Pub Date : 2016-01-01DOI: 10.4103/1947-2714.175188
Ismail Mahmood, A. El-Menyar, W. Dabdoob, Y. Abdulrahman, Tarriq Siddiqui, Sajid Atique, S. Arumugam, R. Latifi, H. Al-Thani
Background: Serum troponin T (TnT) is a common marker of myocardial injury. However, its implication in the absence of clinical evidence of cardiac reason is not well established. Aims: The aim of this study was to identify the implications of positive TnT in traumatic chest injury (TCI) patients regardless of the cardiac involvement. Materials and Methods: We conducted a retrospective analysis of all TCI patients admitted to level 1 trauma center between 2008 and 2011. Patients who underwent TnT testing were divided into two groups: Group 1 (positive TnT) and Group 2 (negative TnT). The two groups were analyzed and compared, and multivariate regression analyses were performed to identify predictors of TnT positivity and mortality. Results: Out of 993 blunt TCI patients, 19.3% had positive TnT (Group 1). On comparison to Group 2, patients in Group 1 were 5 years younger and more likely to have head, cardiac, hepatic, splenic, and pelvic injuries, in addition to lung contusion. Positive TnT was associated with higher Injury Severity Score (ISS) (P = 0.001), higher chest Abbreviated Injury Score (AIS) (P = 0.001), and longer hospital stay (P = 0.03). In addition, Group 1 patients were more likely to undergo chest tube insertion, exploratory laparotomy, mechanical ventilation, and tracheostomy. Twenty patients had cardiac involvement, and of them 14 had positive TnT. Among 973 patients who showed no evidence of cardiac involvement, 178 had positive TnT (18.3%). There were 104 deaths (60% in Group 1). On multivariate regression analysis, the predictors of hospital mortality were positive TnT, head injury, and high ISS, whereas, the predictors of TnT positivity were cardiac, hepatic, and pelvic injuries; higher ISS; and age. Conclusions: Positive TnT in blunt TCI patients is a common challenge, particularly in polytrauma cases. Patients with positive TnT tend to have the worst outcome even in the absence of clinical evidence of acute cardiac involvement. Positive TnT is also a reflection of the severity of chest or extrathoracic injuries; however, further prospective studies are warranted.
{"title":"Troponin T in Patients with Traumatic Chest Injuries with and without Cardiac Involvement: Insights from an Observational Study","authors":"Ismail Mahmood, A. El-Menyar, W. Dabdoob, Y. Abdulrahman, Tarriq Siddiqui, Sajid Atique, S. Arumugam, R. Latifi, H. Al-Thani","doi":"10.4103/1947-2714.175188","DOIUrl":"https://doi.org/10.4103/1947-2714.175188","url":null,"abstract":"Background: Serum troponin T (TnT) is a common marker of myocardial injury. However, its implication in the absence of clinical evidence of cardiac reason is not well established. Aims: The aim of this study was to identify the implications of positive TnT in traumatic chest injury (TCI) patients regardless of the cardiac involvement. Materials and Methods: We conducted a retrospective analysis of all TCI patients admitted to level 1 trauma center between 2008 and 2011. Patients who underwent TnT testing were divided into two groups: Group 1 (positive TnT) and Group 2 (negative TnT). The two groups were analyzed and compared, and multivariate regression analyses were performed to identify predictors of TnT positivity and mortality. Results: Out of 993 blunt TCI patients, 19.3% had positive TnT (Group 1). On comparison to Group 2, patients in Group 1 were 5 years younger and more likely to have head, cardiac, hepatic, splenic, and pelvic injuries, in addition to lung contusion. Positive TnT was associated with higher Injury Severity Score (ISS) (P = 0.001), higher chest Abbreviated Injury Score (AIS) (P = 0.001), and longer hospital stay (P = 0.03). In addition, Group 1 patients were more likely to undergo chest tube insertion, exploratory laparotomy, mechanical ventilation, and tracheostomy. Twenty patients had cardiac involvement, and of them 14 had positive TnT. Among 973 patients who showed no evidence of cardiac involvement, 178 had positive TnT (18.3%). There were 104 deaths (60% in Group 1). On multivariate regression analysis, the predictors of hospital mortality were positive TnT, head injury, and high ISS, whereas, the predictors of TnT positivity were cardiac, hepatic, and pelvic injuries; higher ISS; and age. Conclusions: Positive TnT in blunt TCI patients is a common challenge, particularly in polytrauma cases. Patients with positive TnT tend to have the worst outcome even in the absence of clinical evidence of acute cardiac involvement. Positive TnT is also a reflection of the severity of chest or extrathoracic injuries; however, further prospective studies are warranted.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83926611","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: 10.4103/1947-2714.175197
