| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Post ID | Title | Description | Eris approval (To be posted on Saarthi?) | Additional Comments | |||||||||||||||||||||
2 | 5dbea104-ad0f-11e9-a2a3-2a2ae2dbcce4 | Acute Rheumatic Fever with Erythema Marginatum | The present case has been reported in NEJM. A previously healthy 36-year-old man presented with a 1-month history of fever and pain in both shoulders and knees, which had been preceded by a sore throat 2 weeks before the onset of fever. Laboratory studies were notable for a white-cell count of 13,800 per cubic millimeter (85% neutrophils), a C-reactive protein level of 26 mg per deciliter (reference value, ?0.3), and an antistreptolysin O titer of 1478 IU per milliliter (reference value, <241). Transthoracic echocardiography revealed mild aortic regurgitation. His fever and arthralgias abated after the administration of a nonsteroidal antiinflammatory drug. One week later, painless, nonpruritic, red annular macules appeared on the upper limbs and abdomen (Panel A shows the right forearm; black ink dots indicate the diameter of one lesion 10 hours before the time that the photograph was taken). The rash migrated within hours and then faded over the course of a few days while new lesions appeared. Skin biopsy revealed perivascular infiltration of lymphocytes and neutrophils in the dermis (Panel B, hematoxylin and eosin). Acute rheumatic fever with erythema marginatum was diagnosed. Erythema marginatum, an evanescent nonpruritic macular rash, is one of the major Jones criteria for the diagnosis of acute rheumatic fever. The patient began taking amoxicillin for secondary prophylaxis of rheumatic heart disease. The rash disappeared completely 4 months after presentation, and the antistreptolysin O titer decreased to 246 IU per milliliter 12 months after presentation. | NO | Good as case discussion but not in news item | |||||||||||||||||||||
3 | 65bc3320-decf-11e9-92c6-4de9437d36a9 | Non-Shockable Rhythms: Post-Cardiac Arrest Evaluation | In a Recent issue of European Heart Journal, researchers have talked about greater understanding of population-based factors that are associated with cardiac rhythms and outcomes after an out-of-hospital cardiac arrest (OHCA). Sudden cardiac death (SCD) remains a major public heath epidemic worldwide. The recognition of ventricular tachycardia (VT) and ventricular fibrillation (VF) as arrhythmic complications of ischaemia and infarction has resulted in early coronary revascularization and widespread use of beta-blockers, statins, and renin–angiotensin–aldosterone inhibitors. Other clinical trials have further evaluated high-risk populations such as those with heart failure and systolic dysfunction for the prevention of SCD. These studies have led to widespread use of the implantable cardioverter defibrillator (ICD) for the rapid termination of VT and VF in high-risk populations. At present, the absence of VT or VF at the time of cardiac arrest has defined how not to treat the patient. Cardiac resuscitation algorithms create broad distinctions of shockable and non-shockable; and, in large part, the non-shockable rhythms are treated as a monolithic entity. Prophylactic pacemakers may be used to ward off bradycardic arrests similar to how the ICD protects from fatal arrhythmias in patients with a depressed left ventricular ejection fraction. Ultimately, SCD due to an unshockable cardiac rhythm is an evolving epidemic and a large unmet need in public health. Women in both Europe and the USA are disproportionately affected by these rhythms and have poorer clinical outcomes as a result. Source: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz504/5549414?searchresult=1 | Yes | ||||||||||||||||||||||
4 | 65bc5a31-decf-11e9-92c6-4de9437d36a9 | Doctors, nurses need not take TOEFL, IELTS exam to practice in UK | Under the new rules, doctors, nurses, dentists and midwives applying for Tier 2 (General) visas for the UK will not need to sit for English language tests like TOEFL and IELTS as Occupational English Test (OET) scores are enough for them. Earlier, the candidates had to take OET to register with Nursing and Midwifery Council and the General Medical Council, which are the two healthcare boards in the UK, as well as TOEFL or IELTS like exam to apply for a visa. “The Home Office has also streamlined English language testing ensuring that doctors, dentists, nurses and midwives who have already passed an English language test accepted by the relevant professional body, do not have to sit another test before entry to the UK on a Tier 2 visa," the UK government said in a release. This means that these healthcare professionals will be exempt from the English language requirement for their visa application where they have used their successful OET results for registering with the relevant healthcare regulator. The test was recognised by the UK’s Nursing and Midwifery Council and the General Medical Council almost two years ago. The Occupational English Test (OET) is designed to meet the specific English language needs of the healthcare sector. It assesses the language proficiency of healthcare professionals who wish to register and practise in an English-speaking environment. OET is conducted by Cambridge Boxhill Language Assessment (CBLA), a venture between Cambridge Assessment English and Box Hill Institute. Source: https://www.livemint.com/news/world/new-uk-visa-rules-doctors-nurses-need-not-take-toefl-ielts-exam-1569237510552.html | No | Cant be used in Speciality news. May be general international news but still not useful for audience. | |||||||||||||||||||||
5 | 65bef240-decf-11e9-92c6-4de9437d36a9 | Atrial Fibrillation in the Era of Emerging Cancer Therapies | With the advent of newer cancer therapies, global cancer survival has dramatically increased in the present times, with an expected overall survival of over 18 million persons by 2030. Increasingly, the profile of patients presenting with Atrial Fibrillation(AF) has disproportionately shifted to encompass patients with current or prior cancer diagnoses. A recent study, reported a 20% higher adjusted risk of AF in patients with cancer compared to those without cancer. Notably, the incidence of AF was appreciated to be 3.0–4.5 times higher within the first year of a cancer diagnosis compared to later years. Additionaly the cardiovascular and overall prognosis with AF is worse among cancer patients compared to those without cancer, with a two-fold higher adjusted risk for thromboembolic complications, and a six-fold higher adjusted risk for heart failure. The 2019 American College of Cardiology/Heart Rhythm Society (ACC/HRS) update on the management of AF suggested several strategies that may be applicable to cancer patients. As with all patients with Atrial Fibrillation, management of AF in the setting of cancer should start with a calculation of CHA2DS2-VASc score and those with elevated score (≥2 in men and ≥3 in women) should be offered anticoagulation. In conclusion, Atrial Fibrillation is an increasingly frequent presenting cardiovascular condition among cancer patients. Shared epidemiology and risk factors contribute to the association between cancer and AF. However, AF may also be a manifestation of Cardiotoxicity of specific cancer treatments. Source: https://academic.oup.com/eurheartj/article/40/36/3007/5572094 | Yes | ||||||||||||||||||||||
6 | 70b59b60-db99-11e9-a687-894397d3bfab | Detecting cardiovascular diseases may get easier soon, courtesy researchers at IIT-H | The researchers at Indian Institute of Technology, Hyderabad (IIT-H), have collaborated with research institutions across the world to develop a device to detect heart diseases in minutes. In a work published recently in the peer-reviewed Journal of Materials Chemistry B, they say their work not only promises diagnosis or prediction of heart disorders within minutes, but can also be extended to detection of other diseases. Headed by Renu John, head of Department of Biomedical Engineering, IIT-H, the research team says clinical complications of cardiovascular diseases (CVD) are at present the major causes of morbidity and mortality worldwide. Primary and specialist health-providers use a variety of tools for clinical assessment of the existing heart diseases and to identify vulnerable patients at risk for CVD. Biosensors are one such tools. Prof. Renu John’s studies on microfluidics would help in building biomarker-based biosensors that could be used for instantaneous detection of heart attack and other cardiac diseases. “Biomarkers are biological molecules that represent health and disease states. They are specific chemicals that are released in the body in response to certain physiological conditions. Cardiac troponins or cTns, for instance, are biomarkers of heart diseases and are conventionally detected in the blood stream using antibodies that bind specifically to them. Biosensors are devices that combine the sensing element (the antibody) with a transducer that converts the interaction of antibody into electrical or optical signal that can be measured. Conventional biosensing includes such techniques as ELISA, chemiluminescent immunoassay and radioimmunoassay,” said Prof. Renu John. Prof. Renu John and his team tested the performance of the microfluidic biosensors using blood serum of cardiac patients and compared the results with those of conventional chemiluminescence assays. They found that the microfluidic devices could detect the CVD biomarker cTns with extremely high degree of accuracy and sensitivity. cTns levels as low as 0.000000000005 grams in one millilitre of blood could be detected, which makes this technique a useful tool for detection of cardiovascular maladies, they say. Source: https://www.thehindu.com/sci-tech/health/detecting-cardiovascular-diseases-may-get-easier-soon/article29164338.ece | Yes | But in general national medical news | |||||||||||||||||||||
7 | 70b5c271-db99-11e9-a687-894397d3bfab | Litigation forces doctors to take Rs 1 crore-plus insurance cover | A cardiovascular surgeon in Mumbai has sought an indemnity cover of a staggering Rs 20 crore, highlighting a trend of doctors buying bigger-than-before insurance policies to safeguard against litigation. Health activists and even a section of doctors have called it an unhealthy trend, “a reflection of growing commercialization of healthcare”. Most medical associations now advise doctors to go for minimum insurance of Rs 1 crore per annum, which is four times what they would opt for just a couple of years ago. The period has seen a 30-40% annual rise in the number of doctors enrolling for indemnity schemes to cover legal costs if sued, as well as to shore up against possible payouts to aggrieved patients. “When courts now grant compensation in crores, what choice do doctors have but to go for higher insurance covers?” said Dr Sudhir Naik, who heads the medico-legal cell of the Association of Medical Consultants (AMC). His reference is to a Supreme Court judgment of 2013, awarding an eye-popping Rs 11.4 crore to an NRI, Dr Kunal Saha, for his wife’s death at a Kolkata hospital, which marked a precedent for the award of large payouts after litigation. The costs of all ranges of covers have gone up in recent years. While Rs 50 lakh to Rs 2 crore (and far above that) is what gynaecologists, neurosurgeons, heart surgeons, intensivists and anaesthetists choose (as they are the most susceptible to litigation), Rs 50 lakh-Rs 1 crore is what orthopaedics, general surgeons, radiologists, and pathologists opt for. Even general physicians, paediatricians, and psychiatrists, who traditionally have been at the lowest risk of litigation, have upgraded to a minimum of Rs 20 lakh versus 5 lakh earlier. The need for protection from medico-legal liabilities, doctors say, has mainly been brought on by increasing litigation and the decisions of “consumer-friendly” courts. One of the first bodies in the country to offer an indemnity scheme to its members in 2000, AMC today has insured nearly 7,500, or 65%, of its 11,500 members (the body pays an annual premium of Rs 4.5 crore to the Oriental Insurance Company). AMC said there are 11 ongoing cases against its members at the National Consumer Disputes Redressal Commission and 58 at state commissions. Cases in the states nearly doubled from 15 in 2017-18 to 27 in 2018-19. “The SC order changed a lot of things,” said Dr Anand Kate of the Indian Medical Association (IMA), which has since 2013 added nearly 300 members in its indemnity scheme every year. “A payout of that scale can wipe out a doctor’s entire practice and push him into financial distress.” The Association of Surgeons of India (ASI), a body of 22,000 specialists, rolled out an indemnity scheme three years ago following strong demand from members. “Associations can bargain better with insurance firms than individual doctors,” said Dr Arvind Kumar, head of surgery at AIIMS and president of ASI. Some doctors say it’s one-sided to blame litigators or the courts. They say that the situation has come about in the first place because of the increased commercialization of healthcare. ‘If you charge more, treating medicine as a service and not a human right, you will get sued if the patient isn’t satisfied with that “service”,’ goes the refrain. “What’s happening is a direct product of commercialisation of healthcare, and a sign of a deeper problem, which is the breakdown of the patient-doctor relationship,” said Dr Abhay Shukla, convenor, Jan Swasthya Abhiyan. “Like in the US, we are witnessing a shift from a trust-based relationship to a conflicting one. Unfortunately, neither the patient nor the doctor gains much in such an arrangement. It’s the insurance company that laughs its way to the bank.” Saurav Datta of ICICI Lombard said there is a near-10% increase in doctors opting for indemnity cover annually. “It’s true that covers have started moving into crores as patients demand more accountability and no longer want to look at treatment outcomes as God’s work,” he said. Doctors, and also activists, also fear a rise in healthcare costs in the near future owing to the insurance trend. “In many hospitals, it’s a prerequisite. A doctor has to submit indemnity policy papers to get on board as a consultant,” said noted gynaecologist Dr Kiran Coelho, who consults at Lilavati and Hinduja hospitals. “Most doctors I know have a cover of Rs 1-3 crore,” she said. Medico-legal experts feel the Consumer Protection Act, 2019 could fuel the trend. “Under this new Act, people can demand higher compensation of up to a crore right in the district forums (the cap used to be Rs 25 lakh) without having to go to the national commission. “Though India is not close to the situation prevailing in the US,one in 14 doctors is sued every year,” said Dr Shivkumar Utture, a general surgeon, “ in the west-like trend, no doctor is encouraged to practice without insurance, will give rise to defensive practice.” The net loser is likely to be the patient. Source: https://timesofindia.indiatimes.com/city/mumbai/litigation-forces-docs-to-take-rs-1cr-plus-cover/articleshow/70940623.cms | No | Can be used in Indian News not in speciality section | |||||||||||||||||||||
