Pattern of coronary artery disease with no risk factors under age 35 years

Coronary artery disease [CAD] is no more deemed to be an ailment of the 4[th] or 5[th] decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors. This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography. Out of a total of 104 patients, 85 [81.73%] patients were men, and 19 [18.27%] were women. The mean age of the whole group was 32.66 +/- 3.237 [22-35] years. Significant CAD [>50% diameter narrowing of at least one major coronary artery] was found in 87 [83.7%] patients while 17 [16.3%] patients had non-atherosclerotic coronary artery disease, including 12 [11.53%] patients having normal coronary arteries, 1 [1%] patient had anomalous origin of right coronary artery [RCA], 1 [1%] patient had coronary arteritis, 2 [1.92%] patients had coronary artery ectasia, and 1 [1%] patient had a myocardial bridge over left anterior descending artery [LAD]. Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 [51.9%], 22 [21.2%] and 11 [10.6%] respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient [1%] had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions. In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with

Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis [RAS] is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease [CAD]. A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Forty-one of the patients were female [20.4%]; ninety patients were hypertensive [44.8%]; 49 patients [24.4%] were smokers; 19 patients [9.5%] had renal insufficiency; 88 patients [43.8%] had high cholesterol levels; 44 patients [21.9%] were diabetic. Thirty-two patients [15.9%] had single coronary artery disease, 59 patients [29.4%] had two vessel disease, and 110 patients [54.7%] had three vessel disease. Significant renal artery stenosis [>/= 0.50% stenosis] was present in 26 patients [12.9%]. Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis [24.39% vs 10.0%, p=0.01]. The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD

Morphological study of the polypoid lesions of the gastrointestinal tract

This study was carried out to evaluate the frequency, of polypoid lesions of the gastrointestinal tract and to observe the frequency of dysplastic / malignant change in these polyps. This was a 13-years retrospective study. Department of Pathology, Basic Medical Sciences Institute [BMSI], JPMC Karachi and included all polypoid lesions from the attached hospital, Pakistan Medical Research Council [PMRC] and small numbers from private clinics, from January 1991 to December 2003. This study was based on the review of 152 Polypoid lesions of gastrointestinal tract. The relevant clinical data and parameters like size, number ,presence or absence of stalk, were recorded. The polyps were classified histologically in adenomatous, hamartomatous, inflammatory, neoplastic other than adenomatous and miscellaneous type. Large intestine was the commonest site where 142 out of 152 polyps were found. Juvenile polyps were the commonest finding. Six polyps were found in the stomach, three in the small intestine, and one was in esophagus. In comparison with studies from western countries, polypoid lesions especially adenomatous polyps were found less common in the population of Karachi. This study was based on hospital admission and as such do not give any idea of the true incidence of the polyps. There is a need for developing a registry for cases of polyps/polyposis

Frequency, types and complications of Barrett's esophagus in patients with symptoms of gastro-esophageal reflux

This study was carried out to evaluate the frequency, types and complications of Barrett's esophagus in symptomatic gastro-esophageal reflux patients. Setting: Department of Pathology, Basic Medical Sciences Institute, JPMC and the Pakistan Medical Research Council, JPMC, Karachi. Subjects: A total of 100 patients of gastro-esophageal reflux were studied to evaluate the frequency, types and complications of Barrett's esophagus. Endoscopic biopsies were taken and examined with H and E and various special stains like PAS, Alcian blue/PAS, high iron diamine/Alcian blue and Giemsa stains. Of 100 cases studied, 32 were found to have Barrett's esophagus on microscopy. The remaining 68 cases showed low and high grade changes of gastro-esophageal reflux. In comparison with studies from western countries, Barrett's esophagus was found to be relatively more common in our population. However, the frequency of complications like ulcer, stricture, dysplasia and adenocarcinoma was lesser

Sternalis: an anatomic variant of chest wall musculature

To study the prevalence of sternalis muscle in the Kingdom of Saudi Arabia [KSA] and resolve the question of its genesis by studying the innervation of this uncommon variant of anterior chest wall musculature. A morphological study of 75 adult cadavers of both sexes was carried out over a 5-year period by macroscopic dissection. We also retrospectively studied the medical records of 1580 adult females who had undergone screening and diagnostic mammographic imaging at King Khalid University Hospital, Riyadh, KSA, from 1997 to 2001. Out of 75 cadavers studied, 3 cases of sternalis muscle were observed. Two adult male cadavers had well developed bilateral sternalis muscles whereas one female cadaver exhibited right sided unilateral sternalis. All 5 sternalis muscles were positioned vertically, in a parasternal position superficial to the medial part of pectoralis major and innervated by branches of intercostal nerves. None of the 1580 women, however, who had undergone mammographic imaging were found to be sternalis positive. Consistent with other geographic populations of the world, the frequency of sternalis in KSA is approximately 4%; however, its innervation by the intercostal nerves, as observed in our study is not common. This study highlights the need for familiarity with sternalis, which may mimic a focal density in medial breast craniocaudal mammograms and may be encountered during reconstructive surgery of breast and chest wall

Adenomyosis with tuberculosis of uterus

AIMS: To establish various factors that affect TB treatment adherence over time. DESIGN/SETTING: Semi-structured questionnaire. All newly diagnosed cases of TB at Bethamia Hospital, Sialkot were interviewed at the beginning of treatment, one month of therapy and at the end of intensive phase. Perception of TB as a stigmatising disease was found related to early defaulting and to a lesser degree to late defaulting. Knowledge of TB in itself did not have a clear impact on defaulting, but the attitude towards interruption of treatment did. The strongest risk factor is irregularity of drug intake and appointment keeping. Strategies to improve treatment adherence should concentrate on methods to increase patient's motivation for treatment