Satyajeet Roy, A. Sherman, Mary Joan Monari-Sparks, Olga Schweiker, N. Jain, Etty Sims, M. Breda, G. Byraiah, R. Belecanech, Michael Coletta, C. Barrios, K. Hunter, J. Gaughan
Background: Type 2 diabetes mellitus (T2DM) is a poorly controlled epidemic worldwide that demands active research into mitigation of the factors that are associated with poor control. Aims: The study was to determine the factors associated with suboptimal glycemic control. Materials and Methods: Electronic medical records of 263 adult patients with T2DM in our suburban internal medicine office were reviewed. Patients were divided into two groups: Group 1 [optimal diabetes control with glycosylated hemoglobin (HbA1c) of 7% or less] and Group 2 (suboptimal diabetes control with HbA1c greater than 7%). The influence of factors such as age, gender, race, social history, comorbid conditions, gestational diabetes, family history of diabetes, diabetes management, statin use, aspirin use, angiotensin convertase enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use, body mass index (BMI), blood pressures, lipid profile, and urine microalbumin level were analyzed in the two groups. Results: In the suboptimal diabetes control group (N = 119), the majority (86.6%) of the patients were 41-80 years old. Factors associated with the suboptimal control were male gender [odds ratio (OR) 2.6, 95% confidence interval (CI), 1.579-4.321], Asian ethnicity (OR 1.4, 95% CI, 0.683-3.008), history of peripheral arterial disease (PAD; OR 3.9, 95% CI, 1.017-14.543), history of congestive heart failure (CHF; OR 3.9, 95% CI, 1.017-14.543), elevated triglycerides (OR 1.004, 95% CI, 1.000-1.007), and elevated urine microalbumin level of 30 mg/24 h or above (OR 4.5, 95% CI, 2.446-8.380). Patients with suboptimal diabetes control had a 3.8 times greater odds (95% CI, 1.493-6.885) of receiving the insulin and oral hypoglycemic agent together. Conclusions: In adult patients with T2DM, male gender, Asian ethnicity, CHF, PAD, management with insulin along with oral hypoglycemic agents, hypertriglyceridemia, and microalbuminuria were associated with suboptimal control.
{"title":"Association of Comorbid and Metabolic Factors with Optimal Control of Type 2 Diabetes Mellitus","authors":"Satyajeet Roy, A. Sherman, Mary Joan Monari-Sparks, Olga Schweiker, N. Jain, Etty Sims, M. Breda, G. Byraiah, R. Belecanech, Michael Coletta, C. Barrios, K. Hunter, J. Gaughan","doi":"10.4103/1947-2714.175197","DOIUrl":"https://doi.org/10.4103/1947-2714.175197","url":null,"abstract":"Background: Type 2 diabetes mellitus (T2DM) is a poorly controlled epidemic worldwide that demands active research into mitigation of the factors that are associated with poor control. Aims: The study was to determine the factors associated with suboptimal glycemic control. Materials and Methods: Electronic medical records of 263 adult patients with T2DM in our suburban internal medicine office were reviewed. Patients were divided into two groups: Group 1 [optimal diabetes control with glycosylated hemoglobin (HbA1c) of 7% or less] and Group 2 (suboptimal diabetes control with HbA1c greater than 7%). The influence of factors such as age, gender, race, social history, comorbid conditions, gestational diabetes, family history of diabetes, diabetes management, statin use, aspirin use, angiotensin convertase enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use, body mass index (BMI), blood pressures, lipid profile, and urine microalbumin level were analyzed in the two groups. Results: In the suboptimal diabetes control group (N = 119), the majority (86.6%) of the patients were 41-80 years old. Factors associated with the suboptimal control were male gender [odds ratio (OR) 2.6, 95% confidence interval (CI), 1.579-4.321], Asian ethnicity (OR 1.4, 95% CI, 0.683-3.008), history of peripheral arterial disease (PAD; OR 3.9, 95% CI, 1.017-14.543), history of congestive heart failure (CHF; OR 3.9, 95% CI, 1.017-14.543), elevated triglycerides (OR 1.004, 95% CI, 1.000-1.007), and elevated urine microalbumin level of 30 mg/24 h or above (OR 4.5, 95% CI, 2.446-8.380). Patients with suboptimal diabetes control had a 3.8 times greater odds (95% CI, 1.493-6.885) of receiving the insulin and oral hypoglycemic agent together. Conclusions: In adult patients with T2DM, male gender, Asian ethnicity, CHF, PAD, management with insulin along with oral hypoglycemic agents, hypertriglyceridemia, and microalbuminuria were associated with suboptimal control.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75246220","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: 10.4103/1947-2714.175217
S. Gulati, Z. Corrêa, N. Karim, S. Medlin
Context: Elderly patients with visual loss often have age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract as common causes of visual loss. Other less common etiologies should be considered, especially in those presenting with systemic associations. Case Report: The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma. Conclusion: Because of the significant rate of disseminated disease among patients with lymphomas in the orbit that carries a worse prognosis, early diagnosis is essential to promote better overall survival of these patients. We describe here a patient diagnosed with conjunctival lymphoma associated with pronounced visual loss and review the literature on this subject.
{"title":"Ocular Adnexal Lymphoma Presenting with Visual Loss","authors":"S. Gulati, Z. Corrêa, N. Karim, S. Medlin","doi":"10.4103/1947-2714.175217","DOIUrl":"https://doi.org/10.4103/1947-2714.175217","url":null,"abstract":"Context: Elderly patients with visual loss often have age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract as common causes of visual loss. Other less common etiologies should be considered, especially in those presenting with systemic associations. Case Report: The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma. Conclusion: Because of the significant rate of disseminated disease among patients with lymphomas in the orbit that carries a worse prognosis, early diagnosis is essential to promote better overall survival of these patients. We describe here a patient diagnosed with conjunctival lymphoma associated with pronounced visual loss and review the literature on this subject.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84510245","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 : 2015-12-01DOI: 10.4103/1947-2714.172839
Chandrasekar Poosarla, A. R. Rajendra Santosh, Swetha Gudiseva, Indira Meda, Venkata Reddy Baddam
Molecular cancer research studies focus on identifying diagnostic, screening, and metastatic indicators, and monitoring therapeutic responses. Migration of tumor cells and lymphocytes are important aspects in metastasis. High endothelial vessels are specialized histological structures identified in the blood vessels in lymphoid organs, which allow the migration of lymphocytes. In the recent decades, the role of high endothelial vessels is being addressed in cancer metastatic research. This review article is to highlight the histological and molecular structural aspects of high endothelial venules (HEVs) in the lymph node, and to demonstrate the role of HEVs in oral cancer metastasis, specifically oral and pharyngeal squamous cell carcinoma. The literature for the present paper were searched from the data sources such as Medline/PubMed, CINAHL plus, and gray literature sources from inception to May 2015. Searches were conducted using both free texts and medical subject headings related to the title of the present paper. Only the full text manuscripts of the search results that support the objective(s) of the paper and papers written in English were included. HEVs are unique structures that are identified in the lymphocytes and primarily assist in the lymphocytic migration from the blood stream into the lymph node. Understanding the histomolecular characteristics of HEV will allow researchers to develop novel therapeutic approaches in cancer tissues.
