Background. Distal embolization due to microthrombus fragments formed during predilation ballooning is considered one of the possible mechanisms of slow flow/no-reflow (SF/NR). Therefore, this study aimed to compare the incidence of intraprocedure SF/NR during the primary percutaneous coronary intervention (PCI) in patients with high thrombus burden (≥4 grade) with and without predilation ballooning for culprit lesion preparation. Methodology. This prospective descriptive cross-sectional study included patients with a high thrombus burden (≥4 grades) who underwent primary PCI. Propensity-matched cohorts of patients with and without predilation ballooning in a 1 : 1 ratio were compared for the incidence of intraprocedure SF/NR. Results. A total of 765 patients with high thrombus burden undergoing primary PCI were included in this study. The mean age was 55.75 ± 11.54 years, and 78.6% (601) were males. Predilation ballooning was conducted in 346 (45.2%) patients. The incidence of intraprocedure SF/NR was significantly higher (41.3% vs. 27.4%; p < 0.001 ) in patients with predilation ballooning than in those without preballooning, respectively. The incidence of intraprocedure SF/NR also remained significantly higher for the predilation ballooning cohort with an incidence rate of 41.3% as against 30.1% ( p = 0.002 ) for the propensity-matched cohort of patients without predilation ballooning with a relative risk of 1.64 (95% CI: 1.20 to 2.24). Moreover, the in-hospital mortality rate remained higher but insignificant, among patients with and without predilation ballooning (8.1% vs. 4.9%; p = 0.090 ). Conclusion. In conclusion, predilation ballooning can be associated with an increased risk of incidence of intraprocedure SF/NR during primary PCI in patients with high thrombus burden.

Congenital venous anomalies are uncommon, incidental findings encountered during adult interventional electrophysiology procedures. Femoral venous access is conventionally used during cardiac electrophysiology studies to gain access to the heart. The chance finding of an inferior vena cava anomaly may preclude the performance of these procedures from the femoral approach. We describe two cases in which we were able to successfully perform different radiofrequency catheter ablation procedures in the presence of an unusual venous anomaly, the left-sided IVC. doi: https://doi.org/10.12669/pjms.36.6.2947 How to cite this:Awan RA, Khanzada MF, Mumtaz Z, Qadir F. Successful radio-frequency catheter ablation of two cases of supraventricular tachycardia via a left-sided inferior vena cava. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2947 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: The objective of this study was to determine the level of adherence and possible barriers to secondary prophylaxis among patients with Rheumatic heart disease (RHD). Methodology: It is a cross-sectional study conducted at the largest tertiary care cardiac center of Karachi, Pakistan. We included patients with RHD, based on transthoracic echocardiography and adherence to the secondary prophylaxis and possible barriers were assessed using a structured questionnaire. Results: Among total of 195 patients 66.7% (130) were female, mean age was 32.25 ± 13.78 years. Rural residents were 51.3% (100) and 59.5% (116) of the patients were illiterate. Benzathine Penicillin injection was prescribed to 56.4% (110) patients, out of them 70.0% (77) of the patients were counseled regarding duration of secondary prophylaxis. The most common reason for non-adherence was reported to be a painful injection (19.1%). Conclusion: Majority of the RHD patients are not being prescribed and effectively counseled regarding secondary prophylaxis. Low adherence to the secondary prophylaxis was observed and the common reasons for non-adherence were painful injection, non-availability of nearby health facility, friends/family advising them otherwise, allergic reaction, and patients feeling sick and unable to take injection.

Objectives: This study was conducted to assess the predictive value of Shock Index-Creatinine Clearance (SI-C) for the risk stratification of contrast induced nephropathy (CIN) in patients after primary percutaneous coronary intervention (PPCI). Methodology: 1150 consecutive patients of STEMI and candidates of PPCI presenting at our tertiary care cardiac center were included in this study. Patients with significant hemodynamic instability, allergic reaction to contrast agent or having exposure to contrast agent within a week prior to PPCI and those requiring renal replacement therapy were excluded from this study. SI-C and Mehran risk scores were calculated and the rise in post procedure serum creatinine level by 0.5 mg/dL or up to 25% from baseline was characterized as CIN. The predictive power of both SIC and Mehran risk score was assessed with help of receiver operating characteristic (ROC) curve analysis. Results: Out of 1150 participants, 960 were male with a mean age of 55.64 ± 11.45 years. Out of which 113 (9.8%) patients developed CIN.  Area under the cure (AUC) for the prediction of CIN was 0.702 [95% confidence interval (CI): 0.651 to 0.753] for SI-C as against 0.633 [95% CI: 0.574 to 0.692] for Mehran score. SIC also retained its statistical significance as independent predictor of CIN with adjusted odds ratio of 1.01 [95% CI: 1.01 to 1.02] on multivariable regression analysis. Conclusion: SI-C has demonstrated strong discriminative power to determine the risk of CIN in PPCI setting when compared with Mehran risk score.

