A simpler approach to seal severe coronary perforation with bare metal stent

The case of a coronary artery perforation in which overinflation of a balloon at an angulated segment of the left anterior descending (LAD) artery after stent deployment resulted in an Ellis type III coronary artery perforation is presented. A bare metal stent (BMS) was used successfully to seal this high-grade perforation. Here, it is demonstrated that it may not be illogical to consider BMS as the first choice before embarking on use of a covered stent if the clinical/haemodynamic condition of the patient allows it and if a covered stent is not available

Percutaneous Non-Stenting Approach for Distal Simultaneous Multivessel Acute Coronary Occlusions

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein (GP) IIb/IIIa inhibitor and Factor X inhibitor (Rivaroxaban) with full resolution of flow in the distal vessels. Thus, coronary lesions, not amenable to stenting, can be dealt percutaneously, using a combination of old and newer pharmacological agents without stenting

Mother and child technique combined with super selective pharmacological intervention for large intracoronary thrombus

Primary percutaneous intervention (PCI) in acute ST elevation myocardial infarction (MI) is a preferred way of treatment nowadays. Sometimes it becomes difficult to get good myocardial blood flow during PCI if clot burden is large. In this case of an elderly lady, the use of Mother and Child Technique combined with super selective pharmacological intervention is demonstrated to achieve good blood flow when conventional means are not working

Terrorism and Its Impacts on Export of Pakistan an Empirical Analysis

This research paper study the empirical relation between export and terrorism in Pakistan. Using data from 1996 to 2015, by applying the simple linear regression model, the Ordinary Least Square (OLS) testing approach is used to check the relationship among variables, the normality and linearity of the data have been checked. By estimating the Model the result clearly showed that there is significant relationship between both variables, terrorism have negative significant effects on Pakistan export. The study suggests that government should take positive step to maintain peace in the country and negotiate with all terrorist groups and parties who are responsible for all that kind of vicious activities. It hampers economic growth of Pakistan, as export play a vital role in the economic growth of a country. Keywords: Export, Terrorism, Pakista

Tirofiban and rivaroxaban use in the management of right coronary artery thrombus as a primary manifestation of essential thrombocythemia

A 45 year old male with hypertension was presented to our centre with a recent inferior wall myocardial infarction (IWMI) and post infarction angina. Invasive coronary angiography revealed an occluded proximal right coronary artery (RCA) with high thrombus burden, in the absence of obstructive disease in the remaining coronary vasculature. Based on raised platelet counts of 923,000/microliter and positive Janus kinase (JAK 2- V617) mutations tested by polymerase chain reaction (PCR), a diagnosis of essential thrombocythemia (ET) was made. A therapeutic strategy of aspiration thrombectomy along with I/V Tirofiban was used for three days, followed by reassessed angiogram and percutaneous coronary intervention (PCI) with drug eluting stent (DES) placement was applied. In addition to dual antiplatelet and statin therapy, patient was treated with Rivaroxaban 15 mg once daily for a month and Hydroxyurea 500mg twice daily. At one month follow up, patient was asymptomatic, with decreasing platelet counts and no bleeding complication

Port choice by intra-regional container service operators : an application of decision-making techniques to liner services between Malaysian and other Asian ports

Intra-regional container service operators are challenged to design regular and reliable liner services connecting regional ports at the lowest cost and shortest transit time while considering customer demand. This paper focuses on the selection of ports of call in regular intra-regional container services, an under-researched part of the container shipping market. A combination of decision-making techniques (i.e. Analytical Hierarchy Process, fuzzy link-based and Evidential Reasoning) are presented to assist intra-regional container service operators in selecting ports of call. The proposed methodology is empirically applied to container services between Malaysian and other nearby Asian ports. While Port Klang is the main gateway to Malaysia, the results show that other Malaysian ports should play a more prominent role in accommodating intra-Asian container services. This research can assist maritime stakeholders in evaluating intra-regional port-to-port liner service configurations. Furthermore, the novel mix of decision-making techniques complements and enriches existing academic literature on port choice and liner service configuration