{"title":"Histomolecular Structural Aspects of High Endothelial Vessels in Lymph Node and Its Significance in Oral Cancer and Metastasis","authors":"Chandrasekar Poosarla, A. R. Rajendra Santosh, Swetha Gudiseva, Indira Meda, Venkata Reddy Baddam","doi":"10.4103/1947-2714.172839","DOIUrl":"https://doi.org/10.4103/1947-2714.172839","url":null,"abstract":"Molecular cancer research studies focus on identifying diagnostic, screening, and metastatic indicators, and monitoring therapeutic responses. Migration of tumor cells and lymphocytes are important aspects in metastasis. High endothelial vessels are specialized histological structures identified in the blood vessels in lymphoid organs, which allow the migration of lymphocytes. In the recent decades, the role of high endothelial vessels is being addressed in cancer metastatic research. This review article is to highlight the histological and molecular structural aspects of high endothelial venules (HEVs) in the lymph node, and to demonstrate the role of HEVs in oral cancer metastasis, specifically oral and pharyngeal squamous cell carcinoma. The literature for the present paper were searched from the data sources such as Medline/PubMed, CINAHL plus, and gray literature sources from inception to May 2015. Searches were conducted using both free texts and medical subject headings related to the title of the present paper. Only the full text manuscripts of the search results that support the objective(s) of the paper and papers written in English were included. HEVs are unique structures that are identified in the lymphocytes and primarily assist in the lymphocytic migration from the blood stream into the lymph node. Understanding the histomolecular characteristics of HEV will allow researchers to develop novel therapeutic approaches in cancer tissues.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84928080","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 : 2015-12-01DOI: 10.4103/1947-2714.172853
Harshal T Pandve, Purushottam A Giri
{"title":"HIV/AIDS Prevention and Control in India: Achievements and Future Challenges.","authors":"Harshal T Pandve, Purushottam A Giri","doi":"10.4103/1947-2714.172853","DOIUrl":"10.4103/1947-2714.172853","url":null,"abstract":"","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89182493","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 : 2015-12-01DOI: 10.4103/1947-2714.172849
Jonah M. Pozen, A. Mankad, J. T. Owens, I. Jovin
Context: ST-segment elevations in two or more contiguous leads or new left bundle branch block (LBBB) on electrocardiography (ECG) in a patient with acute onset chest pain are diagnostic criteria for acute myocardial infarction (AMI) and generally warrant urgent coronary angiography and cardiac catheterization. However, the significance of new right bundle branch block (RBBB) without other acute ECG changes is unclear and is currently not considered a criterion. Case Report: We present a patient with chest pain, positive biomarkers of myocardial necrosis and isolated new right bundle block on ECG. He was diagnosed with AMI but did not undergo urgent reperfusion therapy in the absence of ST-segment elevations or new LBBB. However, angiography ultimately demonstrated complete coronary occlusion. Conclusion: The established criteria for emergent catheterization may prove to be more sensitive with the inclusion of the presence of new RBBB on ECG.
{"title":"New Right Bundle Branch Block as a Criterion for Emergent Coronary Angiography","authors":"Jonah M. Pozen, A. Mankad, J. T. Owens, I. Jovin","doi":"10.4103/1947-2714.172849","DOIUrl":"https://doi.org/10.4103/1947-2714.172849","url":null,"abstract":"Context: ST-segment elevations in two or more contiguous leads or new left bundle branch block (LBBB) on electrocardiography (ECG) in a patient with acute onset chest pain are diagnostic criteria for acute myocardial infarction (AMI) and generally warrant urgent coronary angiography and cardiac catheterization. However, the significance of new right bundle branch block (RBBB) without other acute ECG changes is unclear and is currently not considered a criterion. Case Report: We present a patient with chest pain, positive biomarkers of myocardial necrosis and isolated new right bundle block on ECG. He was diagnosed with AMI but did not undergo urgent reperfusion therapy in the absence of ST-segment elevations or new LBBB. However, angiography ultimately demonstrated complete coronary occlusion. Conclusion: The established criteria for emergent catheterization may prove to be more sensitive with the inclusion of the presence of new RBBB on ECG.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77125999","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 : 2015-12-01DOI: 10.4103/1947-2714.172846
Subrata Ghosh, M. Acharyya, Titlee Majumder, Anandi Bagchi