8 | 70c61620-db99-11e9-a687-894397d3bfab | Hospitals to get gold, silver, bronze ratings based on facilities provided | In a bid to fill the gap of healthcare facilities in rural India for the poorest of poor, the Centre has now moved to ease accreditation norms for hospitals. In a first in India, hospitals would now get bronze, silver and gold ratings depending on the quality of healthcare facilities they provide. At present, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has an accreditation system which takes six-eight months for a hospital to get accredited. However, with healthcare infrastructure lacking in Tier 2 and Tier 3 cities and remote rural areas, the National Health Authority (NHA) has framed a new accreditation system which would help smaller hospitals also to get licences and operate in rural areas under Ayushman Bharat, the Modi government’s health insurance scheme for the poor. Rather than rejecting accreditation of smaller hospitals, the Centre would give them a lower rating at a cheaper cost so that people know what facilities to expect. The accreditation system, developed with the help of Quality Council of India, would bring down the accreditation cost significantly from Rs 80,000-Rs 1.5 lakh to Rs 10,000. As the name suggests, the bronze rating would be given to the lowest in the rung of a healthcare provider. The government would introduce a self-assessment process. Speaking to ET, Dr JL Meena, general manager (hospital networking and quality assurance), NHA, said, “The new system would be evidence-based self-assessment accreditation. After self-assessment, a desktop assessment would be done by QCI. This would be followed by external assessment after which a certificate would be generated. This would take 25-35 days as compared with six-eight months of NABH certification.” NHA has developed simple-to-follow guidelines which would demonstrate to hospital administration with photographs on the standards to be maintained. Also read: https://pxmd.co/WhatIsNABH Source: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/hospitals-to-get-gold-silver-bronze-ratings-based-on-facilities-provided/articleshow/71157218.cms | No | General ection not specilaity | |||||||||||||||||||||
9 | 70c61621-db99-11e9-a687-894397d3bfab | Radiation therapy effective against deadly heart rhythm | A single high dose of radiation aimed at the heart significantly reduces episodes of a potentially deadly rapid heart rhythm, according to results of a phase one/two study at Washington University School of Medicine in St. Louis. Patients in the study were severely ill and had exhausted other standard treatment options. The radiation used to treat the irregular heart rhythm (ventricular tachycardia) is the same type of therapy used to treat cancer. In ventricular tachycardia (VT), the lower chambers of the heart beat exceedingly fast and fall out of sync with the upper chambers, interfering with blood flow and raising the risk of sudden cardiac death. The new method is a noninvasive outpatient procedure that involves the use of electrocardiograms and computed tomography scans of a patient's heart to locate the origin of the arrhythmia. Doctors can target the problem area of the heart with a single high-dose beam of radiation that often takes less than 10 minutes to administer and requires no anesthesia or hospitalization. In a study published in 2017 in The New England Journal of Medicine, the same research team reported a 90% reduction in episodes of tachycardia and improved survival in the six months after radiation therapy. Source: https://www.eurekalert.org/pub_releases/2019-09/wuso-rte091619.php | Yes | ||||||||||||||||||||||
10 | 70c61623-db99-11e9-a687-894397d3bfab | Lasker Awards honor advances in Immunology & Cancer treatments | Five scientists have won prestigious medical awards for creating an innovative breast cancer treatment and discovering key players of the disease-fighting immune system. They will share two $250,000 awards from the Lasker Foundation, to be presented later this month in New York, the foundation announced Tuesday. They can be a sign of future accolades as well: Eighty-eight Lasker laureates have gone on to receive the Nobel Prize. One prize honors the invention of Herceptin, a breast cancer treatment. The award will be shared by H. Michael Shepard and Axel Ullrich, who were with the biotech company Genentech when they did the research, and Dennis Slamon of the University of California, Los Angeles. Herceptin transformed care for breast cancer when it was approved in 1998. It interferes with a protein called HER2 on the surface of breast cancer cells. The honorees’ work, which began in the 1980s, included identifying HER2 as a driver of breast cancer and showing that Herceptin could help treat some cases of the disease. The three scientists “conceived and executed a new blueprint for drug discovery that has already bestowed tens of thousands of women with time and quality of life,” the foundation said. The other award goes to Max Cooper of Emory University in Atlanta and Jacques Miller, an emeritus professor at the Walter and Eliza Hall Institute of Medical Research in Australia. In work that began around 1960, they independently discovered two key classes of immune system cells, B and T cells. Their work set the stage for fundamental discoveries over the past 50 years, the foundation said. It also led to treatments for a wide range of illnesses, including cancer and autoimmune disorders. The foundation’s public service award goes the global vaccine alliance, Gavi, an international public-private partnership that works to expand global vaccine coverage for children. Since it was launched in 2000, the group has helped vaccinate more than 760 million children, the foundation said. Source: https://www.nytimes.com/2019/09/10/health/lasker-awards-medical-immunology-gavi.html | No | General Indian News | |||||||||||||||||||||
11 | 70ddbcd0-db99-11e9-a687-894397d3bfab | Malaria may increase heart failure risk by 30 percent: Study | Patients suffered with malaria need to take precautionary measures as they could be vulnerable to heart failure risk. As per a latest research, such patients are 30 per cent higher risk of heart failure. “We have seen an increase in the incidence of malaria cases and what is intriguing is that we have seen the same increase in cardiovascular disease in the same regions,” said the first author of the study, Philip Brainin, a postdoctoral research fellow at the Herlev-Gentofte University Hospital in Denmark was quoted as saying by IANS. “Even though we have taken preventive measures to decrease the malaria numbers, it remains a major burden,” Brainin said. “These patients had a 30 per cent increased likelihood of developing heart failure over the follow-up time,” Brainin said. More research will be needed to further validate the findings, but recent studies have found that malaria could be a contributor to functional and structural changes in the myocardium, which is the muscle tissue of the heart. Experimental studies have also shown that malaria may affect the blood pressure regulatory system causing hypertension, which is a contributor to heart failure. Source: https://ehealth.eletsonline.com/2019/09/malaria-may-increase-heart-failure-risk-by-30-percent-study/ | Yes | Also for Internal Medicine | |||||||||||||||||||||
12 | 7113c0f0-db99-11e9-a687-894397d3bfab | WHO opens global registry on human genome editing | WHO urges countries to ensure a halt to all germline gene editing until ethical norms are framed An expert advisory committee of the World Health Organisation (WHO) has approved the first phase of a global registry to track research on human genome editing as the UN’s international public health monitor seeks to address the ethical and regulatory challenges surrounding promising new technologies to address gene-based treatments. “New genome editing technologies hold great promise and hope for those who suffer from diseases we once thought were untreatable,” WHO’s director-general Dr. Tedros Adhanom Ghebreyesus said in a press release. “ But they also pose unique ethical, social, regulatory and technical challenges,” he noted, adding that countries should not allow any further work on human germline genome editing in human clinical applications until the technical and ethical implications had been properly considered. Accepting the committee’s recommendation, WHO has now announced plans for an initial phase of the registry using the International Clinical Trials Registry Platform (ICTRP). “This phase will include somatic and germline clinical trials,” the WHO said in the release. “In order to ensure that the registry is fit for purpose and transparent, the committee will engage with a broad range of stakeholders on how it will operate,” it added. The 18-member expert committee also announced an online consultation on the governance of genome editing. The committee called on all relevant research and development initiatives to register their trials. To enhance the development of a global governance framework for human genome editing, the committee will undertake both online consultations and in-person engagement. Source: https://www.thehindu.com/sci-tech/science/who-opens-global-registry-on-human-genome-editing/article29303484.ece | No | Internation General Medical news | |||||||||||||||||||||
13 | 7131d040-db99-11e9-a687-894397d3bfab | Last-Resort Device OK'd for Advanced Heart Failure | An implanted cardiac neuromodulator that provides baroreflex stimulation in patients with hard-to-treat advanced heart failure won FDA approval, the agency announced late Friday. The Barostim Neo System is indicated for improving symptoms in patients "who are not suited for treatment with other heart failure devices, such as cardiac resynchronization therapy," the FDA said. Left ventricular ejection fraction should be no greater than 35% to be eligible for the Barostim system. "Patients with advanced heart failure have limitations of physical activity, experiencing fatigue, palpitation or shortness of breath with activity and may not benefit from standard treatments, including currently marketed drugs and devices. This approval provides patients with a new treatment option for the symptoms associated with advanced heart failure," said Bram Zuckerman, MD, director of the Office of Cardiovascular Devices in the FDA's Center for Devices and Radiological Health, in the agency's approval announcement. The system includes a pulse generator implanted below the clavicle, with leads attached to the carotid artery where a current is delivered to so-called baroreceptors. "The brain, in turn, sends signals to the heart and blood vessels that relax the blood vessels and inhibit the production of stress-related hormones to reduce heart failure symptoms," the FDA statement explained. Approval was heavily influenced by a study showing improved quality of life and heart function, as well as favorable effects on the biomarker NT-proBNP. The Barostim product comes with some risk of adverse effects, including potential need for revision surgery, infections, hypotension, nerve or vascular damage, and allergic reactions, the FDA noted. Contraindications include anatomic features incompatible with device placement, uncontrolled bradycardia, atherosclerotic or ulcerative plaques near the implant site, and known allergy to silicone or titanium. Source: https://www.medpagetoday.com/cardiology/chf/81669 | Yes | Internal Medicine also | |||||||||||||||||||||
14 | 71324571-db99-11e9-a687-894397d3bfab | 42% Indians misdiagnosed or miss diagnosis of hypertension | Nearly 42% Indians are either misdiagnosed or have missed diagnosis of hypertension, a study has found. Medical experts say this phenomenon leads to unnecessary medication or lack of medication leaving patients exposed to risk factors. The blood pressure (BP) measurement study covering 18,918 Indians has revealed nearly 24% people had white coat hypertension — a syndrome wherein a patient records high BP when measured in a doctor’s clinic. Around 18% Indians had masked hypertension — a syndrome wherein a person records normal BP at a clinic, but records a spike when measured at home. The study involved 1,233 doctors across the country who first measured the BP at their clinic and then handed over a BP measuring device to the patient to record the values at home for seven consecutive days and twice daily. After a week, the patient’s BP was recorded at the doctor’s clinic for a second time and all the readings were analysed for the study. In Mumbai, of the 1,643 people studied, nearly 22.8% were white coat hypertensives and 51.4% were masked hypertensives. The study also revealed that first day BP values were unreliable and BP readings taken in the evening were often higher than morning, which debunks the popular belief about the morning surge in BP. Dr. Willem Verberk, a specialist in BP measurements from the Netherlands, who was also part of the study, said BP values fluctuate constantly. “Measuring the BP over seven days is more reliable,” he said, adding nearly 70% of doctors use a mercury sphygmomanometer device which needs to be calibrated every six months for accurate readings. “But very few doctors actually calibrate it.” Doctors said mercury-based devices have been banned and that digital devices also known as oscillometric devices are more reliable. Source: https://www.thehindu.com/news/cities/mumbai/42-indians-misdiagnosed-or-miss-diagnosis-of-hypertension/article29165118.ece | Yes | Also for Internal Medicine | |||||||||||||||||||||
