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Twenty children (18 boys and 2 girls) with a proven or presumptive diagnosis of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency developed intravascular haemolysis following administration of antimalarials in 9, chloroquine and chloramphenicol in 1, chloroquine, chloramphenicol and aspirin in 1, chloramphenicol and aspirin in 3, and aspirin alone in 4. Eleven of these children developed acute renal insufficiency. All were managed with supportive care, including blood transfusion, forced diuresis and peritoneal dialysis wherever indicated. Only 16 children recovered completely. The occurrence of G-6-PD deficiency is being reported for the first time in Afghanistan.

IntroductionInadvertent malposition of a pacemaker ventricular lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown. It may be underestimated and underreported because of a possible asymptomatic course. A 12-lead electrocardiogram is important to confirm proper placement.Case presentationWe report a case of a 60-year-old Caucasian man with a malpositioned transvenous permanent pacing lead into the left ventricle via a patent foramen ovale that was not suspected during implantation and went undiagnosed for two years without complications. The patient remained asymptomatic as he was being treated with oral anticoagulation therapy for atrial fibrillation. The decision was made to leave the pacing lead in place and continue lifelong warfarin therapy.ConclusionsInadvertent insertion of pacing wires into the left ventricle is a potentially dangerous complication that may happen under fluoroscopic guidance and may be overlooked by routine pacemaker interrogation. It is advisable to obtain a 12-lead electrocardiogram during or immediately after transvenous pacemaker implantation rather than use a routine pacemaker interrogation or a limited electrocardiogram.

Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.