Holter monitoring

To determine association between patient's symptoms and incidence of arrhythmia on 24-hour electrocardiographic Holter monitoring. A cross-sectional descriptive study. The Cardiology Department, Liaquat National Hospital, Karachi, from January to June 2007. Patients above 15 years of age, of either gender, referred for Holter monitoring with symptoms of palpitations, dizziness and syncope were evaluated for arrhythmia. The symptoms were documented by the patients in their symptom diaries [historical logs] during Holter monitoring. Patients who had permanent pacemaker implants were excluded. Descriptive statistics were used to calculate the frequencies and percentages of different symptoms, different arrhythmias were noted on Holter monitoring and the age of patients was noted. Chi-square test was applied to calculate p-values with significant at value less than 0.05. The mean age of patients was 53.71 +/- 15.52 years. There were 54% females and 46% males. Eighty two percent had documented arrhythmias on their Holter monitoring reports. The complaints for which patients were referred included dizziness in 24%, palpitations in 61% and syncope in 15%. On analysis of the historical logs of patients only 64% had symptoms during Holter monitoring and 23% had concurrence of their symptoms with an arrhythmia. Patients who had sinus exit block [p=0.02] and sinus arrest [p=0.002] had significant association with arrhythmia. Twenty percent patients with dizziness, 50% patients with palpitations and 12% of patients who presented with syncope had documented arrhythmias. Twenty four hour Holter monitoring is an important investigation for evaluation of patients with palpitation, dizziness and syncope. Arrhythmias were detected frequently in both symptomatic and asymptomatic patients. One must be careful to avoid attributing a symptom to an arrhythmia until a close temporal relationship is demonstrated

Highly sensitive c-reactive protein concentration and angiographic characteristics of coronary lesion

The role of inflammation in all stages of atherosclerotic disease is increasingly recognized especially in last few years. The chronic inflammatory process can develop to an acute clinical event by the induction of plaque rupture and therefore cause acute coronary syndrome. Creative protein is a strong predictor of clinical outcome in coronary artery disease and inflammation has been implicated in the process. We aimed to evaluate the relationship between pre-procedural highly sensitive C - reactive protein [hs-CRP] and angiographic features in patients with acute coronary syndrome. In a cross-sectional study, we examined 100 patients admitted with acute coronary syndrome and assessed the relationship between preprocedural hs- CRP concentration and coronary angiographic lesions. One hundred patients with acute coronary syndrome were assessed. Some of the results were as follows: mean age 59.26 +/- 11.04, 64% male and 36% female. 34% of patients had unstable angina, 43% had Non ST elevation myocardial infarction [NSTEMI] and 23% had ST elevation myocardial infarction [STEMI]. The mean value of hs-CRP was 4.26 +/- 1.42 mg/dl with highest values in patients eccentric/irregular lesion and patients having macroscopic thrombus [p=0.01]. Among patients with acute coronary syndrome increased levels of hs-CRP correlates with specific high risk coronaryartery lesions

PCI to chronic total occlusion, Liaquat National Hospital experince

Background: PCI of chronic total occlusion represents 10%- 20% of all angioplasty procedures and poses a management dilemma for the interventional cardiologist. Percutaneous coronary interventions in chronic total occlusions have been associated with lower success rate. We therefore studied percutaneous interventions in chronic total occlusions done during year 2004 at Liaquat National Hospital Karachi

Methods: All patients with chronic total occlusion undergoing percutaneous coronary interventions were included during year 2004. Data was analyzed using SPSS 10. Version

Results: 57 patients with chronic total occlusions underwent PCI out of them 31.58% are female and 68.42%are male. There was no periprocedural or in hospital complications. 49.1% patients had multivessel disease. 33.33% left anterior descending artery lesion, 29.82% right coronary lesion, 24.56% circumflex lesion and 12.28% obtuse marginal lesion. Predilation was done in all cases using various size balloons. Various wires were used and in most cases more than one wire were used. Cypher, Taxus and driver stents were used for stenting. 75.4% are successful while 24.6% were unsuccessful

Conclusion: Revascularization success rate for CTO in our study was 75.4%that was comparable to other data worldwide. The most common reason for procedural failure included the inability to cross the occlusion with guidewire [57.14%], failure to cross the occlusion with a balloon [28.57%] and failure to dilate the stenosis [12.28%]