Background: Brickfield workers in India perform manual materials handling (MMH) and as a result, are at a high risk of developing oxidative stress. This results in an alteration of the various markers of metabolic oxidative stress at the cellular level. Since red blood cell (RBC) is the central point where oxygen, glucose-6-phosphate dehydrogenase (G-6-PD), and glutathione (GSH) are involved, the surface roughness and its alteration and modeling with respect to workers exposed to MMH may be considered as helpful determinants in predicting early damage to the cell and restoring better health to the exposed population, that is, the worker exposed to stress. Hence, nanometric analysis of the surface roughness of the RBC may serve as an early indicator of the stress-related damage in these individuals. Aims: The purpose of the study was to identify early red blood corpuscular surface damage profile in terms of linear modeling correlating various biochemical parameters. Linear modeling has been aimed to be developed in order to demonstrate how individual oxidative stress markers such as malondialdehyde (MDA), G-6-PD, and reduced GSH are related to the RBC surface roughness [root mean square (RMS)]. Materials and Methods: Conventional analysis of these biochemical responses were evaluated in MMH laborers (age varying between 18 years and 21 years) and a comparable control group of the same age group (with sedentary lifestyles). Peak expiratory flow rate (PEFR) and RBC surface analysis by atomic-force microscopy (AFM) and correlated scanning probe microscopy (SPM-analytical software) with corresponding image analysis were performed immediately after completion of standardized exercise (MMH) at the brickfield. Results: A number of correlated significances and regressive linear models were developed among MDA, G-6-PD, GSH, and RBC surface roughness. Conclusion: It appears that these linear models might be instrumental in predicting early oxidative damages related to specific occupational hazards.
{"title":"Metabolic Signatures of Oxidative Stress and Their Relationship with Erythrocyte Membrane Surface Roughness Among Workers of Manual Materials Handling (MMH)","authors":"Subrata Ghosh, M. Acharyya, Titlee Majumder, Anandi Bagchi","doi":"10.4103/1947-2714.172846","DOIUrl":"https://doi.org/10.4103/1947-2714.172846","url":null,"abstract":"Background: Brickfield workers in India perform manual materials handling (MMH) and as a result, are at a high risk of developing oxidative stress. This results in an alteration of the various markers of metabolic oxidative stress at the cellular level. Since red blood cell (RBC) is the central point where oxygen, glucose-6-phosphate dehydrogenase (G-6-PD), and glutathione (GSH) are involved, the surface roughness and its alteration and modeling with respect to workers exposed to MMH may be considered as helpful determinants in predicting early damage to the cell and restoring better health to the exposed population, that is, the worker exposed to stress. Hence, nanometric analysis of the surface roughness of the RBC may serve as an early indicator of the stress-related damage in these individuals. Aims: The purpose of the study was to identify early red blood corpuscular surface damage profile in terms of linear modeling correlating various biochemical parameters. Linear modeling has been aimed to be developed in order to demonstrate how individual oxidative stress markers such as malondialdehyde (MDA), G-6-PD, and reduced GSH are related to the RBC surface roughness [root mean square (RMS)]. Materials and Methods: Conventional analysis of these biochemical responses were evaluated in MMH laborers (age varying between 18 years and 21 years) and a comparable control group of the same age group (with sedentary lifestyles). Peak expiratory flow rate (PEFR) and RBC surface analysis by atomic-force microscopy (AFM) and correlated scanning probe microscopy (SPM-analytical software) with corresponding image analysis were performed immediately after completion of standardized exercise (MMH) at the brickfield. Results: A number of correlated significances and regressive linear models were developed among MDA, G-6-PD, GSH, and RBC surface roughness. Conclusion: It appears that these linear models might be instrumental in predicting early oxidative damages related to specific occupational hazards.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77910036","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 : 2015-12-01DOI: 10.4103/1947-2714.172850
P. Shrestha, Janak Adhikari, D. Poudel, R. Pathak, P. Karmacharya
