At present, one of greatest concerns of medical personnel is Zika virus (ZIKV). Though it has been reported for quite a long time, its rapid emergence, new modes of transmission, and more importantly, the congenital anomalies associated with it have made the situation worse. It was first detected in 1947. After that, this infection was found in the countries of Africa as well as Asia. At present, interestingly it has been reported from Brazil. Microcephaly and intracranial calcification have been postulated to be related to maternal infection with this virus. Though it is asymptomatic in maximum number of cases, the serious complications of the infection should be prevented at the earliest. No specific treatment and vaccine are available till now. But research continues and hopefully, success is not far off. The right information about this infection should reach patients as well as physicians. It will prevent unnecessary panic. In August, Brazil is going to organize the Olympic and Paralympic Games and all eyes are now focused on this. In this review article, the authors have tried to focus on the important points about this infection. The data were gathered after searching for relevant articles published in PubMed, the World Health Organization's (WHO) website, Centers for Disease Control and Prevention's (CDC) website, and some other related websites on the Internet.
{"title":"Zika Virus: A Global Threat to Humanity: A Comprehensive Review and Current Developments.","authors":"Adrija Hajra, Dhrubajyoti Bandyopadhyay, Shyamal Kumar Hajra","doi":"10.4103/1947-2714.179112","DOIUrl":"10.4103/1947-2714.179112","url":null,"abstract":"<p><p>At present, one of greatest concerns of medical personnel is Zika virus (ZIKV). Though it has been reported for quite a long time, its rapid emergence, new modes of transmission, and more importantly, the congenital anomalies associated with it have made the situation worse. It was first detected in 1947. After that, this infection was found in the countries of Africa as well as Asia. At present, interestingly it has been reported from Brazil. Microcephaly and intracranial calcification have been postulated to be related to maternal infection with this virus. Though it is asymptomatic in maximum number of cases, the serious complications of the infection should be prevented at the earliest. No specific treatment and vaccine are available till now. But research continues and hopefully, success is not far off. The right information about this infection should reach patients as well as physicians. It will prevent unnecessary panic. In August, Brazil is going to organize the Olympic and Paralympic Games and all eyes are now focused on this. In this review article, the authors have tried to focus on the important points about this infection. The data were gathered after searching for relevant articles published in PubMed, the World Health Organization's (WHO) website, Centers for Disease Control and Prevention's (CDC) website, and some other related websites on the Internet. </p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"8 3","pages":"123-8"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/24/NAJMS-8-123.PMC4821090.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34432704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.4103/1947-2714.179128
José Luis Alonso Martinez, Francisco Javier Anniccherico Sánchez, Miren Aranzazu Urbieta Echezarreta, Ione Villar García, Jorge Rojo Álvaro
Background: Studies aimed at assessing whether the emboli lodged in the central pulmonary arteries carry a worse prognosis than more peripheral emboli have yielded controversial results.
Aims: To explore the impact on survival and long-term prognosis of central pulmonary embolism.
Patients and methods: Consecutive patients diagnosed with acute symptomatic pulmonary embolism by means of computed tomography (CT) angiography were evaluated at episode index and traced through the computed system of clinical recording and following-up. Central pulmonary embolism was diagnosed when thrombi were seen in the trunk or in the main pulmonary arteries and peripheral pulmonary embolism when segmental or subsegmental arteries were affected.
Results: A total of 530 consecutive patients diagnosed with pulmonary embolism were evaluated; 255 patients had central pulmonary embolism and 275 patients had segmental or subsegmental pulmonary embolism. Patients with central pulmonary embolism were older, had higher plasma levels of N-terminal of the prohormone brain natriuretic peptide (NT-ProBNP), troponin I, D-dimer, alveolar-arterial gradient, and shock index (P < .001 for each one). Patients with central pulmonary embolism had an all-cause mortality of 40% while patients with segmental or subsegmental pulmonary embolism (PE) had an overall mortality of 27% and odds ratio of 1.81 [confidence interval (CI) 95% 1.16-1.9]. Survival was lower in patients with central PE than in patients with segmental or subsegmental pulmonary embolism, even after avoiding confounders (P = .018).
Conclusions: Apart from a greater impact on hemodynamics, gas exchange, and right ventricular dysfunction, central pulmonary embolism associates a shorter survival and an increased long-term mortality.