Outcomes of Left Main Percutaneous Coronary Intervention

Objective: To study the outcomes of left main percutaneous coronary artery (LMCA) revascularisation. Study Design: A descriptive study. Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from February till July 2016. Methodology: The study included all adult patients aged 18 years or more, who underwent percutaneous LMCA revascularisation at study centre from April 2006 till April 2015. In-hospital outcomes were ascertained of patients via charts along with telephonic follow-up for outcome ascertainment at 1-year and 5-year. Results were expressed in terms of means and standard deviation for quantitative variables and percentages for qualitative variables. Results: Of the 86 patients, the mean age was 66.05 ±12.6 years and 69% (59 cases, n=86) of them were males. Sixteen (18.6%) patients presented with cardiogenic shock and 17.4% (15 cases, n=86) required mechanical ventilation upon arrival. Among the 86 patients, 23.3% (20 patients, n=86) underwent PCI because of unstable condition for CABG and refusal by the surgeons. Mean follow up time for participants was 40.5 ±25.7 months with mean length of hospital stay of 4.36 ±2.4 days. In-hospital mortality was 12.8%, while mortality at 1-year and at mean follow-up was 7.3% and 6.9%, respectively. Conclusion: LM percutaneous coronary intervention is a viable option for patients who are hemodynamicaly unstable and require urgent revascularisation or for patients denying bypass surgery due to other reasons in Pakistan. Prospective studies in future may be required to evaluate the role of PCI for LM lesions in elective setting in contrast to existing treatment options

A Multiparous Woman with Lately Diagnosed Multilevel Left Ventricular Obstruction

A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society (CCS) class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography (TTE) revealed moderate aortic stenosis (AS) and mid cavity left ventricular outflow (LVO) obstruction. Left heart catheterization (LHC) showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well

Faktor-Faktor Stres Pekerjaan Pensyarah Politeknik : Satu Kajian Kes Di Politeknik Sultan Abdul Halim Mu'adzam Shah

The purpose of this study is to identify the level of stress among the polytechnic lecturers based on demographic factor (which includes gender, length of service, academic qualification and departments which lecturers are attached to). It also aims to explain the level of stress in relation to stress factors which are conflict of role, ambiguity of role, workload, climate and organizational relationship and career development factors. The survey was carried out in Polytechnic Sultan Abdul Halim Mu'adzam Shah (POLIMAS), Jitra, Kedah. 165 lecturers from this politechnic were chosen as sample. Data was collected through 34 item questionnaires constructed on a likert scale. Both descriptive and inferential statistics were used to analyse the data using the SPSS version 10.0. Statistical tools such as t-test and One Way Analysis of Variance (ANOVA) were used to test the hyphotheses. The 0.05 level of significance was used for this study. The findings of this study shows that there are significant differences between gender, departments which the lecturers are attached to and the length of service which the causes of stress being studied. The departments which the lecturers are attached to is found to have significance difference with all the causes of stress namely conflict of role, ambiguity of role, workload, climate and organizational relationship and career development. The overall level of stress of POLIMAS lecturers is average

Trans-radial approach for coronary angiography in an adult postoperative patient with tetralogy of Fallot with complex anatomy

2015 BMJ Publishing Group Ltd.A 42-year-old, postoperative patient with tetralogy of Fallot (TOF) with right-sided aortic arch, presented with heart failure secondary to left ventricular dysfunction, severe valvular regurgitation and residual ventricular septal defect (VSD). After initial stabilisation, he underwent successful coronary angiography through a trans-radial approach followed by aortic valve replacement, pulmonary valve and VSD repair, and was discharged home in stable condition. This case report highlights the trans-radial approach as a feasible option for coronary angiography in postoperative patients with TOF with right-sided aortic arch