S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

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Primary mediastinal sarcomas are aggressive tumors with a very rare incidence. This report describes the case of a 35-year-old male patient who presented with acute symptoms of dyspnoea, facial puffiness, voice-hoarseness, and engorged neck veins. With the clinical picture consistent with the superior vena cava (SVC) syndrome, the patient was investigated with computed tomography of the chest. This revealed a large soft tissue density mass lesion compressing the SVC along with other critical superior mediastinal structures. Histopathological evaluation of the mass revealed features consistent with a soft tissue sarcoma and positive staining was observed for vimentin and S-100. Cytogenetic analysis by fluorescent in situ hybridisation (FISH) demonstrated the t(X:18) translocation. Thus diagnosis was established as primary mediastinal synovial sarcoma. Patient was treated with three cycles of neoadjuvant chemotherapy, to which there was a partial response as per the RECIST criteria. Surgical excision of the mediastinal mass was performed, and further postoperative treatment with adjuvant chemoradiotherapy was provided. Patient currently is free of disease. This is to the best of our knowledge the first report in the world literature of a successfully treated case of “primary mediastinal sarcomas presenting as SVC syndrome.” Patient is under regular surveillance at our clinic and remains free of recurrence one year after treatment completion.

In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.

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Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05). Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.

LQTS can cause seizures due to prolonged ventricular arrhythmias in high risk subgroup. Children, who present with LQTS and seizures, generally have a precipitating event causing seizures, and they respond well to drug therapy.