15 | 714fdf90-db99-11e9-a687-894397d3bfab | Nicotine is now a class A poison in Karnataka | To strengthen enforcement of the ban on production and sale of electronic cigarettes, the State government has amended the Karnataka Poisons (Possession and Sale) Rules 2015, notifying nicotine as Class A poison under the rules. Highly toxic chemicals, which even in very small quantities as gas or vapour in the air are dangerous to life (such as cyanogen, hydrocyanic acid, nitrogen peroxide, and phosgene), are notified under Class A. A gazette notification was published last month and the new rules are now called the Karnataka Poisons (Possession and Sale) Rules 2019. Electronic cigarettes are small battery-operated devices that vapourise liquid nicotine to provide the same experience as smoking tobacco. Although the Karnataka government had banned the sale and production of e-cigarettes in June 2016, illegal sale and smuggling of nicotine cartridges and e-cigarettes are rampant in the State. They are often marketed as a way to cut down or cut out cigarette smoking altogether and sold as aids to quit smoking. The ban was imposed after a study by the State Health Department and experts that showed that e-cigarettes encourage the younger generation to use conventional cigarettes. While use of two milligrams of nicotine is permitted only in chewable chocolates to help with de-addiction, e-cigarette manufacturers misuse this clause for their sale. The ban — invoking sections of Drugs and Cosmetics Act and Food Safety Act — also ordered the suspension of all kinds of promotion of e-cigarettes, including online promotion. “Despite this, we find that illegal sale of e-cigarettes is rampant in the State. The Cybercrime police recently issued notices to e-commerce platforms cautioning them that they cannot sell e-cigarettes online. Also customs officials have been seizing nicotine cartridges and e-cigarettes from people flying into Karnataka from outside,” said U.S. Vishal Rao, member of the State government’s High-Powered Committee on Tobacco Control. “Nicotine is used as a direct substance in e-cigarettes and the content ranges up to 36 mg/mL. Although regular cigarettes too have nicotine, it is in the range of 1.2 to 1.4 mg/mL,” Dr. Rao explained. Source: https://www.thehindu.com/sci-tech/health/nicotine-is-now-a-class-a-poison-in-karnataka/article29167577.ece | No | General Indian News | |||||||||||||||||||||
16 | 716897b0-db99-11e9-a687-894397d3bfab | ICMR Releases India's First National Essential Diagnostics List (NEDL) | The Indian Council of Medical Research (ICMR) has formulated a new list of essential diagnostics on the lines of the essential medicines list, to ensure that quality diagnosis is provided at all levels of healthcare facilities. Recognizing the fact that availability of high quality diagnostics in healthcare system is crucial for imparting good quality health services, Indian Council of Medical Research (ICMR) has developed the National Essential Diagnostic List (NEDL). Following the release of first edition of EDL by WHO in May, 2018, India is the first country to launch the National EDL (NEDL). The current system is equipped to manage only the few notified devices. With this, India has become the first country to compile such a list that would provide guidance to the government for deciding the kind of diagnostic tests that different healthcare facilities in villages and remote areas require. “The list is on the lines of the drug list. It is a scientifically designed list, which has been based on the World Health Organization’s list of essential diagnostics for key areas like HIV and hepatitis, but it also takes into account the priority areas of non-communicable diseases and diseases prone to outbreaks such as dengue,” said Dr Kamini Walia, senior scientist at ICMR. ICMR, the apex body in India for the formulation, coordination and promotion of biomedical research, however, is not the implementing authority and cannot fix prices of the test. “The list prepared by ICMR may be considered by the committee that is in the process of developing the new national medicine list for 2018. If the diagnostic list is included, the prices will be regulated under the Drug Price Control Order, 2013,” said a senior official from the country’s apex drug regulator Central Drugs Standard Control Organisation (CDSCO). The current committee formed for routine update of the medicine list, which is done every three years, has been given a wider mandate to include certain devices and products, like sanitary napkins. The diagnostics list mentions 105 general laboratory tests for a broad range of common conditions, 30 disease-specific tests such as for HIV, hepatitis, tuberculosis, and 24 imaging tests including X-rays, CT and MRI scans and ultrasound sonography. The diagnostics list was prepared after two national consultations of stakeholder and consultation with device manufacturers this year. The WHO also released its essential drugs list earlier this year focusing on priority areas like tuberculosis, malaria, HIV, and Hepatitis B and C. The village-level diagnostics done by an Asha volunteer (village health worker), ANM (auxiliary nurse midwife) or other health workers includes tests for pregnancy, blood-sugar monitoring, malaria, urine albumin to detect kidney disease, blood sugar tests for diabetes and test for filaria, a parasitic disease that causes swelling of lymph nodes. At the primary healthcare (PHC) level, the list includes electrocardiography (ECG) for diagnosing heart disease and X-ray. Tests to measure cholesterol levels and thyroid, along with a pap smear to detect cervical cancer, have also been included at the PHC level. The list also includes specialised tests like fine-needle aspiration cytology for detecting cancerous lumps would be available at community health centres. Pulmonary function test to diagnose respiratory diseases has also been included as an essential test at district level hospitals. Tests for eye disease have also been included at the district hospital level. To read the complete document click on: https://pxmd.co/NEDL The list of Essential Diagnostic Tests is available from Page No 9 of the above document. Source: ICMR Website | No | General Indian News | |||||||||||||||||||||
17 | 716a6c70-db99-11e9-a687-894397d3bfab | 103-year-old patient undergoes successful stenting procedure at PGIMER | A 103-year-old patient underwent a successful stenting procedure at the Advanced Cardiac Centre (ACC) in PGIMER This was the oldest patient in the history of the department and also one of the oldest in the world, as doctors claim. Talking about the case, Dr Himanshu Gupta, assistant professor in ACC who did the procedure, said that the patient was admitted with a complaint of chest pain and breathlessness. After investigations, it was found that two of his heart vessels were critically blocked. Dr Gupta informed that the treatment of these kind of patients becomes very high risk and difficult as the blockages become very hard due to advanced age and very friable blood vessels. He said special techniques and equipment are required to treat such blockages. He added that the kidney functions in this age group of patients are also compromised and extreme caution must be exerted while performing these kinds of cases. The department of cardiology in PGIMER is very well equipped to handle all types of complex cases commented, prof Yashpaul Sharma, head of the department at ACC who also was supervising the case. Both arteries were stented in the same procedure. The patient did absolutely fine after the procedure and was discharged after two days of the procedure with a very good cardiac function. The cardiologists emphasised that very elderly patient can undergo safe angioplasty and hence we should not ignore the problems of very elderly patients and should have a positive mindset to treat them. Source: https://timesofindia.indiatimes.com/city/chandigarh/chandigarh-103-year-old-patient-undergoes-successful-stenting-procedure-at-pgimer/articleshow/70716464.cms | Yes | But as General Indian Medical News | |||||||||||||||||||||
18 | 71959b20-db99-11e9-a687-894397d3bfab | US FDA tests find salmonella in MDH sambar masala, three lots recalled | At least three lots of MDH’s sambar masala were withdrawn from the US earlier this week after tests conducted by the country’s food and drug regulator revealed that the products contained salmonella, it said. “This product was tested by FDA through a certified laboratory to be positive for salmonella,” stated the US Food and Drug Authority (US FDA) in an official release on the move. “The recall was initiated after it was discovered by the FDA that the salmonella contaminated products were distributed,” it added. The statement does not specify that the recall was voluntary. Salmonella is a bacteria that causes salmonellosis, a common food borne illness with symptoms like diarrhea, abdominal cramps and fever. Most people recover from it without treatment, but some may have diarrhea so severe that they would require hospitalisation, according to the FDA. In more severe cases, patients may develop a high fever, aches, headaches, lethargy, rash, blood in the urine or stool and, in some cases, salmonellosis may become fatal, according to it. The recalled lots (codes: 47, 48 and 107) were manufactured by R-Pure Agro Specialities, sold by US-based supplier ‘House of Spices’ and distributed in northern California retail stores. R-Pure has the same directors on its board as MDH, according to data accessed by The Indian Express on the Ministry of Corporate Affairs (MCA) website on Tuesday. Source: https://indianexpress.com/article/business/companies/us-fda-tests-find-salmonella-in-mdh-sambar-masala-three-lots-recalled-5984534/ | No | NO | |||||||||||||||||||||
19 | 71a579a0-db99-11e9-a687-894397d3bfab | Maharashtra Govt Offers 10% MBBS Quota For Doctors Willing to Work in Villages | In an attempt to ensure better healthcare facilities in rural India, Maharashtra cabinet on Monday proposed a bill to introduce 10 per cent reservation on MBBS and 20 per cent on medical post-graduation sets for in-service doctors who are willing to work in rural areas for five to seven years. The Maharashtra government has decided to pass the bill to tackle the scarcity of doctors in government hospitals the interior parts of the state and bridge the doctor-patient gap in villages. The reservation comes with the condition of mandatory completion of the course. Those who opt for the quota and fail to work in state-run hospitals after course completion may face up to five years of imprisonment and cancellation of medical degrees, a Times of India report stated. “The decision has been taken to ensure that we have enough doctors to man the primary health centres and other rural health facilities in rural, hilly or remote areas. Students getting a seat under the quota will have to sign a bond,” said Dr TP Lahane, Head of Directorate of Medical Education and Research. “Any breach would attract imprisonment if five years as well as cancellation of degrees. Only those with the state’s domicile certificate can opt for the quota,” he added. Source: https://timesofindia.indiatimes.com/india/maharashtra-offers-10-mbbs-quota-for-those-ready-to-work-in-villages-for-5-years/articleshow/71057066.cms | No | Can only be read by doctors whose kids are preparing for MBBS orelse useless to all our doctors | |||||||||||||||||||||
20 | 71bc0ee0-db99-11e9-a687-894397d3bfab | Tactile breast screening by visually-impaired show promise of early detection of breast cancer in India | What is tactile breast screening? As a technique it uses the highly developed sensory skills of visually-impaired women for manual breast health screening called Medical Tactile Examiners (MTEs) who use strips of tape called ‘docos’ marked with Braille coordinates, the technique, originally introduced in Germany about 10 years ago, has been gaining traction in India ever since its launch here. Such has been the rise that over the last four months, MTEs have been able to detect pre-cancerous or cancerous lesions in around 17 women. Their findings were affirmed medically by radiological tests, according to a validation study started by the CK Birla Hospital for Women (CKBHfW), Gurugram and National Association for the Blind (NAB) India in March 2019, with support from Bayer Crops Science Group in India in collaboration with Discovering Hands, Germany. As per the study, more than 500 random women from Gurugram and other parts of Delhi NCR underwent TBE; along with breast ultrasound for those less than 40 years and mammogram for those more than 40 years of age. Could tactile breast screening be effective in detecting breast cancer? According to the study results, the initial trends suggested “very high level of sensitivity for detecting breast lesions”. “Changes were detected in 30 per cent women, 40 per cent of which were confirmed by radiology and 20 per cent had cancerous or pre-cancerous changes. Majority of them were still at stage I and stage II. Overall 3.5 per cent of women were detected with lesions that could have affected them adversely,” the study read. “The MTEs are able to detect lumps as small as 0.5-0.6 mm compared to when it is escalated to a size of 1-2 cms which can mostly be detected through a clinical examination,” said oncologist Dr Mandeep Malhotra from CKBHfW. Commenting on the findings emerging from the study, Dr Malhotra said, “The country is witnessing a steady rise in incidence of breast cancer (11.54 per cent, Globocan 2012) and also mortality due to the disease (13.82 per cent, Globocan 2012). In urban areas, one in 22 women are likely to suffer from breast cancer during their lifetime. Of these, 50 per cent may not survive within five years of diagnosis. Inadequate screening and advanced stage of presentation are the contributors to the rising death toll. Early detection by effective screening protocols is the possible solution.” How is tactile examination done? The examination by MTE involves dividing the breast region into a four-part grid using strips which cover the breasts, underarms area till the ribs, neck and back. The examiner then slowly feels her way along this grid using the Braille-enabled tapes and records the findings digitally on a computer. It also involves recording of risk factors for breast cancer including family history, teaching women how to do SBE, and encouraging them to undergo timely radiology. Source: https://pxmd.co/jNebC | No | General Indian News | |||||||||||||||||||||
