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ABSTRACT Background: Myocardial infarction remains a leading cause of global morbidity and mortality. One major risk factor for atherosclerosis and MI is smoking, a highly prevalent habit in South Asian adolescents and healthcare professionals; particularly in Pakistan. This study was conducted to compare clinical presentation and outcome of myocardial infarction (MI) in smokers and non-smokers. Methodology: This study included a total of 100 patients who presented to a tertiary care centre for cardiac patients in Karachi. Patients between 18-65 years presenting with MI were included in the study (N=100). They were divided into two groups, based on smoking status. The smoking group included patients who had smoked for 10 years or more. Patients who had smoked for less than 10 years or had quit less than 5 years back were excluded from both samples. Informed consent was taken from each participant. Results: This study observed that 46% of the non-smokers as compared to 8% smokers present with chest pain (p = 0.001). Arrhythmia was seen in 20% of the smokers compared to 4% of the non-smokers (p = 0.001). Acute heart failure was seen in 24% smokers and only 4% non-smokers (p = 0.004). Of the smoking group, 32% of the patients expired despite treatment as compared to 6% of smokers (p = 0.001). Conclusions: Specific symptoms of myocardial infarction are more commonly seen in non-smokers, aiding early diagnosis and consequently leading to a good prognosis. Alternatively, fatal complications and death rate is a more likely outcome in smokers.

Background: The phenomenon of smoking among schoolchildren has been observed to stem from lenient attitudes of teachers towards smoking. Smoking, a health hazard, proven over years of research, leads to increase in morbidity and mortality rates. This study determined the role of school policies and teacher attitudes towards the perception and adoption of smoking habits by students of private and public schools. Method: This was a cross-sectional study in which 632 school personnel in various private and public schools of South Karachi filled a questionnaire. Informed consent was obtained from all participants; ethical approval for this study was obtained from the Ethical Review Committee of JPMC before the study was conducted. Data was collected via survey forms after consent from individuals. Statistical analysis was done using SPSS v.17. Results: The prevalence of teacher smoking within school premises was found to be 8.8% and 5.9% in private and public sectors, respectively. A significant difference was found between the school policies enforced in private and government schools against personnel found smoking (p=0.00016). Even though private school personnel smoked more in school premises than government but 32.6% of private school teachers felt responsible for teaching about health compared to only 21.5% public school teachers (p=0.0072). Conclusion: There is a pressing need for awareness and education of teachers regarding their attitude towards smoking on school grounds and its significant link with students adopting smoking. Other exposures and risk factors influencing student tobacco usage needs to be studied in more depth.

Pulmonary alveolar microlithiasis is a rare disease with an almost unheard of pathogenesis. With very few cases to document worldwide, predominantly being discovered in Turkey, Italy, and America, it has been nearly impossible to determine a concrete etiology. However, one standout biochemical finding most cases of PAM have in common is a mutation in the SLC34A2 gene coding for the sodium-phosphate cotransporter found in Type II alveolar cells. This cotransporter is responsible for maintaining equilibrium of phosphorus which is a vital component of surfactant. Diagnostic exploration is achieved via radiological imaging, bronchoalveolar lavage and above all, transbronchial lung biopsy. However, in this particular case, due to the patient’s hypoxic condition, Technetium 99m diphosphonate scanning was employed in place of the biopsy. A non-invasive procedure, technetium 99m can detect extensive pulmonary uptake, hereby diagnosing the patient and protect against the physical damage and accompanying side effects inflicted upon the patient by various invasive procedures. In future, to avoid wastage of resources, the use of technetium 99m diphosphonate scanning should be more prevalent in the diagnosis process of PAM.

Fusion of two teeth is rare developmental disorder which is encountered by a clinician. It is commonly reported in deciduous dentition. The fused crown appears broader and usually an esthetic concern. This condition usually reveals a decreased teeth count. Unilateral occurrence of fusion in permanent mandibular anterior teeth is a rare phenomenon. Hence this case report is presented.

Background: A lung abscess is characterized by a necrotic lesion with marked cavitation and exudate within the lung parenchyma. The objective of this study was to identify the most common causative agent of lung abscess within our target population. Methods: Retrospective data from two consecutive years was obtained from the pulmonology department at Jinnah Postgraduate Medical Centre, one of Pakistan’s largest public hospitals. A total of 41 cases of lung abscess were identified on the bases of clinical, radiological and microbiological evidence. These cases were then analysed to establish a link between the incidence of abscess and key factors such as the most common causative organism, the correlation of age and gender and the location within the lung parenchyma. Results: Sputum for routine culture and sensitivity (C/S) showed Pseudomonas Aeruginosa (29.3%) as the most common causative organism. Correlation between abscess and risk factors such as history of smoking (65.9%), poor oral hygiene (56.1%), diabetes (43.9%) and alcoholism (14.6%) have been discussed and compared to previous publications. The frequency of common symptoms such as productive cough (90.2%), fever (82.9%) hemoptysis (58.5%) and clubbing of fingers (46.3%) have been analysed and a contrast is drawn in some instances between our obtained values and pre-existing data. The most common site of involvement is the lower lobe of the right lung (51.2%). Conclusion: Pseudomonas Aeruginosa was found to be the most common causative bacteria within the population for lung abscess while smoking was shown to be the most common risk factor.