{"title":"Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival.","authors":"José Luis Alonso Martinez, Francisco Javier Anniccherico Sánchez, Miren Aranzazu Urbieta Echezarreta, Ione Villar García, Jorge Rojo Álvaro","doi":"10.4103/1947-2714.179128","DOIUrl":"10.4103/1947-2714.179128","url":null,"abstract":"<p><strong>Background: </strong>Studies aimed at assessing whether the emboli lodged in the central pulmonary arteries carry a worse prognosis than more peripheral emboli have yielded controversial results.</p><p><strong>Aims: </strong>To explore the impact on survival and long-term prognosis of central pulmonary embolism.</p><p><strong>Patients and methods: </strong>Consecutive patients diagnosed with acute symptomatic pulmonary embolism by means of computed tomography (CT) angiography were evaluated at episode index and traced through the computed system of clinical recording and following-up. Central pulmonary embolism was diagnosed when thrombi were seen in the trunk or in the main pulmonary arteries and peripheral pulmonary embolism when segmental or subsegmental arteries were affected.</p><p><strong>Results: </strong>A total of 530 consecutive patients diagnosed with pulmonary embolism were evaluated; 255 patients had central pulmonary embolism and 275 patients had segmental or subsegmental pulmonary embolism. Patients with central pulmonary embolism were older, had higher plasma levels of N-terminal of the prohormone brain natriuretic peptide (NT-ProBNP), troponin I, D-dimer, alveolar-arterial gradient, and shock index (P < .001 for each one). Patients with central pulmonary embolism had an all-cause mortality of 40% while patients with segmental or subsegmental pulmonary embolism (PE) had an overall mortality of 27% and odds ratio of 1.81 [confidence interval (CI) 95% 1.16-1.9]. Survival was lower in patients with central PE than in patients with segmental or subsegmental pulmonary embolism, even after avoiding confounders (P = .018).</p><p><strong>Conclusions: </strong>Apart from a greater impact on hemodynamics, gas exchange, and right ventricular dysfunction, central pulmonary embolism associates a shorter survival and an increased long-term mortality.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"8 3","pages":"134-42"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/f3/NAJMS-8-134.PMC4821092.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177347
V. Mishra, S. Sinha, M. Razi
Dear Editor, We read with interest the recent case reported by Pozen et al. that was published in your esteemed journal.[1] Physicians are often faced with a patient with suspected acute myocardial infarction (MI) and bundle branch block (BBB). There are different questions, depending on the presence of a left BBB (LBBB) or a right BBB (RBBB) that need to be answered in such scenarios. Is the conduction disturbance new or a presumably new occurrence? Often, this question cannot be answered with certainty. If at all the patient has acute coronary syndrome (ACS), does the BBB mask any electrocardiographic features of MI with ST-segment elevation? Is it possible to assess the area of myocardium at risk with the use of investigations such as echocardiography (ECHO)?[2] Although, an RBBB does not theoretically mask the repolarization phase; nor can a preexisting Q-wave, minor ST-segment elevation in the anterior leads (i.e., V1–V4) be missed, because these are “compensated” by the pseudonormalization of the negative T-waves. RBBB as a consequence of the current anterior MI is most commonly related to the proximal occlusion of left descending coronary artery with compromise of circulation in the septal arteries supplying the bundle branches. Due to anterior location of the right ventricle than that of the left ventricle, activation of the right ventricular free wall can neutralize the abnormal septal forces associated with an anteroseptal MI. Therefore, in most patients with an anteroseptal infarction, abnormal Q waves in right precordial leads is mostly manifest during RBBB showing the classical qRBBB pattern, due to delayed activation of the right ventricle. Very rarely, early depolarization of the right ventricular free wall could mask the abnormal Q waves in some patients with an anteroseptal MI.[3] The analysis of HERO-2 demonstrated that in MI, RBBB occurs alone or in combination with left anterior hemiblock or left posterior hemiblock. In the setting of an anterior ST-segment elevation MI (STEMI), the presence of an RBBB is associated with a higher risk of death when compared with that of patients with normal conduction, as these patients experienced more extensive MI due to involvement of the proximal left anterior descending artery or the left main coronary artery.[4] Rarely with the involvement of the atrioventricular (A-V) branch of the right coronary artery, can RBBB be associated with an inferior wall MI with ST-T changes in lead II, III, avF without the pathological Q waves in the anterior leads. The changes in the inferior leads can often be subtle and missed. The prognosis of RBBB due to the involvement of the A-V branch of the right coronary artery, RBBB associated with an inferior infarction, does not portend a worse prognosis as often a small amount of myocardium is jeopardized.[4] This was observed in the case described by Pozel et al. as well.[1] In the case scenario described by Pozen et al., it would have been i
