Post-Cardiac Injury Syndrome Following Permanent Pacemaker Implantation Presenting Exclusively As Massive Pleural Effusion: A Rare Occurrence.

Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro- pericardial symptoms and raised inflammatory markers. Its occurrence following the insertion of a pacemaker has been reported infrequently and varies in different studies with an estimated prevalence of 1-2%. Our case reports a unique incidence of isolated pleural effusion following the implantation of a pacemaker in a 62-year-old female with complete heart block with no evidence of pericardial effusion on imaging. She developed dyspnoea, pleuritic chest pain, and lethargy. She successfully responded to treatment with NSAIDs and colchicine with no recurrence. This report demonstrates the uncommon course of the disease and highlights the need to consider PCIS as a possible diagnosis in patients presenting with predominant pulmonary findings and suspect it early so that timely treatment can be started, thereby preventing complications.

Predictors of Contraceptive practice in married women of Punjab, Pakistan.

Objective: Pakistan is the sixth most populous country in the world. Current contraceptive use in Pakistan is only 26% despite being one of the leading countries in Asia to launch National family planning programs. Major constraint of acceptability among women is the lack of awareness and implementation of contraceptive methods. The objective of this study was to explore the reasons behind this behavior. Methods: A cross-sectional survey was conducted with non-probability convenient sampling with sample size of 400 married women attending Fazle-Omar Hospital, Chenab Nagar, Punjab, having age between 15 to 60 years from August 2019 to February 2020. To assess the awareness of respondents about contraception, a questionnaire was made after testing its internal consistency. Data was analyzed via SPSS-21; nominal data was expressed as frequencies and percentages, quantitative as mean and standard deviation. Binary logistic regression analysis was carried out to determine predictors for contraception practice. P-value < 0.05 was considered significant. Results: Our respondents mean age was 30.73±5.9 years. Majority of responders (65%) were educated and (61%) belonged to low socio-economic class. Mean awareness score was 65 ± 26. Out of 400 respondents, 260 (65%) were practicing contraception. Relatives and media were major sources of awareness while clinics and LHVs were contributing less. Condom was the most practiced method of contraception. Low socio-economic class, increase number of kids, responders' education and awareness score were the predictors of contraception practice. Conclusion: The education of women and awareness score are independent predictors of contraceptive practice in women. Hence by educating mothers and increasing awareness through various means, practice of contraception can be increased. There is much room to improve the working of family health clinics and LHV.

The Effect of C/Si Ratio and Fluorine Doping on the Gas Permeation Properties of Pendant-Type and Bridged-Type Organosilica Membranes.

A series of pendant-type alkoxysilane structures with various carbon numbers (C1-C8) were used to fabricate sol-gel derived organosilica membranes to evaluate the effects of the C/Si ratio and fluorine doping. Initially, this investigation was focused on the effect that carbon-linking (pendant-type) units exert on a microporous structure and how this affects the gas-permeation properties of pendant-type organosilica membranes. Gas permeation results were compared with those of bridged-type organosilica membranes (C1-C8). Network pore size evaluation was conducted based on the selectivity of H2/N2 and the activation energy (Ep) of H2 permeation. Consequently, Ep (H2) was increased as the C/Si ratio increased from C1 to C8, which could have been due to the aggregation of pendant side chains that occupied the available micropore channel space and resulted in the reduced pore size. By comparison, these permeation results indicate that pendant-type organosilica membranes showed a somewhat loose network structure in comparison with bridged-type organosilica membranes by following the lower values of activation energies (Ep). Subsequently, we also evaluated the effect that fluorine doping (NH4F) exerts on pendant-type [methytriethoxysilane (MTES), propyltrimethoxysilane (PTMS)] and bridged-type [1,2-bis(triethoxysilyl)methane (BTESM) bis(triethoxysilyl)propane (BTESP)] organosilica structures with similar carbon numbers (C1 and C3). The gas-permeation properties of F-doped pendant network structures revealed values for pore size, H2/N2 selectivity, and Ep (H2) that were comparable to those of pristine organosilica membranes. This could be ascribed to the pendant side chains, which might have hindered the effectiveness of fluorine in pendant-type organosilica structures. The F-doped bridged-type organosilica (BTESM and BTESP) membranes, on the other hand, exhibited a looser network formation as the fluorine concentration increased.

Accessory Cardiac Conduction Pathway with an Unusual Presentation.

Pre-excitation syndrome (PES) is a congenital abnormality in which there is conduction through accessory pathway in addition to atrioventricular (AV) node between the atria and the ventricles. Conduction through accessory pathway is without any delay and; hence, results in early excitation of ventricles. This dual connection provides substrate for atrioventricular reciprocating tachycardia (AVRT), a type of supra-ventricular tachycardia. Wolf-Parkinson-White (WPW) syndrome is the commonest form of PES. PES with third degree AV block or complete heart block (CHB) is a rare association. We report here a case of 37-year male with surface ECG findings consistent with PES who presented with syncope. The combination of pre-excitation on ECG with syncope usually draws attention towards tachy-arrhythmias. However, ECG monitoring revealed CHB with intermittent conduction through accessory pathway. It highlights the critical evaluation of PES patients with syncope because therapeutic strategy is entirely different. This case was managed with dual chamber pacemaker implantation instead of accessory pathway ablation.

Persistent left superior vena cava: A disconcerting finding for interventionist.

Persistent left superior vena cava (PLSVC) is one of the commonest venous anomalies of thoracic venous system. These cases usually have normal right sided superior vena cava (SVC). Patients with PLSVC are often asymptomatic hence, it is diagnosed as an incidental finding during procedures like central venous line placement or pacemaker implantation. We report here a case that was taken to catheterization laboratory for pacemaker implantation. Due to PLSVC, we struggled to advance pacing lead into right ventricular apex. We thought of right subclavian vein access but contrast medium injection revealed absent right sided SVC. So procedure was abandoned and finally epicardial placement of the pacing lead was done through subxiphoid laparotomy incision next morning. This case report highlights a rare variant of PLSVC with absent right sided SVC in structurally normal heart and emphasizes the need of pre-procedure assessment of venous anatomy.