Giant pulmonary bulla with mediastinal shift in a 12 1/2 year old girl

Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects

Safety and Efficacy of Drug-Eluting Balloons in the Treatment of Drug-Eluting In-Stent Restenosis: Experience of a Tertiary Care Hospital

Background: The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan. Methods: All Patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis. Patient baseline characteristics and angiographic data about the lesion characteristics were obtained. Postprocedural and follow-up endpoints, including cardiac death, myocardial infarction, and repeat revascularization, ie, major adverse cardiovascular events (MACE), were included in the analysis. Results: A total of 26 Patients received treatment with DEB in the study period, with a significant number having major predisposing factors for the development of ischemic heart disease (IHD, 46% diabetics, 92% hypertensives). The culprit lesion was most commonly identified in the left anterior descending (31%), with presence of American College of Cardiology/American Heart Association lesion type C in 68% of Patients. The SeQuent Please paclitaxel-eluting balloon (B. Braun) was used for revascularization. Patients were followed for a median of 16 months. Only 5 Patients (19%) developed MACE during this period. Conclusion: Our experience demonstrates the effectiveness of DEBs in the treatment of drug-eluting ISR, especially in complex lesions with Patients having significant risk factors for development of IHD. However, further studies are needed to define their indications in this role

Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed

Massive Fluid Requirements and an Unusual BUN/Creatinine Ratio for Pre-Renal Failure in Patients with Cholera

Background: Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in Patients with cholera. Methods: This study was conducted on 191 Patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the Patients while their stay in the hospital and the data was analyzed on SPSS 15.0. Results: Out of the 191 Patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD+/-18.34). The average duration of symptoms was 3.75 days (SD+/-2.04). Of 191 Patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer\u27s Lactate (R/L) + Normal Saline (N/S), 45 (24%) Patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the Patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD+/-16.6), mean creatinine was 2.47 (SD+/-2.35) and mean BUN/Creatinine ratio was 11.63 (SD+/-5.7). Conclusion: Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of \u3e20:1, Patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of \u3c15:1

Multiple autoimmune syndromes associated with psoriasis: a rare clinical presentation

Autoimmune diseases are known to have association with each other but it is very rare to see multiple autoimmune diseases in one patient. The combination of at least three autoimmune diseases in the same patient is referred to as multiple autoimmune syndrome. The case we are reporting features multiple autoimmune syndrome with five different conditions. The patient had type 1 diabetes mellitus, autoimmune hemolytic anemia, systemic lupus erythematosus, vitiligo, and psoriasis. Psoriasis has rarely been reported previously under the spectrum of autoimmune syndrome. Although the relationship of autoimmune conditions with each other has been explored in the past, this case adds yet another dimension to the unique evolution of autoimmune pathologies. The patient presented with a combination of five autoimmune diseases, which makes it consistent type three multiple autoimmune syndromes with the addition of psoriasis. The current case is unique in this aspect that the combination of these five autoimmune disorders has never been reported in the past

Predictors of oral tobacco use among young adult patients visiting family medicine clinics in Karachi, Pakistan.

Prevalence of cancers associated with the use of oral tobacco (OT) is rising very rapidly and prevention of use is the best option to tackle this scenario. This cross-sectional study estimated the proportion of OT use and predictors associated with its initiation and determined the knowledge, attitude and practices of OT users. A total of 231 young adult Patients (15-30 years age) were interviewed by medical students in family practice clinics in Karachi, Pakistan. OT use was considered as usage of any of the following: betel quid (paan) with tobacco, betel nuts with tobacco (gutkha), and snuff (naswar). Overall, 49.8% (95% CI=43.3-56.2) subjects had used OT at least in one form. Multivariable analysis demonstrated independent association of OT users with secondary education level (adjusted OR=3.6, 95% CI=1.6-8.1) and use of OT by a family member (OR=2.3, 95% CI=1.3-4.0). Among OT users, 37.4% started after being inspired by friends/peer pressure, 60% using for more than 5 years, 53.2 % users reported getting physical/mental comfort from the use of OT while 31.6% tried to quit this habit but failed. We suggest socially and culturally acceptable educational and behavioral interventions for control of OT usage and hence to prevent its associated cancers

Surgical management of valvular heart diseases in pregnancy

Heart disease in pregnancy remains one of the important causes for maternal and fetal mortality and morbidity. Cardiac surgery undertaken in pregnancy presents specific additional issues for both the mother and fetus, especially cardiopulmonary bypass and the factors associated with it. Successful outcome of cardiopulmonary bypass surgery during pregnancy depends upon the multidisciplinary management of the Patient, which is frequently under reported from the developing world. We present our experience of two cases where cardiopulmonary bypass surgery for cardiac valve replacement was successfully performed during pregnancy without any maternal or fetal mortality. A review of published literature is also undertaken in order to present evidence based recommendations for undertaking such procedures in pregnancy

Marine collagen as a source of bioactive molecules. A review.

Skins, scales and bones are the major by-products of the fish-processing industry. These by-products are not regarded as ordinary saleable products and are usually discarded causing a heavy environmental impact. However, marine by-products are a good source of collagen that could be extracted and further enzymatically hydrolyzed to liberate interesting bioactive peptides. Collagen-derived peptides may exhibit interesting antioxidant activity, potent antihypertensive activity, antimicrobial activity against different strains of bacteria, protective effect on cartilage, capacity to stimulate bone formation, and also other interesting activities (e.g., satiety, calciotropic, or opioid). The bioactive properties of collagen-derived peptides, and also their resistance to protein digestion, make them potential ingredients of health promoting foods.Peer Reviewe