{"title":"Right Bundle Branch Block: A Masquerader in Acute Coronary Syndrome","authors":"V. Mishra, S. Sinha, M. Razi","doi":"10.4103/1947-2714.177347","DOIUrl":"https://doi.org/10.4103/1947-2714.177347","url":null,"abstract":"Dear Editor, \u0000 \u0000We read with interest the recent case reported by Pozen et al. that was published in your esteemed journal.[1] Physicians are often faced with a patient with suspected acute myocardial infarction (MI) and bundle branch block (BBB). There are different questions, depending on the presence of a left BBB (LBBB) or a right BBB (RBBB) that need to be answered in such scenarios. Is the conduction disturbance new or a presumably new occurrence? Often, this question cannot be answered with certainty. If at all the patient has acute coronary syndrome (ACS), does the BBB mask any electrocardiographic features of MI with ST-segment elevation? Is it possible to assess the area of myocardium at risk with the use of investigations such as echocardiography (ECHO)?[2] \u0000 \u0000Although, an RBBB does not theoretically mask the repolarization phase; nor can a preexisting Q-wave, minor ST-segment elevation in the anterior leads (i.e., V1–V4) be missed, because these are “compensated” by the pseudonormalization of the negative T-waves. \u0000 \u0000RBBB as a consequence of the current anterior MI is most commonly related to the proximal occlusion of left descending coronary artery with compromise of circulation in the septal arteries supplying the bundle branches. Due to anterior location of the right ventricle than that of the left ventricle, activation of the right ventricular free wall can neutralize the abnormal septal forces associated with an anteroseptal MI. Therefore, in most patients with an anteroseptal infarction, abnormal Q waves in right precordial leads is mostly manifest during RBBB showing the classical qRBBB pattern, due to delayed activation of the right ventricle. Very rarely, early depolarization of the right ventricular free wall could mask the abnormal Q waves in some patients with an anteroseptal MI.[3] \u0000 \u0000The analysis of HERO-2 demonstrated that in MI, RBBB occurs alone or in combination with left anterior hemiblock or left posterior hemiblock. In the setting of an anterior ST-segment elevation MI (STEMI), the presence of an RBBB is associated with a higher risk of death when compared with that of patients with normal conduction, as these patients experienced more extensive MI due to involvement of the proximal left anterior descending artery or the left main coronary artery.[4] \u0000 \u0000Rarely with the involvement of the atrioventricular (A-V) branch of the right coronary artery, can RBBB be associated with an inferior wall MI with ST-T changes in lead II, III, avF without the pathological Q waves in the anterior leads. The changes in the inferior leads can often be subtle and missed. The prognosis of RBBB due to the involvement of the A-V branch of the right coronary artery, RBBB associated with an inferior infarction, does not portend a worse prognosis as often a small amount of myocardium is jeopardized.[4] This was observed in the case described by Pozel et al. as well.[1] \u0000 \u0000In the case scenario described by Pozen et al., it would have been i","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"64 1","pages":"121 - 122"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84335253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177315
P. Shah, U. Bhosale, Ankush Gupta, R. Yegnanarayan, S. Sardesai
Background: If postoperative acute pain remains unrelieved, it may result in significant morbidity and mortality. Preemptive analgesic initiated before surgery offers premature analgesia even before exposure to an initial noxious stimulus bestowing effective postoperative analgesia. In developed countries, it is regularly practiced as a part of well-defined protocol. In our country however, only a few centers practice it and that too irregularly and with undefined protocol. Few studies support preemptive analgesic efficacy of novel antiepileptic agent gabapentin. Though lamotrigine is a proven analgesic in animal models of chronic pain and clinical studies of gabapentin-resistant neuropathic pain, a literature search revealed scarce data on its preemptive analgesic efficacy. Aims: The present study is designed to study the preemptive analgesic efficacy of lamotrigine in comparison with diclofenac sodium in postoperative pain control. Materials and Methods: This randomized clinical trial included 90 patients of both sexes, between 18 years and 70 years undergoing major surgeries. Patients were randomly allocated into placebo, control, and test groups and received the respective treatment 30 min before the induction of anesthesia. Aldrete score and pain score were recorded using visual analog scale (VAS), facial rating scale (FRS), and behavioral rating scale (BRS) at awakening and at 1 h, 2 h, 4 h, 6 h, and 24 h. Postoperative rescue analgesic consumption for 24 h was recorded. Results: Significantly higher pain scores were observed in the placebo group postoperatively for 2 h on all pain scales (P < 0.05), whereas in the control group it was significantly higher at 1 h (P < 0.05). The test group patients were more comfortable throughout the study and postoperative analgesic requirement was significantly less (P < 0.05). Conclusions: The study recommends the use of single oral dose lamotrigine as preemptive analgesic for effective postoperative pain control.
