Paediatricians’ referral preference of patients with embolised intravascular foreign bodies: a survey-based study

Background: Central line insertion is a routine procedure in medical practice. Dislodgement of lines into the vascular system is a rare complication. We noticed that paediatric health care providers (PHCP) contact the cardiac or general paediatric surgeon for extraction of dislodged lines more frequently than using the less invasive percutaneous approach.Aim: To study the referral preference of PHCP for patient with embolised intravascular foreign bodies.Methods: A questionnaire with three questions was distributed to PHCP of all paediatric subspecialties, including surgery, in two tertiary care centres. The questions were about the total number of patients seen with central line, experience with complications, and preferred specialty for removal of dislodged central lines.Results: The questionnaire was distributed to 128 professionals. The response rate was 79% (n101). Incomplete answers (n14) were excluded. The grades of responders were senior consultants 18%, junior consultants 38%, and residents 43%. Thirty nine percent of care providers experienced dislodgement or fragmentation of central lines. The majority (82%) prefer to refer the patients for surgical removal. Conclusions: Most PHCP in the selected hospitals prefer to refer patients with embolised foreign bodies in the vascular system for surgical removal. The local health policy should be updated for the use of the alternative percutaneous approach.Keywords: cardiac surgery; clinical practice; transcatheter retrieva

Assessment of Heavy Metals in Fodder Crops Leaves Being Raised with Hudiara Drain Water (Punjab-Pakistan)

The present study was designed with the objectives to assess heavy metals' concentration in Hudiara drain water and investigation of the concentration of heavy metals in different fodder crops grown with this drain water and the determination of heavy metals in milk of cattles grazing these contaminated fodder crops. A survey was conducted and ten different sites were selected along Hudiara drain after entering Lahore. Five water samples and three samples of crops from a each site. The samples were processed, stored and then analyzed for heavy metals like Lead, Cadmium, Chromium, Nickel, Zinc, Iron, Copper and manganese. Lead pollution was not found, whereas, Cadmium, Chromium and Nickel contamination was shown in Hudiara drain water. Similarly, Zinc pollution was not found in Hudiara drain water regarding irrigation and Iron, Copper and Manganese contamination was present in Water samples. Most of the fodder crops samples were contaminated with all heavy metals having levels of heavy metals above the Recommended Concentrations. It is noted that Pb+2 of Hudiara drain and irrigated Pb+2 of fodder crop were in positive correlation and negative correlation between Pb+2 and Cr+2, Ni+2, Cu+2. There is positive correlation between Cd+2 and Cr+2, Fe+2 and also negative correlation between Cd+2 and Pb+2, Cd+2, Ni+2, Zn+2, Cu+2, Mn+2 of fodder crop irrigated with Hudiara drain

Carotid Doppler ultrasonography in young stroke patients

Background: The present study focuses on the role of carotid doppler ultrasonography (CDUS) in the diagnosis and management of carotid stenosis in young stroke patients. Methods: The findings of carotid doppler in 45 ischemic stroke patients between 15-45 years of age were reviewed retrospectively. The variables of interest for this study included risk factors for atherosclerotic disease, primary abnormality detected on carotid doppler ultrasonography (ulceration vs. stenosis), degree of stenosis and the type of plaque (soft vs. calcified). Results: The prevalence of hypertension and diabetes was 50% and 35% respectively. The rate of carotid stenosis in the study population was found to be 31%. The degree of stenosis was mild in 35% and moderate in 21%. High-grade stenosis was found in 21% of patients. The plaque was soft in the majority of cases (43%). CONCLUSION: The proportion of carotid stenosis in young stroke patients was relatively high compared with previous studies. This may be due to an increase in the risk factors for atherosclerotic disease in developing countries

Lithological and facies analysis of the Roseneath and Murteree shales, Cooper Basin, Australia

