Anomalous left coronary artery from pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare cardiac disease. This condition may present with complications such as myocardial infarction, left ventricular dilatation, mitral regurgitation, and left heart failure in children. We report a case of a four-year-old boy who presented with shortness of breath, palpitations, and recurrent upper respiratory tract infections. He was diagnosed with mitral regurgitation. During the surgery, left coronary artery (LCA) was not present in its anatomical position and ALCAPA was identified. One should keep in mind the possibility of ALCAPA in presentation of mitral regurgitation in children despite not being reported in echocardiography.
Background and Aim: Mechanical prosthetic heart valves exert a lifelong thromboembolic complication requiring continuous antithrombotic therapy. Vitamin K antagonist is the recommended therapy of choice along with meticulous INR monitoring to achieve and maintain an INR of 2.0 -3.0. The study aimed to assess the compliance of anticoagulant therapy in pediatric patients after AVR and to highlight the challenges faced during follow-ups. Methods: A retrospective study was conducted at NICVD Hospital in Karachi, Pakistan for a time frame of 2 years from 2020-2021 where 7 patients were selected. Data were collected using hospital medical records and then validated through a phone call mediated structured questionnaire-based interview. Results: 2 out of 7 patients in the case series were compliant to regular follow-ups and had their INR in the desired range owing to their higher education status and access to INR clinic for regular follow-up in urban setting. Younger patients in the case series were non-compliant. 4 out of 7 patients who were on dual anti-coagulant regimens including warfarin and aspirin were either closer or within the range than compared to those on single drug regimen. Conclusion: Compliance was observed in patients who had favorable demographics and higher education. Multiple recent trials including PROACT and PROACT XA are underway to develop novel treatment options apart from warfarin after mechanical aortic valve replacement. Home-based INR testing kits provide easy access to regular testing in remote areas. Multi-center studies are required for in-depth analysis regarding reasons of noncompliance in pediatric population.
Cyanotic congenital cardiac anomalies increase the risk of thrombosis. In pediatric congenital heart disease, the diagnosis of pulmonary artery thrombosis is rare. We reported an 11-year-old male child who developed progressive shortness of breath over six months. He was subsequently referred to the National Institute of Cardiovascular Diseases, Karachi, Pakistan. The child was diagnosed as a case of double outlet left ventricle, levo-transposition of the great arteries, pulmonary stenosis, ventricular septal defect and thrombus in the main pulmonary artery with extension into the branch pulmonary arteries. He underwent thromboendarterectomy with a Glenn shunt and made an uneventful postoperative recovery.
Objective: To find the association between delayed diagnosis of breast cancer over the degree of invasiveness for each of the immune-histochmically defined molecular type of invasive ductal carcinoma among the patient in tertiary care hospital of Karachi. Study Design and Setting: A cross sectional study was conducted on 153 post mastectomy patients in a time frame of two years at Bait-ul-Sukoon Hospital who had their immunohistochemistry workup. Methodology: The patients included in the research were diagnosed cases of breast cancer; had post-mastectomy with their histopathological and immunochemistry status work up reports. In addition to demographic variables; the histopathological report of specimen, histological tumor type and grade, invasive tumor size, axillary lymph node status, Paget’s disease and stage of the disease were recorded from the histopathological report however ER, PR and Her 2 neu receptor statuses were confirmed via immunochemistry report. Volume of the tumor was calculated using the following formula V = (W2 × L)/2 Convenient sampling was applied and the data was analyzed on SPSS 20.0 with CI-95% and P=0.05. Results- All 153 patients reported because of unpleasant symptoms.47.1% of the participants presented with LT while the remaining 52.9% were grouped as NLT. The association of molecular type with stage at mastectomy was statistically significant (P=0.015) in the ERG. Her-2 enriched variant shows that there was a moderate positive statistically significant relationship between log of total delay and log of tumor volume +2. Conclusion: Delay in diagnosis due to lack of screening modalities, lesser awareness among low socioeconomic groups and inaccessibility to tertiary care were not the major causes of aggressive tumors at diagnosis in developing countries, instead all the major known risk factors influence to the tumor burden collectively
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