{"title":"A Randomized Double-Blind Placebo-Controlled Study to Compare Preemptive Analgesic Efficacy of Novel Antiepileptic Agent Lamotrigine in Patients Undergoing Major Surgeries","authors":"P. Shah, U. Bhosale, Ankush Gupta, R. Yegnanarayan, S. Sardesai","doi":"10.4103/1947-2714.177315","DOIUrl":"https://doi.org/10.4103/1947-2714.177315","url":null,"abstract":"Background: If postoperative acute pain remains unrelieved, it may result in significant morbidity and mortality. Preemptive analgesic initiated before surgery offers premature analgesia even before exposure to an initial noxious stimulus bestowing effective postoperative analgesia. In developed countries, it is regularly practiced as a part of well-defined protocol. In our country however, only a few centers practice it and that too irregularly and with undefined protocol. Few studies support preemptive analgesic efficacy of novel antiepileptic agent gabapentin. Though lamotrigine is a proven analgesic in animal models of chronic pain and clinical studies of gabapentin-resistant neuropathic pain, a literature search revealed scarce data on its preemptive analgesic efficacy. Aims: The present study is designed to study the preemptive analgesic efficacy of lamotrigine in comparison with diclofenac sodium in postoperative pain control. Materials and Methods: This randomized clinical trial included 90 patients of both sexes, between 18 years and 70 years undergoing major surgeries. Patients were randomly allocated into placebo, control, and test groups and received the respective treatment 30 min before the induction of anesthesia. Aldrete score and pain score were recorded using visual analog scale (VAS), facial rating scale (FRS), and behavioral rating scale (BRS) at awakening and at 1 h, 2 h, 4 h, 6 h, and 24 h. Postoperative rescue analgesic consumption for 24 h was recorded. Results: Significantly higher pain scores were observed in the placebo group postoperatively for 2 h on all pain scales (P < 0.05), whereas in the control group it was significantly higher at 1 h (P < 0.05). The test group patients were more comfortable throughout the study and postoperative analgesic requirement was significantly less (P < 0.05). Conclusions: The study recommends the use of single oral dose lamotrigine as preemptive analgesic for effective postoperative pain control.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"10 1","pages":"93 - 99"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83119144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177316
S. Chandak, Ashutosh Kumar
Background: Dengue fever (DF) is a viral hemorrhagic fever causing severe morbidity and mortality in affected patients. Aims: The purpose of our study was to evaluate the changing trends in radiological findings in DF, to find if ultrasound is useful in the diagnosis of DF during an epidemic in absence of serological tests, and also to investigate the effects of DF in pregnancy. Materials and Methods: A prospective study was conducted in 2013 comprising of 400 patients who were serologically positive for dengue. Out of these, radiological investigations were conducted for 107 patients who were analyzed. Results: Out of the 107 patients, 85 patients underwent ultrasound, 12 computed tomography (CT) scans of brain or paranasal sinuses, and 21 chest radiography. The maximum numbers of patients (79%) were in the age group of 20-50 years. The most common ultrasound finding was hepatomegaly that was seen in 62% of the patients. Other findings were splenomegaly (45%), gallbladder (GB) wall edema (45%), right-sided pleural effusion (37%), bilateral pleural effusion (22%), and ascites (36%). Out of 10 pregnant patients, 5 had oligohydramnios, 2 had intrauterine growth restriction, 2 had intrauterine fetal demise, and 5 had a normal antenatal ultrasound. Conclusion: Ultrasound findings of hepatosplenomegaly, GB wall edema, right-sided or bilateral pleural effusion, and ascites in patients presenting with signs and symptoms of DF during an epidemic are virtually diagnostic of DF. There have been recent changing trends with hepatosplenomegaly being the more common manifestation, in comparison to ascites and GB wall edema. DF also has catastrophic effects in pregnancy such as oligohydramnios and intrauterine fetal demise.