21 | 71e0d4f0-db99-11e9-a687-894397d3bfab | Grievance Redressal Committee for DNB/FNB trainees to address work-place based issues mandatory | To address work-place based issues between the DNB/FNB trainees and NBE accredited hospitals, a Grievance Redressal Committee is to be mandatorily constituted at each of the accredited hospital. The accredited hospitals shall be required to constitute this committee as per composition detailed below and widely notify the provisions made for addressing grievances of the DNB & FNB candidates. Members of the Grievance Redressal Committee will include the head of the Institute as Chairman. Other members like In-house, senior consultant, medical speciality, In-house, senior consultant, surgical speciality, DNB Coordinator of the hospital, medical superintendent or equivalent in the hospital, representative of DNB & FNB Candidates of the hospital & external medical expert of the rank of professor of a Govt. Medical College with Basic Science background are the other members which will be included in the Grievance Redressal Committee The Terms of Reference for this committee shall be as under: - To attend to grievances of registered DNB & FNB candidates related to DNB/FNB training against the hospital. - To attend to disciplinary issues related to DNB/FNB training against registered DNB & FNB trainees of the hospital. - To submit an action taken the report to NBE in matters which are escalated for redressal at NBE level. "Any grievance related to DNB training shall be attended by this committee. Such matters shall not ordinarily be entertained by NBE directly. However, if the complainant is not satisfied with the decision of the hospital Grievance Redressal Committee, such matters shall be forwarded for further adjudication to the Grievance Redressal Committee of NBE constituted for this purpose along with the action taken report of Grievance Redressal Committee of the concerned accredited hospital." Says the notice Source: NBE Website | No | Doctors are already post there studies and well established. | |||||||||||||||||||||
22 | 71e3e230-db99-11e9-a687-894397d3bfab | Mangaluru Cardiologist Starts Free WhatsApp Helpline to Help Rural Doctors | Dr Padmanabha Kamath still remembers an incident from five years ago, when a young auto rickshaw driver in a remote village in Chikmagalur, had a heart attack and passed away because doctors couldn’t make a diagnosis on time. “He was a 32-year-old, had two small children, and was the sole breadwinner of his family. The only reason for his death was a delay in diagnosis,” says Dr Kamath. The WHO reports that heart attacks are the leading cause of disability and death in India. A Lancet study estimated that the prevalence of heart disease in the country has increased from 2.57 crore in 1990 to 5.45 crore in 2016, and deaths resulting cardiovascular diseases also increased from 13 lakh in 1990 to 28 lakh in 2016. “In India, the average time of 360 minutes is incorrect. Here, it can be anywhere between 10 to 13 hours after one sustains a heart attack,” he says. The incident mentioned earlier disturbed Dr Kamath to the extent that he started a WhatsApp group, Cardiology at Doorsteps (CAD), with about 800 doctors to help aid quicker diagnosis especially in the remote rural areas where specialists are not easily accessible. While the doctors dispense their professional advice on heart-related illnesses for free, they also guide rural doctors in terms of reading electrocardiograms (ECGs) that are posted in the group for a second opinion. The cardiologists also help the doctors working in smaller hospitals and PHCs to connect with a referral hospital and the nearest cardiologist. In the 1.5 years since they began, they have received at least 8000 consultations spread across four groups which comprise of three cardiologists in each group. “Till date, 500 heart attack and 850 heart diseases have been accurately diagnosed in the group,” mentions Dr Kamath. Dr Kamath emphasises that the specialists in the group must share their numbers on the WhatsApp groups as remaining online throughout the day, is not possible. “Every ECG posted is reported immediately and then archived. If ECG is not normal, the doctor is called on mobile in addition to standard WhatsApp reporting to doubly ensure the well-being of the patients,” he says. The group has also raised money and installed over 200 ECG machines in small hospitals and PHCs in remote rural areas. Read More from: https://www.thebetterindia.com/193024/mangaluru-doctor-whatsapp-helpline-free-underprivileged-hero-india/ | Yes | General Indian News | |||||||||||||||||||||
23 | 71ff5970-db99-11e9-a687-894397d3bfab | #DiagnosticDilemma: What is your take on this case? | A 58-year-old man presented to the outpatient clinic for a general medical examination. He reported that he lived a healthy lifestyle and ran 5 mile/d without any symptoms. He had no known medical history and did not take any regular medications. His family history was notable for maternal death from heart failure of an undifferentiated cardiomyopathy at age 73 and a brother requiring coronary artery bypass graft surgery at age 50. Clinical and laboratory examination Physical examination revealed blood pressure of 132/61 mm Hg and a pulse of 77 beats/min. Cardiovascular examination revealed regular rate and rhythm with no apparent murmur. When palpating the chest, a hyperdynamic precordium was appreciated. There was no jugular venous distention or lower extremity edema. The remainder of his examination and basic laboratory assessment was normal. Electrocardiography (ECG) indicated left ventricular (LV) hypertrophy (sum of the S wave in lead V1 and the R wave in lead V5, >35 mm). Because of his ECG findings, screening transthoracic echocardiography was performed, which revealed a normal LV chamber size, a left ventricular ejection fraction (LVEF) of 72%, asymmetric septal hypertrophy with a maximum thickness of 20 mm, no resting or provocable LV outflow tract obstruction, and bileaflet mitral valve prolapse with systolic anterior motion of the mitral valve chordae. On the basis of the patient's cardiovascular testing results, which one of the following is the most likely diagnosis? a. Left ventricular hypertrophy secondary to chronic hypertension b. Fabry disease (α-galactosidase A deficiency) c. Hypertrophic cardiomyopathy (HCM) d. Athlete's heart e. Cardiac amyloidosis Answer to be disclosed shortly! Source: Mayo clinic | No | Can be used as case discussion | |||||||||||||||||||||
24 | 72370b40-db99-11e9-a687-894397d3bfab | Heart attacks halved by polypill- The Lancet | A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries. The study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. The non-pharmacological preventive interventions (including educational training about healthy lifestyle—eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome—occurrence of major cardiovascular events (including hospitalisation for the acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)—was centrally assessed by the GCS follow-up team, who were masked to allocation status. Between Feb 22, 2011, and April 15, 2013,6838individuals were enrolled in the study—3417 in the minimal care group and 3421in the polypill group. 1761 (51·5%) of 3421 participants in the polypill group were women, as were 1679 (49·1%) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5%. During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group. The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up—ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. Interpretation: Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. Source: The Lancet | Yes | Also for Internal Medicine | |||||||||||||||||||||
25 | 72397c40-db99-11e9-a687-894397d3bfab | #DiagnosticDilemma: What is your take on this case? | A 41-year-old man came to the emergency department with several days of bloody diarrhea. His symptoms began 3 days prior with worsening lower abdominal cramping and fecal urgency. This progressed to frank bloody diarrhea with a bowel movement every 1 to 3 hours. He had taken his temperature at home, with a maximum of 100.4°F that resolved within minutes without intervention. He had no chills, night sweats, or weight changes. He denied recent antibiotic use, travel, and sick contacts. His only recent water exposure was visiting a local water park about 2 weeks previously. His only medication was loperamide, which he had started using sparingly to treat his diarrhea. Social history was negative for tobacco use, and he used alcohol only rarely. His family history was significant only for diverticulosis in his mother. Clinical and Laboratory examination Physical examination revealed a blood pressure of 104/74 mm Hg, heart rate of 82 beats/min, respiratory rate of 12 breaths/min, temperature of 37.2°C, and oxygen saturation of 98%. Abdominal examination revealed bilateral lower quadrant tenderness, normoactive bowel sounds, and no peritoneal signs. Rectal examination revealed no hemorrhoids or masses and minimal red stool in the rectal vault. Laboratory studies revealed the following (reference ranges provided parenthetically): hemoglobin, 14.4 g/dL; white blood cell count, 8.5 × 109 cells/L; platelet count, 197 × 109 cells/L; creatinine, 1.09 mg/dL; and fecal hemoglobin, positive. Which one of the following is the most likely cause of this patient’s symptoms? a. Colorectal cancer b. Diverticulosis c. Infectious colitis d. Inflammatory bowel disease e. Ischemic bowel disease The answer to be disclosed shortly! Source: Mayo clinic | No | Only Internal Medicine | |||||||||||||||||||||
26 | 72545740-db99-11e9-a687-894397d3bfab | Doctors to refuse abusive patients: A step taken for the safety of Doctors | Pune chapter of IMA is the first medical body in the country take this step With incidents of violence against doctors are increasing at an alarming rate in the country, city doctors have decided to stop providing treatment to any who us violence, physically and verbally, with them. The Pune branch of the Indian Medical Association (IMA) is the first in the country to start such an initiative. They will be denying treatment to patients who trouble a doctor for no logical reason and have a history of verbal or physical abuse of doctors and health care workers. While the doctors are going to make use of their rights and choose their patients, they will provide emergency life-saving treatment to patients with such history. The doctors have made up a list of patients who have earlier created nuisance and abused doctors and medical fraternity. The details of these patients including, name, family member’s name, address of incident, type of violence are going be been recorded in the registry, said the doctors. Dr Jayant Navarange, chairman, medico-legal cell, IMA Pune, said, “A patient or his family who have troubled a doctor for no logical reason, but usually to dishonour legitimate fees; those who create nuisance of any sort, indulge in violence of any sort like verbal, physical, destructive, pollution, coming in alcoholic state or under some intoxicated state, etc. need to be refuse treatment.” Except in life-threatening emergency conditions, they will be provided treatment. Doctors have a legitimate right of refusing a patient or say, choosing a patient, as per Medical Council of India rules 2.1.1 (Rules of ethics, 2002 and as amended in 2016), he said. “Not only such persons are a threat to doctors, staff, or medical establishment, they are dangerous to other patients and overall, peaceful atmosphere required to treat a patient in the clinic or hospital premises,” added Navrange, who is also the vice-chairman, medico-legal cell, IMA HQ, Delhi. Dr Sanjay Patil, president, IMA, Pune chapter, said, “The doctors have the right to choose their patients and refuse the treatment as per the Medical Ethics and Code of Conduct. Due to the alarming situation, the doctors have decided to take such steps. We have developed the registry and are going to keep on updating the details of such patients in them. The data of this registry is been shared internally.” Commenting on this, Dr Shivkumar Utture, president of Maharashtra Medical Council stated that the doctors have a right as per the Indian Medical Council Act, 1956; to choose their patients and can deny treatment to a patient if it’s not lifesaving. “But no doctor can deny treatment that is emergency lifesaving and limb saving treatment. As per the MCI Act, the doctor has to provide the emergency treatment mandatory and then refer the patient if needed to the required tertiary care,” he said. There is also the rule of the Supreme Court is for the trauma patients or accident patients in which the accident victim cannot be denied treatment. “Similar to the patients have the rights to choose their doctors the doctors too have a right to choose his patients in certain circumstances,” added Utture. Source: https://punemirror.indiatimes.com/pune/civic/doctors-to-refuse-abusive-patients/articleshow/70866049.cms | Yes | General Indian News | |||||||||||||||||||||
27 | 725df430-db99-11e9-a687-894397d3bfab | MCI amends 'Minimum Qualifications for Teachers in Medical Institutions Regulations' | Through a recent gazette notification, the Medical Council of India Board of Governors (MCI BOG) has amended the Teacher Eligibility qualifications (TEQ) Rules, to incorporate the new definition of Senior Resident. The gazette amends the definition of Senior resident so as to include Diploma Candidates as well as to increase the upper age limit of senior residents from earlier 40 years to 45 years. The gazette reads as follows: "Senior Resident is one who is doing his/her residency in the concerned post graduate subject after obtaining PG degree/Diploma (MD/MS/DNB/Dip.) and is below 45 years of age." Read the official gazette released by MCI in the PDF attached below. Source: MCI Gazette | Yes | General Indian News | |||||||||||||||||||||
