Chunky Mitral Annular Calcification: Caseoma or a Tumor?

Mitral annular calcification (MAC) is relatively common in clinical practice. Females are more often affected than males. Patients with end-stage renal disease have MAC relatively more commonly than the general population. Patients with MAC often develop conduction system disturbances, including advanced atrioventricular blocks. They are also more likely to develop various arrhythmias, including atrial fibrillation. Caseous mitral annulus calcification is a variant of MAC that often looks like a cardiac tumor on an echocardiogram and needs to be differentiated.

Evolution of Stress Echocardiogram in the Era of CT Angiography.

The ideal diagnostic modality for acute chest pain is a highly debated topic in the cardiovascular community. With the rapid rise of coronary computed tomography angiography (CTA) and the fall of functional testing, stress echocardiography (SE) is at a delicate crossroads. Though there are many advantages of coronary CTA, it is not without its flaws. The exact realm of SE needs to be clearly defined, as well as which patients need diagnostic testing. The emergence of additional parameters will propel the evolution of modern SE. In this review article, we explore the role of SE, guidelines, comparison of SE versus CTA, and additional parameters in the coronary CTA era.

Assessment of anaesthesia workforce capacity in district and tehsil (taluka) hospitals in Sindh province of Pakistan: a survey.

OBJECTIVES: Our objective was to determine the current availability of human resource at secondary care hospitals in Sindh province and to identify gaps in term of appropriate number of anaesthesiologists available for delivery of safe anaesthesia care. DESIGN: A cross-sectional survey of anaesthesia workforce. SETTING: All district and taluka hospitals in the Sindh province of Pakistan. PARTICIPANTS: Administrative anaesthesia leaders in the hospitals. OUTCOME MEASURES: Standard descriptive statistics (percentages and numbers) of anaesthesia workforce in these hospitals including both full-time and part-time physician anaesthesiologists, and non-specialist physicians providing anaesthesia services as well as technician support. RESULTS: Only 54 (75%) hospitals had a full-time anaesthesia physician, and 32 of these had only one. Two hundred and one operating rooms were present in 72 (80%) hospitals with an average of three operating rooms/hospital. CONCLUSIONS: This study has identified a deficit of anaesthesiology personnel in district-level and tehsil-level hospitals of Sindh province of Pakistan.

Sudden Cardiac Arrest in Patient With Ventricular Septal Defect and Marijuana Consumption: A Case Report and Review of Literature.

This case report presents a detailed analysis of a 28-year-old woman who experienced sudden cardiac arrest (SCA). The patient had a history of marijuana consumption and was also diagnosed with a congenital ventricular septal defect (VSD) with no prior intervention or treatment. VSD is a common acyanotic congenital heart disease, which poses a constant risk of premature ventricular contractions (PVCs). During the evaluation, the patient's electrocardiogram PVCs and a prolonged QT interval were revealed. This study highlights the risk associated with the administration or consumption of drugs that can prolong the QT interval in patients with VSD. It also indicates that patients with VSD and who have a history of marijuana consumption should be cautioned about the risk of arrhythmias causing SCA due to prolonged QT interval caused by the cannabinoid. This case emphasizes the requirement of cardiac health monitoring in individuals with VSD and caution while prescribing medications that can affect the QT interval leading to life-threatening arrhythmias.

A Case of JAK2V617F-Negative Myeloproliferative Neoplasm in a Young Female Presenting With Extreme Thrombocytosis.

Thrombocytosis is a commonly observed condition in clinical practice and typically results from various pathophysiological factors, such as iron deficiency, blood loss, infection, medications, rheumatologic conditions, malignancy, asplenia, post-splenectomy, or familial factors. However, extreme thrombocytosis, defined as a platelet count > 10,000 K/UL (equal or greater than a million), is a rare occurrence. In this report, we present a compelling case of severe thrombocytosis attributed to underlying chronic myelogenous leukemia (CML), further complicated by coexisting iron deficiency. It is essential to emphasize that not all instances of extreme thrombocytosis are indicative of essential thrombocythemia. Hence, maintaining a high level of suspicion for non-ET myeloproliferative neoplasms (MPNs) such as CML, as well as other underlying conditions like iron deficiency anemia, is crucial for accurate diagnosis and timely management.

Interpretation of Parathyroid Hormone Levels in Renal Impairment.