{"title":"Can Radiology Play a Role in Early Diagnosis of Dengue Fever?","authors":"S. Chandak, Ashutosh Kumar","doi":"10.4103/1947-2714.177316","DOIUrl":"https://doi.org/10.4103/1947-2714.177316","url":null,"abstract":"Background: Dengue fever (DF) is a viral hemorrhagic fever causing severe morbidity and mortality in affected patients. Aims: The purpose of our study was to evaluate the changing trends in radiological findings in DF, to find if ultrasound is useful in the diagnosis of DF during an epidemic in absence of serological tests, and also to investigate the effects of DF in pregnancy. Materials and Methods: A prospective study was conducted in 2013 comprising of 400 patients who were serologically positive for dengue. Out of these, radiological investigations were conducted for 107 patients who were analyzed. Results: Out of the 107 patients, 85 patients underwent ultrasound, 12 computed tomography (CT) scans of brain or paranasal sinuses, and 21 chest radiography. The maximum numbers of patients (79%) were in the age group of 20-50 years. The most common ultrasound finding was hepatomegaly that was seen in 62% of the patients. Other findings were splenomegaly (45%), gallbladder (GB) wall edema (45%), right-sided pleural effusion (37%), bilateral pleural effusion (22%), and ascites (36%). Out of 10 pregnant patients, 5 had oligohydramnios, 2 had intrauterine growth restriction, 2 had intrauterine fetal demise, and 5 had a normal antenatal ultrasound. Conclusion: Ultrasound findings of hepatosplenomegaly, GB wall edema, right-sided or bilateral pleural effusion, and ascites in patients presenting with signs and symptoms of DF during an epidemic are virtually diagnostic of DF. There have been recent changing trends with hepatosplenomegaly being the more common manifestation, in comparison to ascites and GB wall edema. DF also has catastrophic effects in pregnancy such as oligohydramnios and intrauterine fetal demise.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"165 1","pages":"100 - 105"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81835844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177311
V. Vetvicka, J. Větvičková
Background: Selenium (Se) is an established essential nutrient that plays a role in various biological processes including cancer development. Similarly, stimulation of immune reactions by β-glucans is well-documented. Aims: In the current study, we focused on the stimulation of phagocytosis and interleukin (IL)-2 production and on potentiation of anticancer immunity by a combination of glucan with two types of Se. Materials and Methods: Phagocytosis was evaluated using synthetic microspheres; cancer development was measured either using breast cancer cells or using lung cancer cells. Results: Using two different murine models of cancer, we showed that the Se/glucan combination strongly suppressed the growth of cancer, mostly probably via stimulation of immunity. Conclusions: A combination of glucan with Se offers superior stimulation of immunity and inhibition of cancer growth.
{"title":"Addition of Selenium Improves Immunomodulative Effects of Glucan","authors":"V. Vetvicka, J. Větvičková","doi":"10.4103/1947-2714.177311","DOIUrl":"https://doi.org/10.4103/1947-2714.177311","url":null,"abstract":"Background: Selenium (Se) is an established essential nutrient that plays a role in various biological processes including cancer development. Similarly, stimulation of immune reactions by β-glucans is well-documented. Aims: In the current study, we focused on the stimulation of phagocytosis and interleukin (IL)-2 production and on potentiation of anticancer immunity by a combination of glucan with two types of Se. Materials and Methods: Phagocytosis was evaluated using synthetic microspheres; cancer development was measured either using breast cancer cells or using lung cancer cells. Results: Using two different murine models of cancer, we showed that the Se/glucan combination strongly suppressed the growth of cancer, mostly probably via stimulation of immunity. Conclusions: A combination of glucan with Se offers superior stimulation of immunity and inhibition of cancer growth.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 1","pages":"88 - 92"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73005483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177292
N. Machado
Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
Bochdalek疝(BH)是一种不常见的膈疝。这种疝气的罕见性和非特异性的表现导致了诊断的延迟，并有潜在的并发症风险。本文综述了其表现和管理的相关方面，基于目前的证据在文献。在PubMed, Google Scholar和EMBASE上进行文献检索，检索成人BH的英文文章。包括1955年以后至2015年1月期间的所有病例报告和系列。共研究了180篇文章，包括368例病例。这些患者的平均年龄为51岁(15-90岁)，男性占57%(211/368)。值得注意的是，6.5%的患者年龄在70岁以上，其中3.5%的患者年龄在80岁以上。大多数疝发生在左侧(63%)，右侧疝和双侧疝分别占27%和10%。诱发因素占24%，其中怀孕占5.3%。先天性异常占11%。主要症状包括腹部(62%)、呼吸道(40%)、梗阻性(呕吐/腹胀;36%)，勒死(26%);其中14%无症状(偶然发现)。在184例接受手术干预的患者中，手术入路包括开腹74例(40.27%)，开胸50例(27.7%)，胸腹联合入路27例(14.6%)，腹腔镜23例(12.5%)，胸腔镜修复9例(4.89%)。总体复发率为1.6%。在这些接受腹腔镜修复的患者中，82%接受了选择性手术;66%的患者进行了初级修复，61%的患者在进行或不进行初级修复时需要插入补片或加固。总死亡率为2.7%。因此，对于同时出现腹部和胸部症状的患者，BH应作为鉴别诊断之一。微创手术提供了一种很好的替代方法，住院时间短，发病率和死亡率最低。