28 | 726c2500-db99-11e9-a687-894397d3bfab | Cholesterol Crystal Embolization after Transcatheter Aortic-Valve Replacement | A 79-year-old man was admitted to the hospital after laboratory tests showed a serum creatinine level of 4.0 mg per deciliter (350 μmol per liter) (normal range, 0.7 to 1.2 mg per deciliter [60 to 100 μmol per liter]). He had no fevers, fatigue, weight loss, or myalgias. He had a history of ischemic cardiomyopathy and had chronic kidney disease (with a baseline serum creatinine level of 1.6 mg per deciliter [140 μmol per liter]), and he had undergone transcatheter aortic-valve replacement 1 month earlier. Physical examination showed cyanosis of both feet. Additional skin examination showed no livedo reticularis, and eye examination showed no Hollenhorst plaques. Additional laboratory tests showed a total white-cell count of 6800 per microliter with 15% eosinophils (absolute eosinophil count, 1050 per microliter; normal value, <500). Computed tomographic angiography that had been performed before transcatheter aortic-valve replacement showed diffuse atheroma in the aorta, with evidence of complex plaques (Panel A). Renal biopsy performed during the current admission revealed multiple needle-shaped clefts in arteries and glomeruli (Panel B, arrow), which confirmed cholesterol crystal embolization. The patient was treated with glucocorticoids and continued his previously prescribed treatment with aspirin and a statin. Hemodialysis was not initiated, and his renal function gradually improved. At a 6-month follow-up visit, the patient’s serum creatinine level was 2.2 mg per deciliter (190 μmol per liter). Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1815615 | Yes | Also for Internal Medicine | |||||||||||||||||||||
29 | 7281cfe0-db99-11e9-a687-894397d3bfab | Only 43 people in the world have this rarest of the rare blood group! | Globally, A, B, AB, and O are the most commonly found blood groups. However, there exists a very special blood group, so rare that only 43 people around the world have it. Wondering what it could be? 'Rh-Null' blood type is the rarest blood type observed in people. Also called 'golden blood', the blood type discovered in 1961, is extremely valued since there are only 8 available donors who can help with the transfusion. What gives it the rare stature? The blood running through our veins is made up of red blood cells (RBCs), plasma and antigens, which number around 342. The same antigens work to determine your blood type. While 160 out of the 342 antibodies are very commonly found, people who miss out on these antigens tend to have a rare blood type. Blood is considered Rh-null if it lacks all of the 61 possible antigens in the Rh system. The Rh-Null phenotype reportedly happens in one in 6 million people. Precisely, those who lack 'Rh' antigen in their bloodstream are thought to be the lucky ones carrying golden blood in their veins. Since it's still very rare, scientists are still studying factors and conducting several tests, considering that Rh-null blood type people can act as universal blood donors for people who have rare blood groups. Just like us, people who carry Rh blood type are capable of leading normal, healthy lives without major danger to life. However, since the RBC count is a little low, they tend to be at the risk of borderline anemia. Source: https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/only-43-people-in-the-world-have-this-rarest-of-the-rare-blood-group/articleshow/71010777.cms | No | General Indian News | |||||||||||||||||||||
30 | 7288adb0-db99-11e9-a687-894397d3bfab | 90-year-old IVF legend donates his institute to ICMR | At a time when hospitals are being bought and sold for crores by foreign investors and corporate chains, Dr Baidyanath Chakrabarty, one of the pioneers of IVF in India, is donating the Institute of Reproductive Medicine (IRM) — set up by him in 1986 in Kolkata — to the Indian Council for Medical Research (ICMR) to ensure that “the research work started in 1965 is not interrupted”. “Several corporate organisations from India and abroad approached me. But they were interested in running the IVF facility only. I apprehended that they would not be interested in carrying on the research work, which has always been key to the growth of reproductive medicine. Since ICMR is primarily a research organisation, they, I believe, will use the facility at my institute in an appropriate manner and develop it further. I am relieved that the institute will be run by people who are best suited for the job,” Chakrabarty told TOI. The 90-year-old doctor said he first considered donating his institute to the ICMR after his wife fell ill in 2010. Since his daughter lives abroad and is not interested in running the institute, Chakrabarty was worried that all his hard work would go to waste after his death. Chakrabarty approached ICMR about eight years ago with a proposal for a merger. It was finally approved this year. The takeover could be completed by December. The IRM, housed in two buildings at Salt Lake, includes the Centre for Reproductive Medicine, which treats about 3,000 couples every year and could be worth Rs 18 crore. The institute has an IVF success rate of 30%-40%. It has an active research wing with eight to ten research scholars who work under his guidance. Affiliated to both Calcutta University and the West Bengal University of Health Sciences, the institute has a fellowship programme with six students now enrolled. In his proposal to ICMR, Chakrabarty had pointed out the eastern region had no government-run research facility on reproductive medicine. “I felt the region deserved a government facility. It will ensure that research and fertility treatment continues outside the ambit of business,” said the veteran. “ICMR’s association with Dr Chakrabarty goes back to 1998 when he was chosen to chair the committee constituted to put together the National Guidelines for Accreditation, Supervision and Regulation of ART (assisted reproductive techonology) clinics in India. Dr Chakraborty’s institute is unique because it not only provides IVF facilities but also has an animal house and does serious research, which is rare for a private facility,” explained Dr RS Sharma, head of the Reproductive Biology and Maternal Health and Child Health Division of ICMR. Sharma added that to be able to donate the institute, the Bengal government would have had to be paid Rs 85 lakh as permission fee. “We wrote to the government pointing out that the facility would be invaluable not only for people of the state but for all of east India as it will be the first government-owned IVF facility in the region. The state government has generously waived the permission fee. In the national registry for ART clinics, of over 3,000 clinics registered, government-owned facilities are just five or six,” said Sharma. ICMR envisages IRM as a centre not just for IVF work but also for research into reproductive health issues of women in East India. It will be an extension of the National Institute for Research in Reproductive Medicine, Mumbai under ICMR. The biggest challenge is working out how to merge the existing staff of the institute. “We are working out the MoU to be entered into with the institute,” Sharma said. Chakrabarty worked under Subhas Mukherjee -- who produced India’s first test-tube baby in 1978 but never got recognition for it -- for 16 years till the latter committed suicide in 1981. It inspired the film ‘Ek Doctor Ki Maut’. He considers Mukherjee his mentor and inspiration. Source: https://timesofindia.indiatimes.com/city/kolkata/90-year-old-ivf-legend-donates-his-institute-to-icmr/articleshow/70930035.cms | No | General Indian News | |||||||||||||||||||||
31 | 72c1e620-db99-11e9-a687-894397d3bfab | A device that can detect Vitamin A deficiency for 1 Rupee | An Ahmedabad-based doctor and his engineer son have developed a device that can detect Vitamin A deficiency without drawing a blood sample. The existing test is available at a few diagnostic labs and costs anywhere between Rs 1,500 and Rs 2,000. The doctor, Rajesh Mehta, head of community medicine, Sola Civil Hospital, said Vitamin A deficiency usually remains undetected and such patients struggle to see things in dim light. He said patients take more time to adapt to sudden changes in lighting compared to a normal person. "This can prove to be fatal, particularly if such a person is driving." Mehta has developed manual and electronic versions of the device – Dark Adaptometer. The portable instrument, which costs about Rs 25,000, can bring down the cost of a test to as low as Re 1. Mehta told DNA: "In 1986, when I was posted in Narmada district, I found that I was unable to see anything in the dim light while returning from a village. Most people consider this condition as normal and that is why the problem of Vitamin A deficiency goes undetected. I have worked on this device for over two decades. I have also applied for a patent." Because of its low cost, portability, and low maintenance, the device can be used by schools, colleges, associations, hospitals and small clinics for instant diagnosis of Vitamin A deficiency, which also triggers childhood blindness, asthma and stomach infection. The digital avatar of the device, developed by Mehta's son, who is studying embedded technology in the US, is likely to cost Rs 90,000. The hand-held device works on a simple principle of adjustment of the human eye to low light intensities in which the intensity is measured in 0-999 absolute units. The intensity of light can be increased or decreased as per the requirement to check a patient's vision. According to Mehta, if a person is Vitamin A deficient, he will require light intensities greater than 500 absolute units to see clearly. Such a patient has to be administered Vitamin A supplements and then can be tested again to check improvement. If a patient requires light intensities greater than 900 absolute units, then he immediately needs to visit a doctor. Source: https://www.dnaindia.com/india/report-ahmedabad-no-blood-test-desi-device-can-detect-vitamin-a-deficiency-for-rs-1-2786516 | No | General Indian News | |||||||||||||||||||||
32 | 73046d60-db99-11e9-a687-894397d3bfab | Jabalpur doctor gets patent for anti-suicide fan | RS Sharma, who is posted as a professor in Govt Medical College in Jabalpur, got a patent for an unusual invention which has nothing to do with his profession — a suicide-proof ceiling fan invented. Intellectual Property of India granted patent to Dr Sharma on August 1, 2019, six years after he invented the fan. “The inspiration came from a real-life experience when a teenaged boy in his neighbourhood committed suicide after failing the Class 12 examination. His inconsolable father kept cursing the day he replaced the table fan with a ceiling fan in his room.” The device has a hollow metal tube inside the fan's shaft to which the motor and blades are attached. Hinged to the shaft are four heavy springs designed to take an additional weight of 25 kg besides the motor and the blades. The moment the weight limit exceeds, the springs uncoils, leading to a soft landing of the person without stretching of the neck or straining the noose, explained Sharma. Dr R S Sharma has also attached a siren which starts blaring on shaft displacement. This will alert the persons present nearby. “I am also making an upgrade in the device and now apart from a soft landing and siren going off, the device will also send alerts on the mobile phones of the concerning people and authorities with this upgrade,” Sharma said. “It would hardly cost Rs 500, that too will come down if commercially produced on a large scale. My intention was not monetary benefit, but the government should take steps and make it mandatory for fan manufacturers like the pressure release valve is mandatory in pressure cookers. This little device could be a breakthrough in suicide prevention,” he said. Source: https://timesofindia.indiatimes.com/city/bhopal/jabalpur-doc-gets-patent-for-anti-suicide-fan/articleshow/70527520.cms | No | General Indian News | |||||||||||||||||||||
33 | 756cb630-de8b-11e9-ba1e-894931649f3f | Delhi HC directs centre to consider IGNOU's plea seeking recognition Of Its PG Diploma in Clinical Cardiology | Delhi High Court has directed the central government to consider the application of IGNOU seeking recognition of a PG Diploma course offered by it, under section 11(2) of the Indian Medical Council Act The present writ petition was filed to seek an amendment to the Schedule of Indian Medical Council Act for in order to enter Postgraduate Diploma in Clinical Cardiology (PGDCC), as awarded by IGNOU, as a recognised qualification. The Petitioner had made the following submissions before the court: 1) PGDCC students are already trained MBBS doctors and no laymen to the science of treatment of patients 2) The qualifications and competence of the members of the petitioner-Association are unimpeachable. 3) PGDCC course is modelled on a pattern similar to DNB (Cardiology) Course which is recognised by the respondents under the IMC Act, 1956 without any permission thereof under Section 10A of the said Act. 4) PGDCC-holders have often been asked to manage Intensive Care Unit (ICU) in hospitals, and have been posted as medical Officers in-charge of ICUs, empowered to conduct non-invasive cardiac procedures. Medical Council of India, on the other hand, submitted in its counter-affidavit that IGNOU had commenced the PGDCC course in blatant violation of the applicable rules and regulations and that, therefore, there could be no question of according any recognition to the said course. MCI also cited the judgment of the Supreme Court in Medical Council of India v. State of Karnataka, (1998) 6 SCC 131 to highlight that regulations framed by MCI in consonance with the central government are mandatory and binding, and have pre-eminence over any State enactment, rule or regulation, in relation to the conduct of medical courses. Further, it was also argued that IGNOU, not being a medical college established with the prior permission of the Central Government under Section 10A of the IMC Act, could not have sought permission for the commencement of any Postgraduate Medicine Course. The court rejected the MCI's argument regarding IGNOU not seeking central governments permission under section 10A before starting the course by opining that at the time of commencement of the course, the PGDCC qualification was not a "recognised medical qualification", as it did not figure in any of the Schedules to the IMC Act. There was no requirement, therefore, for the IGNOU to obtain the prior permission of the Central Government, before starting the said course. While perusing the regulations framed under the IMC Act, the court noted that the IMC act does not contemplate, at any point, recognition of an institution. Rather, it mandates is to recognise a qualification. The court, therefore, quashed the decision of the MCI of not considering the application of IGNOU seeking recognition of the PGDCC course provided by it. The ground put forward by the MCI that IGNOU had not obtained the prior permission of the Central Government, under Section 10A of the IMC Act, doesn't stand the scrutiny of the statute. The central government is also directed to again consider the application of IGNOU seeking recognition of the aforementioned course under section 11(2) of the IMC Act. Source: https://www.livelaw.in/news-updates/recognition-of-its-pg-diploma-course-148311 | No | General Indian News | |||||||||||||||||||||