Distinguishing between acute kidney injury and chronic kidney disease (CKD) in an emergency setting may pose a conundrum for physicians, especially when a patient's medical history and records are unknown. Parathyroid hormone (PTH) has proved valuable as a marker of CKD and is frequently assayed for this reason. The use of PTH as a sole marker of CKD may be misleading in certain conditions, and for this reason, physicians need to interpret PTH values with caution. In patients with no existing medical records, it is vital to consider their overall clinical picture, an accurate interpretation of urinalysis and urine microscopy, and the PTH values when making the initial management decisions.

Ketamine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion and Hyponatremia.

Ketamine is a dissociative anesthetic commonly used for the induction and maintenance of anesthesia and has a well-known role in analgesia. However, it also has the potential for addiction, which can lead to neurological, psychological, systemic, and biochemical consequences. In this case report, we are highlighting a rare case of a young Asian female with Ketamine addiction who presented with urinary complaints. The patient was found to have hyponatremia and laboratory tests were consistent with a syndrome of inappropriate antidiuretic hormone (SIADH) release in the absence of other causes.

A Young Heart With Coronary Dissection.

Chest pain is one of the common complaints encountered in clinical practice. Multiple diseases present as chest pain and often the etiology can be challenging to diagnose. Among the cardiac causes, coronary artery dissection is one of the life-threatening conditions and is often misdiagnosed as an acute coronary syndrome because of its similar presentation. In this case report, we will share a case of coronary artery dissection, which was initially managed as a non-ST-elevation myocardial infarction. We will share the modalities used to diagnose spontaneous coronary artery dissection and how the management differs between acute coronary syndrome and spontaneous coronary artery dissection.

The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic Diseases.

For systemic diseases like rheumatoid arthritis, systemic lupus erythematosus (SLE), systemic sclerosis, systemic vasculitis, myopathies, and mixed connective tissue diseases, cardiac disease is a major contributing factor for morbidity and mortality. The cardiovascular manifestations are the result of various pathophysiological components, which complicate management. Furthermore, the signs and symptoms can be subtle and missed due to the complex nature of the underlying condition. As a result, various imaging approaches play an imperative role in diagnosis and prognosis. The evolving role of these modalities could lead to risk stratification and improved therapies in the future. In conclusion, our review article will highlight the role of cardiac imaging in the evaluation of cardiac involvement for systemic diseases.

Awareness regarding risks of self-medication among people visiting community pharmacies.

A cross-sectional survey was conducted from April 2018 to February 2019 to assess the level of awareness regarding the risks of self-medication among people visiting the community pharmacies of Block-13, Gulistan-e-Johar, Karachi. Data was collected from 395 participants after taking their written informed consent by using a pre-tested questionnaire and analysed on statistical package for social sciences version 20. The study results showed that 186 (47.1%) participants were aware that drugs have side-effects, 242 (61.3%) knew that a drug can make a person dependent on it, 220 (55.7%) had the knowledge that long-term use of any medicine can be harmful to the body, 132 (33.4%) were aware that all over-the-counter medicines are not safe to use, whereas178 (45.1%) believed that no medicine should be taken unless recommended by a licensed practitioner. It was concluded that many of the study participants did not have the knowledge regarding risks of self-medication.

Comparision of obstetric outcome among teenage and non-teenage mothers from three tertiary care hospitals of Sindh, Pakistan.

OBJECTIVE: To compare the obstetric outcome of teenage pregnancies with that of non teenage pregnancies. METHODS: A prospective case-control study was conducted in three tertiary care hospitals of Sindh, Pakistan from September 2008 to November 2008. The data regarding obstetric outcome of all teenagers (13-19 years) delivering in the three hospitals was compared with that of selected non teenage women (20 to 35 years) taken as controls. Chi-square and students' t-test were applied with 0.05 as level of significance. RESULTS: Teenage mothers were more likely to suffer from severe anaemia (8% versus 4.3%; p = 0.03) and chorioamnionitis (2.8% vs 0.8%, p = 0.01) and their infants were more likely to suffer from post maturity (4.6% vs 1.8%, P = 0.02) and meconium aspiration syndrome (6.5% vs 2.4%, p < 0.01) compared to non-teenage mothers. On the other hand they were less likely to be overweight than the non-teenagers. Teenagers had instrumental deliveries more often than non-teenagers (7.1% vs 2.2%, p < 0.01). The risk of preterm delivery, low birth weight infant, respiratory distress syndrome, foetal and perinatal death was not significantly different in the two groups. CONCLUSION: Teenage mothers are at a higher risk of developing severe anaemia and chorioamnionitis. They are more likely to have an instrumental delivery than non-teenagers. Post maturity and meconium aspiration syndrome are the neonatal complications seen in infants born to teenage mothers.