Chylopericardium--a rare complication after ventricular septal defect repair

Chylopericardium is a rare complication of cardiac surgery. It may be caused by a lesion in the thoracic duct or its tributaries or by thrombosis in the confluence of the jugular and left subclavian veins, obstructing the drainage of the thoracic duct. The treatment may be conservative or surgical, depending on the duration and on the volume of the effusion. We report the case of a 1 1/2 year-old male, who, in the late postoperative period of VSD repair, was hospitalized with low-grade fever and breathlessness for one week due to the presence of chylopericardium. The clinical findings and treatment performed are discussed

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

Rhabdomyosarcoma embryonal type: in a three and a half year old girl

Rhadomyosarcoma is the most common tumour of the soft tissues in infants and children. We report a case of a 3 1/2 year old girl who presented with a swelling over the neck. Swelling was diagnosed as Rhabdomyosarcoma (embryonal type). Tumour mass was found to be unresectable initially. The patient was subjected to multiple courses of checmotherapy, which shrunk the tumour significantly. There was simultaneous development of cystic lesions in upper lobe of right lung. Excision of the remnant rhabdomyosarcoma mass and biopsy of right lung with cystectomy of right upper lobe cystic lesion was performed. The patient fully recovered and experienced an uneventful 6 months of follow-up

Predictive model of blood transfusion during CABG surgery in Pakistan

OBJECTIVE: To determine predictors of need for transfusion of blood and blood products and create a clinical predictive model to reduce indiscriminate use of blood products during surgery. METHOD: We conducted a retrospective chart review of 485 patients who underwent coronary artery bypass surgery from January 2004 to December 2004 at a Tertiary Care Hospital in Karachi, Pakistan. Independent predictors associated with transfusion were identified and a clinical prediction model developed. RESULTS: The transfusion rate was 37.1%. A predictive model was created based on the presence of pulmonary disease, diabetes mellitus, low ejection fraction and recent/ongoing myocardial infarction. CONCLUSION: The study identifies some predictors of need for blood transfusion in patients undergoing Coronary Artery Bypass Grafting. However, prospective studies with a larger sample of patients are needed to determine other predictors and their applicability in patient selection across institutions

Awareness of the risk factors, presenting features and complications of hypertension amongst hypertensives and normotensives

OBJECTIVES: To assess the level of awareness with regards to risk factors, presenting features and complications of hypertension. Moreover, to Compare the level of awareness amongst patients (hypertensives) and nonpatients (normotensives) in Karachi, Pakistan.METHODS: This cross-sectional study was carried out on a random sample of 440 people (220-normotensives/220-hypertensives) using an interview based questionnaire. Data entry was performed on Epi-info v 6 and managed and analyzed on SPSS v 14. Proportions were calculated for categorical data, means and standard deviations were calculated for continuous data.RESULTS: Hypertensives had a higher mean awareness score than the normotensives (

Secondary prevention of heart disease - knowledge among cardiologists and Omega-3 (Omega-3) fatty acid prescribing behaviors in Karachi, Pakistan

Background: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription. The aim of the study was to determine the practices and associations of dietary fish prescribing among cardiologists of Karachi and to assess their knowledge of fish oil supplementation and attitudes toward dietary practices. Methods: A cross sectional survey was conducted during the period of January to March, 2008. A self report questionnaire was employed. All practicing cardiologists of Karachi were included in the study. Multiple logistic regression analysis was performed to determine the independent factors associated with high fish prescribers. Results: The sample comprised of a total of 163 cardiologists practicing in Karachi, Pakistan. Most (73.6%) of the cardiologists fell in the age range of 28 - 45 years and were male (90.8%). High fish prescribers only comprised 36.2% of the respondents. After adjusting for age and gender, multivariate analysis revealed that only the variable of knowledge about fish oil\u27s role in reducing sudden cardiac death was independently associated with high fish prescribers OR = 6.38 [95% CI 2.58-15.78]. Conclusion: The level of knowledge about the benefits of omega-3 fatty acids is high and the cardiologists harbor a favorable attitude towards dispensing dietary fish advice. However, the prescription practices are less than optimal and not concordant with recommendations of organisations such as the American Heart Association and National Heart Foundation of Australia. The knowledge of prevention of sudden cardiac death in CVD Patients has been identified as an important predictor of high fish prescription. This particular life-saving property of omega-3 fatty acids should be the focus of any implemented educational strategy targeted to improve secondary CVD prevention via omega-3 fatty acid supplementation

Perceptions about the cause of schizophrenia and the subsequent help seeking behavior in a Pakistani population – results of a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior.</p> <p>Methods</p> <p>This cross-sectional study was carried out on a sample of 404 people at the out patient departments of Aga Khan University Hospital Karachi. Data was collected via a self-administered questionnaire. Questions were related to a vignette of a young man displaying schizophrenic behavior. Data was analyzed on SPSS v 14.</p> <p>Results</p> <p>The mean age of the participants was 31.4 years (range = 18–72) and 77% of them were males. The majorities were graduates (61.9%) and employed (50%). Only 30% of the participants attributed 'mental illness' as the main cause of psychotic symptoms while a large number thought of 'God's will' (32.3%), 'superstitious ideas' (33.1%), 'loneliness' (24.8%) and 'unemployment' (19.3%) as the main cause. Mental illness as the single most important cause was reported by only 22%. As far as management is concerned, only 40% reported psychiatric consultation to be the single most important management step. Other responses included spiritual healing (19.5%) and Sociachanges (10.6) while 14.8% of respondents said that they would do nothing. Gender, age, family system and education level were significantly associated with the beliefs about the cause of schizophrenia (p < 0.05). While these variables plus 'religious inclination' and 'beliefs about cause' were significantly associated with the help seeking behavior of the participants.</p> <p>Conclusion</p> <p>Despite majority of the study population being well educated, only a few recognized schizophrenia as a mental illness and many held superstitious beliefs. A vast majority of Pakistanis have non-biomedical beliefs about the cause of schizophrenia. Their help seeking behavior in this regard is inappropriate and detrimental to the health of schizophrenic patients. Areas for future research have been identified.</p

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

Body Dysmorphic Disorder: Gender differences and prevalence in a Pakistani medical student population

<p>Abstract</p> <p>Background</p> <p>Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD.</p> <p>Methods</p> <p>The medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria.</p> <p>Results</p> <p>Out of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%), being fat (32.8%), skin (14.9%) and nose(14.9%), whereas in females they were being fat (40.4%), skin (24.7%) and teeth (18%). Females were significantly more concerned about being fat (p = 0.005). Male students were significantly more concerned about being thin (p = 0.01) and about head hair (p = 0.012).</p> <p>Conclusion</p> <p>BDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.</p

Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure - A national survey of the cardiologists in Pakistan

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.</p> <p>Methods</p> <p>A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File <supplr sid="S1">1</supplr>). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines.</p> <suppl id="S1"> <title> <p>Additional file 1</p> </title> <text> <p><b>Questionnaire</b>. Description: Questionnaire that was administered to participants.</p> </text> <file name="1471-2261-11-68-S1.DOC"> <p>Click here for file</p> </file> </suppl> <p>Results</p> <p>A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation.</p> <p>Conclusion</p> <p>We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.</p