34 | 813648f4-ad2c-11e9-a2a3-2a2ae2dbcce4 | “Frog Sign” in AV Nodal Reentrant Tachycardia | The present case appears in NEJM. An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins. A 12-lead electrocardiogram was obtained and showed a regular, narrow-complex tachycardia, with narrow P waves deforming the terminal QRS complex (Panel A, arrowheads). The P wave is negative in the inferior leads (forming a pseudo-S wave) and positive in lead V1 (forming a pseudo-r? wave). On the application of pressure to the carotid sinus, the tachycardia and the bulging of the internal jugular veins were resolved (Panel B, asterisk, and Video 2) and sinus rhythm was restored. The characteristics of the arrhythmia were suggestive of atrioventricular nodal reentrant tachycardia, a functional reentrant arrhythmia localized to the AV junction. In its typical form, anterograde conduction occurs over the slow pathway to the ventricle, while near-simultaneous atrial activation occurs over the fast pathway of the AV node. These events lead to the parallel electrical activation of the atria and ventricles. Canon A waves result from the simultaneous contraction of the atria and ventricles against closed atrioventricular valves, causing a reflux of blood into the neck veins. The characteristic flapping or bulging appearance of the neck veins is also described as the frog sign. Owing to recurrent symptomatic events, an electrophysiological study was performed and confirmed the diagnosis of atrioventricular nodal reentrant tachycardia. The patient underwent radiofrequency ablation in the region of the slow pathway, and the arrhythmia was resolved. Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1501617 | Yes | ||||||||||||||||||||||
35 | 81364c00-ad2c-11e9-a2a3-2a2ae2dbcce4 | Man with three coronary artery blocks cured without surgery in Chennai | Ten years ago, if a patient's scans revealed 100% block in the artery -- the vessel that carries blood from the heart -- surgeons had no option but to wield a scalpel. Sixty eight-year-old Narayanan didn't show up with one complete block but three. It wasn't a scalpel but a thin tube that saved him.... http://timesofindia.indiatimes.com/city/chennai/Man-with-three-coronary-artery-blocks-cured-without-surgery-in-Chennai/articleshow/54096557.cms | No | General Indian News | |||||||||||||||||||||
36 | 81366096-ad2c-11e9-a2a3-2a2ae2dbcce4 | Unusual Wide Complex Tachycardia During Rhythm Control for AF | The present ECG Challenge has been published recently in the journal Circulation. A 72-year-old woman with paroxysmal atrial fibrillation on oral metoprolol 5 mg twice a day, flecainide 150 mg twice a day for rhythm control, and acenocoumarol 2 mg daily presented with vomiting, presyncope, and fatigue of 3 days duration. Examination revealed a heart rate of 110 bpm, blood pressure of 106/78 mm Hg, and systemic oxygen saturation of 98% at room air. The serum potassium was 3.76 mEq/L, serum magnesium was 1.8 mg/L, serum sodium was 124 mEq/L, and serum creatinine was 1.1 mg/dL. ECG at presentation is shown in Figure 1. What is the rhythm and how should it be treated? The ECG at presentation reveals a regular wide complex tachycardia at a rate of 110 bpm and a QRS duration of 240 ms. The possible differential diagnosis to consider include: 1. Atrial flutter with 1:1 atrioventricular conduction, 2. Sinus tachycardia or supraventricular tachycardia with QRS widening attributable to flecainide, 3. Ventricular tachycardia. The ECG demonstrates a regular wide complex tachycardia with a left bundle-branch block configuration, northwest axis, and a negative concordance in precordial leads. High in the differential is atrial flutter, an arrhythmia often facilitated by flecainide. The drug prolongs the flutter cycle length and paradoxically increases the ventricular rate by promoting 1:1 atrioventricular conduction. In cases of 1:1 flutter, the conducted QRS is generally wide because of flecainide-induced slowing of intramyocardial conduction at faster rates (use dependence). However, a careful examination of lead V2 reveals distortion of ST segments by P waves, indicating VA dissociation and confirming a diagnosis of ventricular tachycardia (red arrowheads in Figure 2A). A negative QRS concordance in precordial leads with a positive QRS in lead aVR indicates apical septal exit with apico-basal depolarization of the ventricles. In our patient, direct current cardioversion was attempted twice with 200 J but was unsuccessful. Intravenous sodium bicarbonate (100 mEq) terminated the tachycardia within 30 minutes and restored sinus rhythm with a QRS duration of 100 ms (Figure 2B). Cardiac MRI done subsequently revealed normal biventricular function with no evidence of scar. Read more here: https://pxmd.co/bxVY2 | No | Can be used as case discussion | |||||||||||||||||||||
37 | 8136642e-ad2c-11e9-a2a3-2a2ae2dbcce4 | Hyperkalemia Induced Brugada Phenocopy: A Rare ECG Manifestation | Hyperkalemia is one of the most common electrolyte abnormalities that caused vast majority of ECG manifestation ranging from ST elevation to sine waves. It can also rarely cause Brugada pattern on ECG and it is very important for the clinicians to be aware of this presentation as treatment for both modalities is totally different, needing correction of potassium balance in hyperkalemia induced Brugada pattern and lot of investigations and ICD consideration in Brugada syndrome. Here we are presenting a case report of Brugada pattern on ECG caused by hyperkalemia that was reversed with the reversal of electrolyte imbalance.... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343243/ | Yes | ||||||||||||||||||||||
38 | 81366a28-ad2c-11e9-a2a3-2a2ae2dbcce4 | A Case of Right Atrial Obliteration Caused by Intracardiac Extension of Hepatocellular Carcinoma | As the fifth most common malignancy worldwide, hepatocellular carcinoma (HCC) is a frequently encountered clinical entity. Symptomatology associated with the diagnosis includes hepatic dysfunction and pain from capsular spread. Additionally, due to its propensity for vascular spread, extrahepatic intravascular involvement can also be seen. We present a unique case of intracardiac involvement of HCC. Originally diagnosed as acute on chronic heart failure, echocardiography revealed the symptom source – tumor obliteration of the right atrium. Clinical case presentation and management, along with radiographic images are presented..... https://www.karger.com/Article/FullText/455092 | Yes | ||||||||||||||||||||||
39 | 81366d0c-ad2c-11e9-a2a3-2a2ae2dbcce4 | Common antihypertensive drug Hydrochlorothiazide tied to increased risk of skin cancer : New Study | According to a study published recently in the Journal of the American Academy of Dermatology, Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs use is associated with a substantially increased risk of Non-Melanoma Skin Cancer (NMSC), especially Squamous Cell Carcinoma (SCC). Hydrochlorothiazide is photosensitizing and has previously been linked to lip cancer. The case-control study examined the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). For the study, researchers examined national prescription registry data on hydrochlorothiazide use from 1995 to 2012 as well as cancer registry records on skin malignancies diagnosed from 2004 to 2012. The results showed that High use of hydrochlorothiazide (?50,000 mg) was associated with Odds Ratios 9ORs) of 1.29 for BCC and 3.98 for SCC. A clear dose-response relationship between hydrochlorothiazide use and both BCC and SCC was found; the highest cumulative dose category (?200,000 mg HCTZ) had ORs of 1.54 and 7.38 for BCC and SCC, respectively. Use of other diuretics and antihypertensives was not associated with NMSC. The study concluded that Hydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC. Read more at: http://bit.ly/2Cagm4j | Yes | Also for Internal Medicine | |||||||||||||||||||||
40 | 81367c0c-ad2c-11e9-a2a3-2a2ae2dbcce4 | Severe pulmonary HTN and ventricular failure revealing antiphospholipid syndrome | The present case report has been published in the journal Annals of the American Thoracic Society. A 43-year-old man with a history of hypertension and obesity presented to his primary physician with the sudden onset of dyspnea. A contrast-enhanced computed tomographic (CT) scan of the chest revealed bilateral pulmonary emboli (PE), and he was treated with rivaroxaban as an outpatient. His dyspnea continued to progress over the next 6 months despite treatment with anticoagulation. An initial ventilation–perfusion (V/ Q) scan was obtained because of concern for chronic thromboembolic pulmonary hypertension (CTEPH), given his history of PE, which showed a triple-matched defect in the right lower lung and on single-photon emission CT (SPECT) imaging noted presence of bilateral mismatched perfusion defects. A closer review of his most recent chest CT imaging revealed interlobular septal thickening in bilateral lung fields, more pronounced on the right, as well as a right-sided pleural effusion. In addition, the CT demonstrated abnormal cardiac morphology with interventricular septal flattening as well as dilatation of the right atrium (RA) and right ventricle (RV). An ECG confirmed severe RV dysfunction, with a severely dilated and hypokinetic RV and normal left ventricular function. Emergent right heart catheterization revealed a right atrial pressure of 23 mm Hg, mean pulmonary artery pressure of 54 mm Hg, with a pulmonary artery wedge pressure of 14 mm Hg and a cardiac index of 1.6 L/ min/m2 . Laboratory values obtained at admission included brain natriuretic peptide and D-dimer levels, which were elevated at 355 pg/ml and 4.78 mg/ml, respectively. The international normalized ratio was elevated to 1.97, and prothrombin time was elevated to 23.4 seconds while on rivaroxaban therapy. Differential diagnosis at this time included CTEPH, idiopathic pulmonary arterial hypertension (PAH), and other causes of PAH related to connective tissue disease or pulmonary venoocclusive disease (PVOD). The patient was transferred to ICU, and intravenous dobutamine was started for inotropic support. Subsequently, intravenous epoprostenol was added for presumed severe PAH and impending RV failure. Within 2 hours of initiating epoprostenol infusion at 2 ng/kg/min, the patient developed significant hypoxemia and acute pulmonary edema, prompting increased concern for PVOD. Epoprostenol infusion was immediately discontinued and the patient was initiated on diuretic therapy, with improvement in pulmonary edema. Serological workup revealed a positive antinuclear antibody test (1:320, homogenous pattern), positive lupus anticoagulant, abnormal dilute Russell viper venom test, and elevated levels of anticardiolipin immunoglobulin G and b2 glycoprotein antibodies. On the basis of these findings, the patient was diagnosed with antiphospholipid syndrome (APS). He remained on intravenous dobutamine and was started on warfarin and hydroxychloroquine. His clinical course stabilized on this regimen while in the ICU. Know more here: https://pxmd.co/q0Hu7 | No | Case discussion not news | |||||||||||||||||||||
41 | 81368184-ad2c-11e9-a2a3-2a2ae2dbcce4 | A man with 'two' hearts: NEJM case report | A 64-year-old man presented with progressive shortness of breath and exercise intolerance due to end-stage ischemic cardiomyopathy. Since he remained severely symptomatic despite maximal medical therapy, he underwent a heterotopic cardiac transplantation. Because of the presence of severe pulmonary hypertension, the recipient's native heart (N) was left in place and the allograft was implanted in the right chest. The native heart maintains right circulation in spite of chronic pulmonary hypertension, while the heterotopic donor heart (D) functions as a biologic left ventricular assist device. The post-transplantation electrocardiogram shows two QRS complexes with different axes (Panel A). The allograft can be seen clearly in the right chest on both the radiograph (Panel B) and the computed tomographic scan (Panel C) of the chest. An automatic implantable cardiac defibrillator and cardiac medications are used to treat the recipient's native heart, as are immunosuppressive medications for the allograft. Source: https://www.nejm.org/doi/full/10.1056/NEJMicm066635 | No | General Indian News | |||||||||||||||||||||
42 | 81368634-ad2c-11e9-a2a3-2a2ae2dbcce4 | Blunt Cardiac Injury due to trauma associated with snowboarding | Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all trauma admissions. Here we report blunt trauma of the left atrium due to snowboarding trauma. A 45-year-old Asian man collided with a tree while he was snowboarding and drinking. He lost consciousness temporarily. An air ambulance was requested and he was transported to an advanced critical care center. On arrival, a pericardial effusion was detected by a focused assessment with sonography for trauma. His presenting electrocardiogram revealed normal sinus rhythm and complete right bundle branch block. https://goo.gl/Es5dOp | No | As in India Snow boarding is very very rare | |||||||||||||||||||||
43 | 81368760-ad2c-11e9-a2a3-2a2ae2dbcce4 | Prostatic abscess in a patient with ST-elevation myocardial infarction | In patients with ST-elevation myocardial infarction (STEMI), urinary tract infection is the most common infection-related complication. Prostatic abscess in a patient with STEMI is very rare.We report the case of a 49-year-old Japanese man who developed fever and shaking chills during hospitalization for STEMI. We initially diagnosed catheter-associated urinary tract infection. However, subsequent contrast-enhanced computed tomography revealed multiple large abscesses in his prostate. We decided to treat with antimicrobial agents alone because the patient was receiving dual-antiplatelet therapy and discontinuation is very high risk for in-stent thrombosis. The patient recovered remarkably after treatment without drainage or surgery.... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759963/ | Yes | ||||||||||||||||||||||