{"title":"Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults","authors":"N. Machado","doi":"10.4103/1947-2714.177292","DOIUrl":"https://doi.org/10.4103/1947-2714.177292","url":null,"abstract":"Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"28 1","pages":"65 - 74"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78999973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.174348
Faisal Inayat, H. Virk, D. Yoon, I. Riaz
Context: Drug-induced pancreatitis (DIP) is rare, but as there are no systematic data on it, the true incidence is not known. Although numerous and varied drugs have been associated with DIP, the clinical evidence on doxycycline-induced pancreatitis is sparse. Case Report: We present the case of a 58-year-old female who presented with complaints of nausea and severe epigastric pain. Her medications included doxycycline which she had been on for only 2 days. Computed tomography of her abdomen showed mild enlargement of body of the pancreas with peripancreatic fatty infiltration, along with lipase level suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to doxycycline therapy was made. Immediate withdrawal of the drug was accompanied by relief of symptoms and resolution of pancreatitis. Conclusion: This report implicates doxycycline as an etiological factor for acute pancreatitis. Knowledge regarding doxycycline related pancreatitis is of paramount importance in order to diagnose cases early and institute effective treatment in patients who are undergoing therapy with this drug.
{"title":"Drug-Induced Pancreatitis: A Rare Manifestation of Doxycycline Administration","authors":"Faisal Inayat, H. Virk, D. Yoon, I. Riaz","doi":"10.4103/1947-2714.174348","DOIUrl":"https://doi.org/10.4103/1947-2714.174348","url":null,"abstract":"Context: Drug-induced pancreatitis (DIP) is rare, but as there are no systematic data on it, the true incidence is not known. Although numerous and varied drugs have been associated with DIP, the clinical evidence on doxycycline-induced pancreatitis is sparse. Case Report: We present the case of a 58-year-old female who presented with complaints of nausea and severe epigastric pain. Her medications included doxycycline which she had been on for only 2 days. Computed tomography of her abdomen showed mild enlargement of body of the pancreas with peripancreatic fatty infiltration, along with lipase level suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to doxycycline therapy was made. Immediate withdrawal of the drug was accompanied by relief of symptoms and resolution of pancreatitis. Conclusion: This report implicates doxycycline as an etiological factor for acute pancreatitis. Knowledge regarding doxycycline related pancreatitis is of paramount importance in order to diagnose cases early and institute effective treatment in patients who are undergoing therapy with this drug.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"1 1","pages":"117 - 120"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85328637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.4103/1947-2714.177345
F. Blaschke, F. Krackhardt, B. Kherad, B. Pieske, W. Haverkamp, M. Rief
Context: Congenital coronary anomalies, including anomalous origin, distribution, intercoronary communications, and coronary fistulae occur at a rate of approximately 1% in the general population and are the most incidental findings. Case Report: A 49-year-old male patient presented to the emergency department with exercise-induced dyspnea and atypical angina pectoris. Coronary angiography (CAG) and contrast-enhanced 320-slice multidetector cardiac computed tomography with subsequent three-dimensional reconstructions revealed a single coronary artery (SCA) arising from the right sinus of Valsalva with a proximal branch giving rise to the left anterior descending coronary artery. The left anterior descending coronary artery shows severe atherosclerotic lesions and it is occluded afterwards. Adenosine stress perfusion cardiac magnetic resonance imaging (MRI) revealed a stress myocardial ischemia at the anterior wall without signs of fibrosis, scar, or necrosis. Conclusion: We present an extremely rare case of a SCA, with the solitary vessel arising from the right sinus of Valsalva. In our patient′s case, the atherosclerotic lesions and occlusion in the branch supplying the anterior wall were considered eligible for neither percutaneous intervention nor bypass graft surgery.