Context: Hemiballismus is characterized by involuntary, irregular, large amplitude, and violent flinging movements of limbs. Stroke (middle and posterior cerebral artery) remains the most common etiology with 2/3 being lacunar. Lesions outside the substantia niagra (STN) can cause hemiballism, and only a minority by STN lesions, unlike the classical belief. Compared to those arising from STN, cortical hemiballismus is usually less severe with a good prognosis. Case Report: A 61-year-old man presented with sudden onset involuntary flinging movements of his right upper extremity accompanied by numbness and tingling. Past medical history was significant for stroke 2 years back with no residual deficits. Vitals signs were blood pressure of 165/84 mm Hg, and heart rate - 82 beats/min. Irregular, arrhythmic, jerky flinging movement, and decreased sensation to light touch in right upper extremity was noted. Magnetic resonance imaging of the brain revealed acute posterior left parietal lobe infarction. He was treated with aspirin and atorvastatin. Thrombolytic therapy was offered but declined. The movements resolved spontaneously over the next 2 days. No further episodes occurred at 3-month follow-up. Conclusion: Lesions affecting various areas outside the STN can cause hemiballism and usually carries a good prognosis with spontaneous resolution. Acute thrombolytic therapy may be considered on an individual basis. Treatment with antipsychotics can be useful for severe and recurring symptoms.
背景:半偏瘫的特点是肢体不自主的、不规则的、大幅度的、剧烈的投掷运动。脑卒中(大脑中、后动脉)仍是最常见的病因，其中2/3为腔隙性卒中。烟灰质(STN)外的病变可引起偏瘫，并且只有少数由STN病变引起，这与传统的观点不同。与STN引起的偏瘫相比，皮质偏瘫通常不那么严重，预后良好。病例报告:一名61岁男性，表现为右上肢突然发作不自主甩动，伴有麻木和刺痛。既往病史对2年前卒中有显著影响，无残留缺陷。生命体征:血压165/84 mm Hg，心率- 82次/分。右上肢有不规则、不律动、剧烈的抛掷运动，轻触感觉减弱。脑磁共振成像显示急性左后顶叶梗死。他接受了阿司匹林和阿托伐他汀治疗。提供了溶栓治疗，但被拒绝。在接下来的2天内，这些运动自然消退。随访3个月无进一步发作。结论:累及STN外不同部位的病变可引起半偏瘫，预后良好，可自行消退。急性溶栓治疗可根据个人情况考虑。抗精神病药物治疗对严重和反复出现的症状是有用的。
{"title":"Cortical Hemiballism: A Case of Hemiballismus Associated with Parietal Lobe Infarct","authors":"P. Shrestha, Janak Adhikari, D. Poudel, R. Pathak, P. Karmacharya","doi":"10.4103/1947-2714.172850","DOIUrl":"https://doi.org/10.4103/1947-2714.172850","url":null,"abstract":"Context: Hemiballismus is characterized by involuntary, irregular, large amplitude, and violent flinging movements of limbs. Stroke (middle and posterior cerebral artery) remains the most common etiology with 2/3 being lacunar. Lesions outside the substantia niagra (STN) can cause hemiballism, and only a minority by STN lesions, unlike the classical belief. Compared to those arising from STN, cortical hemiballismus is usually less severe with a good prognosis. Case Report: A 61-year-old man presented with sudden onset involuntary flinging movements of his right upper extremity accompanied by numbness and tingling. Past medical history was significant for stroke 2 years back with no residual deficits. Vitals signs were blood pressure of 165/84 mm Hg, and heart rate - 82 beats/min. Irregular, arrhythmic, jerky flinging movement, and decreased sensation to light touch in right upper extremity was noted. Magnetic resonance imaging of the brain revealed acute posterior left parietal lobe infarction. He was treated with aspirin and atorvastatin. Thrombolytic therapy was offered but declined. The movements resolved spontaneously over the next 2 days. No further episodes occurred at 3-month follow-up. Conclusion: Lesions affecting various areas outside the STN can cause hemiballism and usually carries a good prognosis with spontaneous resolution. Acute thrombolytic therapy may be considered on an individual basis. Treatment with antipsychotics can be useful for severe and recurring symptoms.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89290631","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 : 2015-12-01DOI: 10.4103/1947-2714.172855
Ammar Humayun, Muhammad Shahzeb Khan, Syed Arish Haider, M. H. Arshad, Ekta Golani
Dear Editor, According to the new guidelines published by the American College of Cardiology, it is predicted by experts that statins will become one of the most commonly prescribed drugs in the age group of 40-75 years.[1] Statins have been clearly shown to improve morbidity and mortality in patients with cardiovascular diseases. Recently, the beneficial effect of statins on the prognosis and risk of various cancers including gynecological malignancies has also been highlighted in multiple studies. Endometrial cancer, the most common cancer of the female genital tract, has already caused more than 10,000 mortalities in the United States alone in the year 2015.