44 | 8136888c-ad2c-11e9-a2a3-2a2ae2dbcce4 | Periodontal disease independently associated with incident stroke risk: New Research | The findings of a recent research have confirmed an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, the authors reported that regular dental care utilization may lower this risk for stroke. The study has been published recently in the journal Stroke. In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs). In the ARIC study 10,362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk; Periodontal disease was significantly associated with cardioembolic and thrombotic stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk. Read more at: http://stroke.ahajournals.org/content/early/2018/01/12/STROKEAHA.117.018990.short | Yes | Also for internal Medicine | |||||||||||||||||||||
45 | 8136902a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Anesthetic management of a case of achalasia cardia with mega-esophagus causing intraoperative cardio-respiratory compromise - JACP | Achalasia along with megaesophagus may lead to airway compression leading to the respiratory compromise. However, cardiovascular compromise has not been reported previously. We present a patient who underwent thoracoscopic assisted esophagectomy with gastric pull-up for achalasia cardia with megaesophagus which resulted in compression of the left bronchus and the great vessels during its separation from the surrounding structures. Case Report: A 46-year-old male was scheduled for thoracoscopic assisted esophagectomy with gastric pull-up. Pulmonary function tests reported moderate restriction and mild airway obstruction. Chest radiograph revealed a markedly dilated esophagus with small air-fluid levels in the mediastinal region with bilateral minimal pleural effusion. Barium swallow skiagram showed a grossly dilated esophagus with residual food suggestive of achalasia cardia and dilated esophagus. Computed tomography of thorax revealed grossly dilated lower third esophagus. Standard monitoring and general anesthesia with left sided double lumen tube (DLT), and thoracic epidural anesthesia was administered. The patient was placed in the left lateral position, and right thoracoscopy was started. As the surgeons started separating the esophagus from the surrounding structures, hemodynamic instability, and arrhythmias occurred coincident with the motion of the thoracoscope. Later, it was noticed that the bellows were gradually collapsing and capnogram showed a decreased value followed by a fall in SpO2. The patient had episodes of hypotension requiring 0.1 mg boluses of phenylephrine. DLT position was reconfirmed. Despite these efforts hypotension persisted and dopamine @ 5-10 mg/kg/min was started. After complete separation of esophagus, thoracic cavity was closed, patient was made supine, DLT was exchanged with 7.5 cuffed endotracheal tube, and the rest of the surgery proceeded uneventfully with tapering off the dopamine infusion... http://bit.ly/2uwezll | No | Case disccusion not news | |||||||||||||||||||||
46 | 81369624-ad2c-11e9-a2a3-2a2ae2dbcce4 | A vena caval mass: A challenging Dx with a rare complication | The present case has been recently reported in the journal LANCET. A 46-year-old woman with a history of chronic hepatitis B infection presented with a 1-month history of malaise and epigastric fullness. Blood tests showed that her serum creatinine concentration was elevated to 89 µmol/L with an estimated glomerular filtration rate of 69 mL/min/1·73m². CT scan revealed a 7·1×6·8×6·5 cm inferior vena caval mass closely associated with the caudate lobe of the liver and an almost complete occlusion of the caval lumen. The preoperative differential diagnosis was hepatocellular carcinoma at the caudate lobe with inferior vena cava invasion, retroperitoneal sarcoma, or leiomyosarcoma of the vena cava that compromised venous return of both kidneys. A tumor biopsy was not considered possible because of the deep tumour location and risk of bleeding from the inferior vena cava. The tumour, together with the involved segment of the inferior vena cava, was surgically removed en-bloc with a right hepatectomy and caudate lobectomy. The inferior vena cava continuity was restored by an interpositional cadaveric iliac vein graft. Postoperative recovery was uneventful. The glomerular filtration rate was restored to above 90 mL/min/1·73 m². Pathology confirmed a diagnosis of leiomyosarcoma with full thickness involvement of the inferior vena cava wall and focal protrusion into the inferior vena cava lumen with fibrin thrombus formation. No lymphovascular permeation was seen and the resection margin was clear. Surveillance CT scan of the abdomen 1 month after surgery confirmed complete tumour clearance with patent inferior vena cava graft. Adjuvant chemoradiotherapy was declined by the patient. She remained well and disease-free at 4 months after surgery. Read more here: https://pxmd.co/gttmN | No | Case disccusion not news | |||||||||||||||||||||
47 | 8136a218-ad2c-11e9-a2a3-2a2ae2dbcce4 | Absent left circumflex artery: extremely rare coronary anomaly | Among the congenital anomalies of the coronary arteries, absent left circumflex artery (LCX) defect is extremely rare. Only a few cases have been reported in the literature. The present case has been reported in the journal Cardiology Research. The authors report a case of a 48-year-old female who presented with a 4-month history of exertional chest pain with positive stress (treadmill) test. Conventional coronary angiogram showed a normal left anterior descending, absent LCX and a super-dominant right coronary artery (RCA) with prominent branches. Aortography also failed to show a separate ostium for the left circumflex artery. Multi-detector computed tomographic coronary angiography was performed to confirm the diagnosis of congenital absence of the LCX. It is a benign incidental finding, however some patients present with angina-like symptoms often resulting in detection of this rare anatomy on coronary angiography. Precise morphological and functional evaluation of the anomalous coronary artery is important for selecting the best treatment modality and better prognosis. Read in detail about the case here: https://pxmd.co/koGIg | |||||||||||||||||||||||
48 | 8136a5ba-ad2c-11e9-a2a3-2a2ae2dbcce4 | Carotid sinus syndrome: cardiac arrest while diving! | Carotid sinus syndrome (CSS) is an exaggerated response to carotid sinus baroreceptor stimulation, which may result in hypotension, prolonged asystole, and subsequently transient loss of consciousness due to cerebral hypoperfusion. However, this commonly benign syndrome may have lethal consequences under certain circumstances such as scuba diving. Published in the European Heart Journal Case Reports, the authors report the case of a trained 73-year-old male diver, who survived an almost fatal diving accident without any neurological deficits due to cardiac arrest under water. After recovery and intensive diagnostics in the local hospital, the origin of cardiac arrest remained unclear. However, after referral to our tertiary care centre CSS could be diagnosed by provoking syncope and asystole with carotid sinus massage (CSM). Consequently, a leadless pacing system was implanted and his medical diving fitness could then be recertified. Learning points • Carotid sinus syndrome (CSS) may be an underdiagnosed cause of loss of consciousness with potential lethal consequences. • Carotid sinus massage should be included in medical examinations in elderly divers and athletes. • Asystole and syncope in cardio-inhibitory CSS can be prevented by cardiac pacing and a leadless intracardiac pacemaker is effective in CSS patients during scuba diving. Know more here: https://pxmd.co/5wuNo | |||||||||||||||||||||||
49 | 8136b1a4-ad2c-11e9-a2a3-2a2ae2dbcce4 | Surprising cause of a hoarse voice: Carotid body tumour | A 78-year-old woman presented to otorhinolaryngology clinic with a 5-year history of gradually progressive, worsening dysphonia, associated with some recent weight loss. She denied any dysphagia, odynophagia, otalgia, dyspnoea or neck lumps. She had a significant cardiovascular history and was a non-smoker with no alcohol intake. Using the grade–roughness–breathiness–asthenicity–strain scale, the patient scored a 2/3 for grade and breathiness, 1/3 for roughness and 3/3 for strain. On examination, there was a large left-sided posterior pharyngeal wall swelling occluding most of the oropharynx. It was firm, non-pulsatile and non-tender, with a normal overlying mucosal appearance. Flexible nasoendoscopy demonstrated that this swelling extended from the level of the soft palate to just below the level of the epiglottis, with laryngeal displacement to the right. However, there was no airway compression, and the patient had normal, mobile true vocal cords bilaterally. Videolaryngostroboscopy was not possible with rigid scope due to the size of the mass in the oropharynx. Examination of the neck was unremarkable, and cranial nerve examination revealed intact cranial nerves IX, X, XI and XII. An MRI base of skull to suprasternal notch was arranged urgently, which showed a well-defined lobulated vascular mass measuring 6 cm in maximal diameter, splaying the origins of the left internal and external carotid arteries. The mass filled the parapharyngeal space extending across the midline of the oropharynx, with displacement of the left piriform fossa. The appearance was consistent with a large carotid body tumour (CBT). Following multidisciplinary team (MDT) discussion, the tumour was deemed too large to be surgically resectable in a patient with complex cardiac comorbidities and who was asymptomatic apart from the dysphonia. In light of the risks of fine-needle aspiration in a highly vascular tumour, especially in a case with good clinical suspicion of CBT on MRI, no cytology was performed. The decision was to treat conservatively with and the patient has not developed any further symptoms in the last 3 months since follow-up. Learning points • Carotid body tumours (CBTs) may present with dysphonia as the only symptom or sign. • A history of non-resolving dysphonia, even if mild, always necessitates prompt investigation. • Early diagnosis and surgical excision is important for successful management of CBTs in order to prevent mortality and reduce morbidity such as neurological damage and vascular sacrifice. Read more at: http://casereports.bmj.com/content/2018/bcr-2018-224686.full | |||||||||||||||||||||||
50 | 8136b2d0-ad2c-11e9-a2a3-2a2ae2dbcce4 | Acute myocardial infarction with “wrap around” right coronary artery mimicking Takotsubo cardiomyopathy | Takotsubo cardiomyopathy (TC) is a cardiomyopathy that shows distinctive clinical conditions first described more than 20 years ago. The ultrasonic cardiography (UCG) or left ventriculogram of TC shows transient left ventricular dysfunction apical ballooning (a round bottom and narrow neck), the shape of which looks a ‘Takotsubo’, a vessel that is used in Japan for trapping octopi.A 63-year-old man was admitted due to sudden onset of chest pain and was in a cardiogenic shock state. His ECG showed ST-segment elevation in precordial (V2–6) and inferior leads (II, III, and aVF) and ST-segment depression in lead aVR. Blood biochemistry showed that cardiac enzymes were not elevated. Ultrasonic cardiography showed that the left ventricular apical level was akinetic, papillary muscle level was severely hypokinetic, and basal level was hyperkinetic, mimicking TC. However, coronary angiogram showed total occlusion of his right coronary artery wrapping around the cardiac apex. Successful percutaneous coronary intervention reversed his critical status.... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840957/ | |||||||||||||||||||||||
51 | 8136c284-ad2c-11e9-a2a3-2a2ae2dbcce4 | Hamman's sign in a teenager with spontaneous pneumomediastinum | The present case has been reported in the Journal of Pediatrics. A previously healthy, 14-year-old boy presented with chest pain lasting 1 day. He had no complaints of fever, cough, dyspnea, nausea, or vomiting nor did he have any history of asthma or trauma. Upon physical examination, a crackling sound synchronous with heartbeat, the so-called Hamman's sign, was noted on cardiac auscultation in the lower left sternal border. Lung auscultation was clear, and no heart murmur was present. No apparent subcutaneous emphysema was found. The chest radiograph showed multiple linear air leaks along the trachea and subcutaneous emphysema in the right shoulder. The characteristic auscultations, radiographic findings, and the absence of signs of other triggers including asthma, trauma, and infection led us to diagnose spontaneous pneumomediastinum. The patient recovered within 1 week. Learning Points:- • Spontaneous pneumomediastinum in children is uncommon, and the diagnosis is challenging for pediatricians and emergency department physicians. • Although chest radiograph and computed tomography are useful, this case highlights the importance of auscultation for suspected spontaneous pneumomediastinum. • This characteristic sound has been described variously as rasping, crunching, bubbling, crepitant, crackling, clicking, or popping1 and is thought to occur as a result of the compression of air-filled mediastinal tissue between the heart and anterior chest wall. • Recognizing these findings is helpful for diagnosing spontaneous pneumomediastinum and may help avoiding unnecessary tests. Source: https://pxmd.co/TlkqQ | |||||||||||||||||||||||