Unconventional shale plays have received marked attention over the last five years because of their economic potential for hydrocarbon generation, and yet they are amongst the least understood of all clastic sedimentary rock systems. The Cooper Basin is one of the largest Gondwana intracratonic basins in Australia, extending from northern South Australia into south-western Queensland and covering approximately 130,000 km2. The basin is may be prospective for shale gas, particularly within the lacustrine shales of the Permian Murteree and Roseneath formations. This study investigates lithological characteristics of these two units in relation to reservoir evaluation. Core samples representing the Dirkala-02 and Moomba-46 wells were used for petrographic analysis. A combination of wireline log analysis, thin section petrography, X-ray diffraction and pyrolysis analysis was used to define and characterize four distinct lithofacies facies within the Roseneath and Murteree shales: siliceous mudstone, organic siliceous mudstone, calcareous siliceous mudstone, and silty siliceous mudstone. The siliceous mudstone and organic siliceous mudstone are the most common. Diagenetic siderite occurs in all four lithofacies. A conceptual depositional model is developed for deposition of the Roseneath and Murteree shales. Wireline-log cross plots were interpreted and utilized in the construction of electrofacies. The study was concentrated on the northern portion of the basin between the Nappameri and Patchawarra Troughs in order to understand the nature of lithofacies and variability in reservoir architecture, which was controlled by relative lake level fluctuation. The results of this study will aid in the evaluation of shale gas potential for this portion of the basin, as well as a better understanding of shale gas opportunities in the Cooper Basin more generally

Clinical profile and outcome of infective endocarditis at the Aga Khan University Hospital

Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan.Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic criteria.Results: Definite IE was found in 59.7% (95/159) patients, while the rest had possible IE. One-third of subjects had acute IE 55/159 (34.5%). Subacute IE was found in 62% (99/159) and Nosocomial IE in 3% of the cases. Eighty six (54%) were classified as having culturenegative endocarditis and 73 (46%) as culture positive. Ninty four patients (59%) had an underlying predisposing factor including congenital heart disease (31%) and rheumatic heart disease (21%). The most frequently isolated organisms were streptococci (52%) and followed by staphylococci (29%). Fourteen (8.1%) patients had right-sided cardiac involvement. Using univariate analysis, patients with heart failure, neurologic or renal complications, septicemia, nosocomial endocarditis, and prosthetic valve endocarditis were at increased risk of death (p ≤ 0.05), however no individual microorganism, or specific site, size, or morphology of vegetation seen on echocardiogram were significantly associated with death. Thirty-seven (23%) patients died of endocarditis or its complications.Conclusion: Endocarditis continues to be an important contributor to morbidity and mortality in Pakistan, especially in young adults. Our patients differ from the west in terms of epidemiology, predisposing factors, microbiology, complications, and outcom

Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi. We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004. We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died. In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors

Mineralogical variability of the Permian Roseneath and Murteree Shales from the Cooper Basin, Australia: Implications for shale properties and hydrocarbon extraction

Brittleness and plasticity indices in hydrocarbon reservoirs are calculated to understand how rocks behave under stress, and for assessing the fracturing performance of clay-rich shale reservoirs and assessing borehole stability. Evaluating shale plasticity/brittleness requires careful analysis of clay mineral composition in target shales and the development of fracking strategies for optimal shale stimulation. Here we report on the mineralogical variability of two Permian lacustrine shale units, the Roseneath and Murteree shales in the Cooper Basin, Australia, that are considered to have potential as unconventional hydrocarbon producers. The study involved a combination of X-ray diffraction, scanning electron microscopy and petrophysical modelling of the Roseneath and Murteree shales in order to obtain a better understanding of the compositions and microfabrics of these two units. This is part of a larger investigation of the shale gas potential of these two units in the Cooper Basin, and the results presented here may ultimately lead to improved reservoir stimulation techniques in both units. Core data has been integrated with wireline logging data to better identify brittle and plastic zones within the Roseneath and Murteree shales. Mineralogical analysis shows that both units are composed mainly of detrital quartz and clay/mica minerals with siderite cement. The clay mineral composition is dominated by illite/mica, and kaolinite in both units. However, based on the relative mineralogical differences between the two units, the Murteree Shale has more favourable brittle properties than the Roseneath Shale, and is considered to be more amenable to hydraulic fracturing for gas exploitation. However, the Roseneath Shale also has potential for gas stimulation, especially in intervals where siderite cement is prevalent