[2] With advanced-stage endometrial cancer presenting with an extremely poor outcome, it is important that factors that can help to decrease the risk of endometrial cancer should be thoroughly investigated. The role of statins in this regard has been highly debatable in the recent past. In an attempt to collect updated evidence, we conducted an extensive literature search utilizing Medline (PubMed and OvidSP) and Cochrane Library to identify all possible studies that have investigated the impact of statins on the risk and prognosis of endometrial cancer. Thirteen relevant citations were found[3,4,5,6,7,8,9,10,11,12,13,14,15] and are shown in Tables Tables11 and and2.2. Three studies[5,6,7] showed that statins significantly reduce the risk of developing endometrial cancer while seven studies[8,9,10,11,12,13,14] reported no such relationship. The three studies that documented favorable impact of statins on endometrial cancers were all limited by lack of randomization, single center locations, relatively small sample sizes, and confounders as patients had multiple comorbidities. Only three studies[3,4,12] were found that investigated the effect of statins on endometrial cancer survival, which are shown in Table 2. Nevadunsky et al.[3] reported that statins significantly (HR = 0.63) prolong survival in patients with endometrial cancer while the other two studies[4,12] concluded that statins have no significant effect on mortality. These studies have not mentioned if they have looked at progression-free survival or overall survival versus a cancer specific outcome such as time to recurrence. Table 1 Summary of the evidence regarding role of statins in the risk of endometrial cancer Table 2 Summary of evidence regarding statins and outcome of endometrial cancer It is vital to consider the duration of statin usage as well. In a recent meta-analysis by Liu et al.,[15] it was shown that when statins were taken for greater than 5 years, the risk of endometrial cancer was reduced by 31%. Moreover, they reported that studies conducted in Asian populations only had a significant relationship when all potential confounders were considered. It is important to note that patients who take statins tend to be elderly, have multiple comorbidities, and medication regime
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Pub Date : 2015-12-01DOI: 10.4103/1947-2714.172847
E. Nwose
This issue of the journal contains an interesting article—“Metabolic Signatures of Oxidative Stress and their Relationship with Erythrocyte Membrane Surface Roughness among Workers of Manual Material Handling (MMH)”. Oxidative stress has been a longtime research interest that is yet to be assessed by a clinical laboratory for evidence-based practice, because it is perceived to be implicated in virtually every disease or condition. The report surely has backing from the literature. For instance, oxidative stress has known metabolic signatures,[1,2] which is hallmarked by glutathione (GSH), as well as reactive oxygen species.[3] The concept of erythrocyte oxidative stress (EOS) further denotes that the biomarkers vis-a-vis metabolic signatures are detectable in red blood cells. Indeed, cardiovascular complications in diabetes represent a major health problem worldwide, but knowledge of progression and degree of risk in prediabetes is limited. Significant changes in biomarkers of EOS and indicators of related macrovascular events that may underlie the development of diabetic macrovascular complications, have been consistently reported. The biomarkers are speculated to be emerging risk indicators, namely, (1) indices of EOS, including erythrocyte-reduced GSH, malondialdehyde, and associated enzymes; (2) indices of vasculopathy, including plasma D-dimer, homocysteine, and whole blood viscosity; and (3) indices of dyslipidemia, namely, total cholesterol (TC), high-density lipoprotein (HDL), and TC/HDL ratio. Thus, there has been the recognition of a spectrum of metabolic profile[3] that should be narrowed down to a useful panel of tests to improve early identification and intervention.[4] The present article highlights the significant impact of EOS on the surface of the blood cell membranes. While this effect may be known,[5] it is probably yet to be appreciated that apparently healthy individuals may suffer oxidative damage as occupational hazard. The authors have attempted to develop a linear model to demonstrate how individual oxidative stress marker is related to surface roughness of the erythrocyte membrane. It will be interesting to see corroborative reports that will exemplify and validate the speculated model. Further, the authors have, albeit passively, also mentioned a phenomenon that the carriage of oxygen inside the blood and/or body must be assessed by means of biochemical parameters and the nanoscale levels of changes in the surface roughness of the erythrocyte membrane. This may follow the concept of EOS being associated with hypoxia — e.g., oxidative stress can induce hyperviscosity that in turn leads to the sequence of reduced blood flow, less oxygen supply, and tissue hypoxia. The phenomenon may follow the concept of oxidative stress-inducing anemia or exacerbating iron-deficiency anemia as well. It would be interesting to see corroborative reports that will expatiate on this phenomenon.