{"title":"A Rare Case of Single Coronary Artery with Atherosclerotic Lesions Arising from the Right Sinus of Valsalva","authors":"F. Blaschke, F. Krackhardt, B. Kherad, B. Pieske, W. Haverkamp, M. Rief","doi":"10.4103/1947-2714.177345","DOIUrl":"https://doi.org/10.4103/1947-2714.177345","url":null,"abstract":"Context: Congenital coronary anomalies, including anomalous origin, distribution, intercoronary communications, and coronary fistulae occur at a rate of approximately 1% in the general population and are the most incidental findings. Case Report: A 49-year-old male patient presented to the emergency department with exercise-induced dyspnea and atypical angina pectoris. Coronary angiography (CAG) and contrast-enhanced 320-slice multidetector cardiac computed tomography with subsequent three-dimensional reconstructions revealed a single coronary artery (SCA) arising from the right sinus of Valsalva with a proximal branch giving rise to the left anterior descending coronary artery. The left anterior descending coronary artery shows severe atherosclerotic lesions and it is occluded afterwards. Adenosine stress perfusion cardiac magnetic resonance imaging (MRI) revealed a stress myocardial ischemia at the anterior wall without signs of fibrosis, scar, or necrosis. Conclusion: We present an extremely rare case of a SCA, with the solitary vessel arising from the right sinus of Valsalva. In our patient′s case, the atherosclerotic lesions and occlusion in the branch supplying the anterior wall were considered eligible for neither percutaneous intervention nor bypass graft surgery.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 1","pages":"114 - 116"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82283219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/1947-2714.175187
H. Al-Shamiri, Samir Elfaki, S. Al-Maweri, N. Alaizari, B. Tarakji
Background: Dental implantation is considered as one of the most widely employed procedures in dental practice. Nasopalatine duct cyst (NPDC) is one of the most common developmental cysts in the oral cavity that develops from the proliferation of embryological epithelial remnants of nasopalatine duct. Aim: The aim of this study was to highlight the development of NPDC after the placement of dental implants. Materials and Methods: A literature search was carried out in March 2015 using PubMed, EMBASE, and Cochrane library databases, searching for articles relating the development of NPDC after placement of dental implants. Results: Our search identified only four case reports of NPDC related to dental implants as reported in the literature published in English. Conclusion: Placement of dental implants can induce development of NPDCs, indicating that placement of dental implants requires well-trained specialists with perfect skills in dental implantology. Additionally, critical selection of appropriate cases is of great importance in order to avoid the development of such complications.
{"title":"Development of Nasopalatine Duct Cyst in Relation to Dental Implant Placement","authors":"H. Al-Shamiri, Samir Elfaki, S. Al-Maweri, N. Alaizari, B. Tarakji","doi":"10.4103/1947-2714.175187","DOIUrl":"https://doi.org/10.4103/1947-2714.175187","url":null,"abstract":"Background: Dental implantation is considered as one of the most widely employed procedures in dental practice. Nasopalatine duct cyst (NPDC) is one of the most common developmental cysts in the oral cavity that develops from the proliferation of embryological epithelial remnants of nasopalatine duct. Aim: The aim of this study was to highlight the development of NPDC after the placement of dental implants. Materials and Methods: A literature search was carried out in March 2015 using PubMed, EMBASE, and Cochrane library databases, searching for articles relating the development of NPDC after placement of dental implants. Results: Our search identified only four case reports of NPDC related to dental implants as reported in the literature published in English. Conclusion: Placement of dental implants can induce development of NPDCs, indicating that placement of dental implants requires well-trained specialists with perfect skills in dental implantology. Additionally, critical selection of appropriate cases is of great importance in order to avoid the development of such complications.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"12 1","pages":"13 - 16"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84346483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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