BACKGROUND: Atrial myxoma is the most common type of primary cardiac tumor. The number of studies examining the possible role of blood groups in cardiovascular diseases is increasing. Our aim was to demonstrate the distribution of ABO and Rh blood groups in a large population of patients with atrial myxoma in Iran.

 METHODS: In a case-control study design, 35,192 patients undergoing cardiac surgery in a tertiary heart care center in Iran were retrospectively reviewed. Demographic and clinical characteristics of patients with histologically confirmed diagnosis of cardiac myxoma were recorded. Control group consisted of age, gender and year of surgery matched 468 non-cardiac myxoma patients.

RESULTS: Of the 117 patients with cardiac myxoma, 64 patients (54.7%) were female. Blood group A and O were the most frequent blood types (42.7% and 30.8%, respectively) as well as Rh⁺ group (82.1%) in the cardiac myxoma group, and blood group O and A were the most frequent blood types (37.8% and 32.8%, respectively) as well as Rh⁺ group (87.8%) in the control group, although the differences were not statistically significant (p>0.05). There was no significant difference between different ABO blood groups and Rh status for tumor size, family history, recurrence, and mortality rate (p>0.05).

 CONCLUSION: Blood group A and O and Rh⁺ status are equally prevalent in patients with and without cardiac myxoma. Whether blood groups have an effect on mortality of patients with cardiac myxoma remains to be seen.

Chronic hepatitis due to hepatitis C virus (HCV) infection is highly prevalent throughout the world. In addition to causing chronic hepatitis, HCV is associated with extrahepatic manifestations, especially renal. The exact mechanism through which HCV infection modulates the development and progression of kidney disease is unknown. Although several studies have examined an association of HCV infection with Glomerular Filtration Rate (GFR), their results have been inconsistent. On the other hand, studies have consistently found an association between HCV and albuminuria.  Patients with unknown cause of proteinuria should be screened for HCV infection and upon positive results be closely followed up for signs and symptoms of deteriorating kidney condition.

Neurofibromatosis type I is a rare genetic disorder with variable manifestations. We present a very unique case of this disorder with primarily skeletal manifestations resulting in lengthening of one lower limb and a limping gait.

BACKGROUND: Discharge against medical advice (DAMA) has been associated with increased morbidity and re-admission of the patients who have been DAMA. The present study aims to evaluate the prevalence of DAMA and to determine the associated factors for DAMA.

 METHODS: A cross-sectional study was conducted from April 2012 to September 2012 in 17 hospitals in Tabriz, Iran. Data collection was performed using a two-part checklist including demographic factors, information about hospital and DAMA reasons. The profile of all DAMA patients was studied.

RESULTS: The overall DAMA rate among hospitals was 5.7%. The highest DAMA rates were from private and educational hospitals, 10.8% and 9.6% respectively. The lowest rates were from social security hospitals with 2.5%. In this study, sex, age, month and health insurance were significant predictors of DAMA.

CONCLUSION: In comparison to other studies, relatively higher rates of DAMA in this study show the need for conducting additional studies to define the causes of DAMA and to devise appropriate interventions to decrease DAMA rate. Determining DAMA rate and its determinants can play an important role in early detection of these at-risk patients and in instituting appropriate intervention.

Bronchogenic cysts of the mediastinum are congenital cystic lesions that can occur in infants, children, and also adults. These are benign in nature and in many instances, asymptomatic. The maximum size of a bronchogenic cyst of mediastinum found in literature is 15 cm. We present a case of a 21 cm large mediastinal bronchogenic cyst.

Early postoperative small bowel obstruction (EPSBO) is a distinct clinical entity, occurring in about 9.5% cases. There is a wide range of causative factors and abdominal drains are a very rare cause of this condition. Due to its rarity, we report a successful management of EPSBO due to an abdominal drain in a 62-year-old gentleman. 

Situs inversus totalis or Kartagener’s syndrome is a rare autosomal recessive disorder with genetic predisposition. It consists of a triad of features; situs inversus totalis, chronic sinusitis and bronchiectasis. Only half of the patients with Kartagener’s syndrome have full triad of the syndrome. Herein, we report a patient with situs inversus totalis with cholelithiasis who was managed by open cholecystectomy.

Tuberculosis (TB) is a common public health problem in Pakistan. It can affect any part of the body but generally spares skeletal muscles, thyroid, pancreas and myocardium. Here we report an unusual case of tuberculous myocarditis in a young female who was treated with antituberculous therapy and steroids.

Follicular thyroid carcinoma is the second most common thyroid cancer after papillary carcinoma. However, follicular thyroid carcinoma ranks first in producing distant metastases among thyroid cancers. Distant metastases at the time of diagnosis are reported in 11-20% of the patients. The usual sites of metastases are lung and bone. We present an unusual case of metastases of follicular thyroid carcinoma to the nasal cavity and paranasal sinuses in a 56-year-old Malay woman who had undergone total thyroidectomy and radioiodine ablation. She presented with recurrent epistaxis, nasal blockage and progressive worsening of vision. She was offered palliative radiotherapy to the metastatic lesions but she declined.

BACKGROUND: Cancer is an important cause of morbidity and mortality among all populations and patients need special care while care providers need special skills and resources; all this constitutes a challenge especially in resource limited settings. The study describes the perceptions of cancer patients, nurses and domiciliary care providers (DCPs) with respect to palliative care needs of adult cancer patients and to identify the levels of patients satisfaction with regards to  care received at the National Institute of Cancer, Maharagam (NICM), Sri-Lanka.

 METHODS: The study was a descriptive cross-sectional survey using both interviewer-administered and self-administered validated questionnaires to collect data from 124 patients, 100 nurses and 100 DCPs at the NICM. The level of satisfaction was identified using a rating scale and percentages were computed.

RESULTS: We found that 68% of patients reported that their most common need was pain relief followed by interpersonal relationship (60%) and majority (86%) confirmed that these were adequately met. 70% of the patients expressed full satisfaction with the psychological support they received. Only 54% of nurses surveyed expressed satisfaction with the care they provided. Most nurses (96%) had not attended any educational program on palliative care, and 94% of DCPs expressed the need to improve their knowledge and skills on palliative care. All DCPs thought that patients have care needs other than the treatment, mainly pain relief. DCPs thought that all patients were satisfied with the care they provided.

CONCLUSION: Palliative care needs of adult cancer patients were well identified by the nurses and the level of patients’ satisfaction was high. However 96% of the nurses had not attended any educational program on palliative care and felt in-service training program can help to improve their knowledge. Although DCPs were satisfied with the services they provided, they too thought that their knowledge was not adequate.