{"title":"Metabolic Signatures of Oxidative Stress in the Red Blood Cells: Editorial Commentary","authors":"E. Nwose","doi":"10.4103/1947-2714.172847","DOIUrl":"https://doi.org/10.4103/1947-2714.172847","url":null,"abstract":"This issue of the journal contains an interesting article—“Metabolic Signatures of Oxidative Stress and their Relationship with Erythrocyte Membrane Surface Roughness among Workers of Manual Material Handling (MMH)”. Oxidative stress has been a longtime research interest that is yet to be assessed by a clinical laboratory for evidence-based practice, because it is perceived to be implicated in virtually every disease or condition. The report surely has backing from the literature. For instance, oxidative stress has known metabolic signatures,[1,2] which is hallmarked by glutathione (GSH), as well as reactive oxygen species.[3] \u0000 \u0000The concept of erythrocyte oxidative stress (EOS) further denotes that the biomarkers vis-a-vis metabolic signatures are detectable in red blood cells. Indeed, cardiovascular complications in diabetes represent a major health problem worldwide, but knowledge of progression and degree of risk in prediabetes is limited. Significant changes in biomarkers of EOS and indicators of related macrovascular events that may underlie the development of diabetic macrovascular complications, have been consistently reported. The biomarkers are speculated to be emerging risk indicators, namely, (1) indices of EOS, including erythrocyte-reduced GSH, malondialdehyde, and associated enzymes; (2) indices of vasculopathy, including plasma D-dimer, homocysteine, and whole blood viscosity; and (3) indices of dyslipidemia, namely, total cholesterol (TC), high-density lipoprotein (HDL), and TC/HDL ratio. Thus, there has been the recognition of a spectrum of metabolic profile[3] that should be narrowed down to a useful panel of tests to improve early identification and intervention.[4] \u0000 \u0000The present article highlights the significant impact of EOS on the surface of the blood cell membranes. While this effect may be known,[5] it is probably yet to be appreciated that apparently healthy individuals may suffer oxidative damage as occupational hazard. The authors have attempted to develop a linear model to demonstrate how individual oxidative stress marker is related to surface roughness of the erythrocyte membrane. It will be interesting to see corroborative reports that will exemplify and validate the speculated model. \u0000 \u0000Further, the authors have, albeit passively, also mentioned a phenomenon that the carriage of oxygen inside the blood and/or body must be assessed by means of biochemical parameters and the nanoscale levels of changes in the surface roughness of the erythrocyte membrane. This may follow the concept of EOS being associated with hypoxia — e.g., oxidative stress can induce hyperviscosity that in turn leads to the sequence of reduced blood flow, less oxygen supply, and tissue hypoxia. The phenomenon may follow the concept of oxidative stress-inducing anemia or exacerbating iron-deficiency anemia as well. It would be interesting to see corroborative reports that will expatiate on this phenomenon.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84423678","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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