Environment and health are interrelated suggesting any change in one will effect and alter the other. Domestic solid waste dump exposure exerts harmful impact on health of humans especially children. Children (age group 5-7 years) were compared with a group of children having similar socio-economic background but not exposed to waste dumps. The results showed that the weight (M=15.8 kg with SD ± 5.6), height (M=41.4 inches with SD ± 3.7) and BMI (M=14.1 kg.m 2 with SD ± 3.3) of observational children were below the values of those not exposed and also below recommended values. Additionally, they exhibited the clinical symptoms of iron, calcium and protein deficiencies seen in their pale eyes, nails and skin, discoloured teeth and brittle hair. Overall disease status in both groups was almost similar. Waste exposed children were suffering more from diarrhoea as compared to others. Other health related problems like eyes infection, skin infections/allergies, respiratory tract infections and nervous disorders were also prevalent among waste dump dwelling children. The results of CDC percentile growth charts depicted that waste-exposed children scored lower for weight-for-age (30%) sample exhibited 3 rd -5 th percentile scores) and BMI-for-age growth charts (25% sample exhibited below 5th percentile scores), whereas height-for-age growth charts showed no discrete results. Hence, it has been proved that compromised health and nutritional status was observed among waste exposed children by reporting malnutrition and wasting in them.

A 50 years old smoker male with arrhythmias and non-obstructive coronaries diagnosed as a case of coronary slow flow phenomenon.

Objectives: To study the frequency of H. pylori infection and its association as acause of upper G.I bleeding in cirrhosis. Study Design: Cross Sectional Study. Setting: MedicalUnit III, JPMC Karachi. Period: January 2014 to December 2014. Methods: 100 patients ofestablished cirrhosis with upper G.I bleeding were included in this study. These patients wereevaluated for viral etiology of cirrhosis. An upper G.I Endoscopy was performed in all patientsand antral biopsies were taken. Rapid urease test was performed on biopsy specimen fordetection of H.pylori infection. Results: Out of 100 patients 71 were males and 29 were femaleswith age ranging between 14 to 70 years. Among them 53% patients turned out to be positivefor H.Pylori infection with rapid urease test. H.pylori infection was detected in 68.7% of HBsAgpositive patients and in 50% of Anti HCV positive patients. On upper G.I endoscopy 96 patientshad PHG and among them 50 (52%) were positive for H.pylori. 4 patients did not have PHGand among them 3 (75%) were positive for H.pylori. Gastric ulcer was present in 17 patientsand amongst them H.pylori was detected in 10 (58.8%) cases. Duodenal ulcer was present in 5patients and among them 2 (40%) were positive for H.pylori. Gastritis was present in 17 casesamong them 11 (64%) were positive for H.pylori. Duodenitis was present in 13 cases amongthem 11 (84.6%) patients were positive for H.pylori infection. Conclusion: The frequency ofH.pylori infection was low in cirrhotic patients. No association was seen in H.pylori infectionand causes of upper G.I bleeding in cirrhosis including PHG, gastric ulcer and duodenal ulcer

Objectives: Rheumatic heart disease remains a significant problem in developing countries, with mitral stenosis (MS) being a frequent manifestation. The objective of this study was to compare transthoracic echocardiographic (TTE) findings of mitral valve calcification with fluoroscopy. Methodology: This cross-sectional study was conducted at the department of adult cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi. All patients were candidates for percutaneous mitral balloon valvuloplasty (PMBV), aged between 15 to 65 years of either gender. Patients who underwent TTE were subjected to fluoroscopy before PMBV. The Kappa coefficient was calculated to assess the agreement between the two modalities. An appropriate t-test or Mann-Whitney U test was applied, and a p-value ≤ 0.05 was taken as the criterion for statistical significance. Results: A total of 160 patients were included in this study with a mean age of 34.01± 12.32 years, 119 (74.4%) were between 18 to 40 years of age, and 108 (67.5%) were female. Calcification was observed in 40.6% (65) on echocardiography and 50.6% (81) of the patients on fluoroscopy. A substantial agreement was observed between the two modalities with a Kappa coefficient of 0.75 for the detection of calcification. Conclusion: No significant difference was observed in the detection of calcification on echocardiography and fluoroscopy, along with a substantial agreement between the two modalities for the detection of calcification. Echocardiography can be a less invasive alternative to fluoroscopy for the detection of calcification before PMBV.