52 | 8136c3ba-ad2c-11e9-a2a3-2a2ae2dbcce4 | ECG-Induced Koebner Phenomenon : NEJM case report | A recently published case report in NEJM describes a case of a 53-year-old man who had a history of psoriasis for more than 20 years and presented to an outpatient dermatology clinic for further management of worsening pruritus and psoriatic lesions. His symptoms had previously been insufficiently controlled with topical calcipotriene and betamethasone. Systemic treatment with fumaric acid and methotrexate had been discontinued because of side effects. Three weeks before this presentation, the patient had undergone electrocardiography (ECG), which had been followed 2 weeks later by the appearance of new lesions in the locations where the ECG electrodes had been placed. The skin examination also revealed sharply defined erythematous plaques of different sizes with silvery scale on the trunk, the arms and legs, and the scalp. In patients with psoriasis, stimuli such as drugs, infection, local irritation, and even psychological stress can trigger relapses of this chronic inflammatory disease. The Koebner phenomenon, also known as an isomorphic response, is characterized by the appearance of new psoriatic lesions after mechanical irritation. The patient was treated with adalimumab, which led to a rapid response and healing of all psoriatic lesions. Read the case report at: http://www.nejm.org/doi/full/10.1056/NEJMicm1706993#figure=f1 | |||||||||||||||||||||||
53 | 8136cb3a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Role of transesophageal echocardiography in surgical closure of coronary: cameral fistula - Annals of Cardiac Anaesthesia | Congenital coronary artery fistula is an uncommon anomaly. Transcatheter coil embolization or Amplatzer vascular plug device closure of fistula is often done in symptomatic patients with safe accessibility to the feeding coronary artery. Embolization of Amplatzer vascular plug device is rare. We report an 11-year-old male child who presented to us with increasing shortness of breath for 7 years. He had a history of Amplatzer vascular plug device closure of right coronary–cameral fistula 8 years back. Echocardiography demonstrated a dilated aneurysmal right coronary artery with turbulent jet entering into the right ventricle (RV) and device embolized into the left pulmonary artery (LPA). Cardiac catheterization eventually confirmed the diagnosis. Surgical closure of fistula and retrieval of device was done using cardiopulmonary bypass. Intraoperatively transesophageal echocardiogram helped in localizing fistula opening in the RV below the anterior leaflet of tricuspid valve, continuous monitoring to prevent further distal embolization of the device during surgical handling, and assessment of completeness of repair of the fistula and LPA following retrieval of the device... http://bit.ly/2xxkXZv | |||||||||||||||||||||||
54 | 8136d44a-ad2c-11e9-a2a3-2a2ae2dbcce4 | A child with fulminant acute myocarditis rescued with extracorporeal membrane oxygenation - IJCRI | Fulminant acute myocarditis (FAM) occurs rapidly, causes pump failure or lethal arrhythmias, sometimes leading to death by cardiogenic shock. We hereby present a three-year-old girl, previously asymptomatic, who developed rapid onset tachycardia, hypotension and cardiorespiratory arrest following an episode of respiratory tract infection. The patient was treated with anti-arrhythmic drugs, inotropes, and cardioversion after being diagnosed as atrial tachycardia, but the rhythm did not revert to sinus rhythm. Due to deteriorating condition patient was put on extra corporeal membrane oxygenation (ECMO) and supported for 131 hours along with supportive and IVIG treatment. After improvement in ejection fraction, patient was weaned off ECMO. The rhythm reverted to sinus after three days of admission and antiarrhythmics were gradually tapered. Patient was discharged on 17th day of admission in a stable condition with an ejction fraction of 58% https://goo.gl/WMohqF | |||||||||||||||||||||||
55 | 8136da8a-ad2c-11e9-a2a3-2a2ae2dbcce4 | An Interesting Case of Peripartum Cardiomyopathy with Mild Pre Eclampsia: - MJOG'17 | Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy defined as systolic cardiac heart failure in the last month of pregnancy or within five months of delivery. Diagnosis of Peripartum cardiomyopathy is often missed, as it is a diagnosis of exclusion and the symptoms mimic physiological conditions associated with normal pregnancy. Overall prognosis is good in majority of the cases, although some patients may progress to irreversible heart failure. Early diagnosis is important and effective treatment reduces mortality rates and increases the chance of complete recovery of ventricular systolic function. We present case report of a rare and interesting case of 20-year-old primigravida with mild pre eclampsia and peripartum cardiomyopathy, which was successfully managed.... http://bit.ly/2v83vwA | |||||||||||||||||||||||
56 | 8136dbb6-ad2c-11e9-a2a3-2a2ae2dbcce4 | Pulmonary artery pseudoaneurysms associated with polyarthritic gout | The present case has been published in the Journal of Clinical Medicine Research. Pulmonary artery pseudoaneurysm is a dangerous pathology often missed as a differential and on imaging. With a 50% mortality rate early detection and intervention are critical to patient outcome, rendering diagnosis based on clinical grounds to be of paramount importance. Herein, the authors report a case of an unprovoked pulmonary artery pseudoaneurysm in a 72-year-old male with no known risk factors or causes for the pathology. Additionally, the authors review the pathophysiology behind the potential association of polyarthritic gout as a cause of pulmonary artery pseudoaneurysms. According to the authors, this is the first reported link between the two diseases, providing grounds to widen literature and increase diagnoses of pulmonary artery pseudoaneurysms. Key Takeaways:- - A high index of suspicion should be placed on patients presenting with unprovoked hemoptysis, hemorrhage or hemothorax. - Knowledge of the common causes of pulmonary artery pseudoaneurysms is also important; however, it is integral to note spontaneous occurrences in patients with no known risk factors. Read in detail about the case here: https://pxmd.co/MBdEi | |||||||||||||||||||||||
57 | 8136e75a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Rings on the eyes, matters of the heart: What would you do next? | The present case appears in the recent issue of Indian Journal of Ophthalmology. An asymptomatic 44-year-old Caucasian woman was found to have a suspicious choroidal melanocytic tumor in the left eye (OS) that had shown recent growth from 1.6 to 2.0 mm thickness. On examination, the visual acuity was 20/20 in each eye. Funduscopy disclosed the mass as choroidal nevus with overlying drusen, measuring 5 mm in basal dimension and 2.6 mm in thickness. Observation was advised. However, anterior segment evaluation revealed bilateral corneal arcus juvenilis. Upon questioning, there was family history of hyperlipidemia and cardiovascular disease (CVD) in first-degree relatives. What Is Your Next Step? a. Fasting lipid panel. b. Corneal transplantation. c. Excisional biopsy. d. Increase statin dosage Correct Answer: a. Based on bilateral corneal arcus juvenilis, fasting lipid panel was advised. Historically, she demonstrated increased serum cholesterol (241 mg/dL [normal <200 mg/dL]) and LDL (176 mg/dL [normal <129 mg/dL]). Nine months after initiation of statin therapy, lipid profile showed a 34% decrease in serum cholesterol (159 mg/dL) and 43% decrease in LDL (100 mg/dL). Corneal arcus remained stable following lipid control. Corneal arcus juvenilis is extracellular deposition of lipid in the peripheral corneal. It is a clinical sign for underlying chronic hyperlipidemia, along with xanthelasma, cutaneous xanthoma, and lipemia retinalis. Diagnosis: Corneal Arcus Juvenilis. Read in detail here: https://pxmd.co/8KAs4 | |||||||||||||||||||||||
58 | 8136f24a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Aortic stenosis with recurrent GI bleeding: Heyde syndrome | The combination of aortic stenosis, acquired coagulopathy, and anemia due to gastrointestinal (GI) bleeding is described as Heyde syndrome. Published in the International Journal of Surgery Case Reports, the authors report a surgical case of a 77-year-old man who was admitted because of melena and exertional chest compression. GI endoscopy could not reveal the origin of the GI bleeding. Conservative therapy including fasting and transfusion improved the anemia. Echocardiography demonstrated severe aortic stenosis (AS) with a hypertrophied left ventricle. Hematologic examination by gel electrophoresis showed deficiency of high-molecular-weight multimers of von Willebrand factor (vWF), resulting in the diagnosis of Heyde syndrome. He electively underwent aortic valve replacement (AVR) with a bioprosthesis using standard cardiopulmonary bypass. In the perioperative period, the patient had no recurrent anemia. He was discharged without subjective symptoms on postoperative day 18. The 20-month follow-up was unremarkable, with no episode of recurrent GI bleeding. Learning Points:- • Heyde syndrome is associated with acquired von Willebrand disease type IIA and AS. The true characteristic of von Willebrand disease type IIA is hemorrhagic diathesis caused by deficiency of high-molecular-weight multimers of vWF. • Under the influence of high shear stress caused by AS, vWF is stretched and easily cleaved by vWF-cleaving protease. Consequently, it causes deficiency of high-molecular-weight multimers of vWF and primary hemostasis impairment. • Therefore, the most effective treatment for Heyde syndrome is correction of AS. AVR can improve not only the hemodynamic status but also coagulopathy. Read more here: https://pxmd.co/to5Mj | |||||||||||||||||||||||
59 | 8136fbc8-ad2c-11e9-a2a3-2a2ae2dbcce4 | A Swinging Heart: NEJM case report | A 39-year-old woman with a 1-year history of Stage IV melanoma presented with progressive shortness of breath, fatigue, and edema in the legs, which had developed over the course of the previous week. At the time of the melanoma diagnosis, a mediastinal and right supraclavicular mass had been seen without identification of a primary tumor. The patient had been treated with five cycles of biochemotherapy and then with antibodies against cytotoxic T lymphocyte antigen 4. Subsequently, the superior vena cava syndrome and tracheal compression had developed, which had required stenting. The patient had then received radiation therapy. Integrated positron-emission tomography and computed tomography continued to show active and spreading disease. The physical examination revealed hypotension, tachycardia, jugular venous distention, pulsus paradoxus, and distant heart sounds. The blood pressure was 82/64 mm Hg, and the heart rate was 110 beats per minute. Transthoracic echocardiography showed a large pericardial effusion with swinging of the heart (see video) and collapse of the right atrium (RA) and left atrium (LA) in end diastole (Panel A, arrows) and diastolic collapse of the right ventricle (RV) (Panel B, arrows), which was consistent with pericardial tamponade. Pericardiocentesis yielded 1.6 liters of bloody fluid; the fluid was subsequently shown to be a malignant effusion. Swinging of the heart that is due to a large pericardial effusion is responsible for the beat-to-beat shift in the axis, amplitude, and morphology of the QRS interval (electrical alternans) on electrocardiography. In this patient, the condition resulted in a “pseudo” 2:1 atrioventricular-block pattern, with an absent QRS interval after every other P wave (Panel A, arrowheads), despite ventricular contraction on echocardiography. Follow-up echocardiography over the next 2 days showed no reaccumulation of effusion. Paclitaxel was administered, but the patient died within 2 months after the initiation of therapy. Source: https://www.nejm.org/doi/full/10.1056/NEJMicm0802946 | |||||||||||||||||||||||
60 | 8136ff60-ad2c-11e9-a2a3-2a2ae2dbcce4 | Very delayed coronary stent fracture presenting as unstable angina: A case report - IJCRI | Coronary stent fracture represents an under diagnosed clinical event of drug-eluting stents which is often associated with adverse clinical outcomes of in-stent restenosis. Numerous risk factors are associated with stent fracture that include stent overexpansion, creation of hinge points due to stent overlapping, use of longer stents for complex lesions as well as mechanical fatigue causing stent distortion in the right coronary artery and vein grafts. Case Report: A 64-year old male, a cigarette smoker, presented with rest angina. Coronary angiogram showed discrete 99% stenosis in proximal left anterior descending artery and a mid-eccentric 90% lesion in the right coronary artery (RCA). The patient was taken up for angioplasty of both the vessels. A type V fracture was detected after four years of zotarolimus-eluting stent placement in the right coronary artery https://goo.gl/WMohqF | |||||||||||||||||||||||
61 | 8137008c-ad2c-11e9-a2a3-2a2ae2dbcce4 | ECG Challenge: Wide QRS Complex Tachycardia | The present case appears in the journal Circulation. A 70-year-old man was admitted to the emergency department for several hours of palpitations, dizziness, and dyspnea. The patient had a history of hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, and paroxysmal atrial fibrillation. His medications included eprosartan, amlodipine, atorvastatin, sitagliptin, indacaterol, and acenocoumarol. On arrival, his heart rate was 170 bpm and blood pressure was 110/50 mm Hg. The following 12-lead ECG was obtained (image enclosed). The ECG in Figure 1 shows a wide QRS complex tachycardia at 170 bpm. Wide QRS complex tachycardia can be originated by 3 main mechanisms:- 1. Ventricular tachycardia (VT). 2. Supraventricular tachycardia (SVT) with an aberrant conduction attributable to a preexisting bundle-branch block or functional bundle-branch block induced by the fast heart rate. 3. SVT with an atrioventricular conduction over an accessory pathway. The ECG at admission revealed several criteria used in common algorithms to diagnose VT: positive concordance with a lack of RS complexes in V1 to V6 leads, initial R wave in V1 and in aVR leads, Q wave nadir time >50 ms in lead II, initial and terminal ventricular activation velocity ratio <1. In this patient, a clinical history of bronchospasm limited the use of adenosine; however, Valsalva maneuvers had no effect on the tachycardia. For all these reasons, the most probable diagnosis was VT, and an infusion of procainamide was started. A second ECG was performed after a few minutes (Figure 2). Ventricular activity was alternating wide QRS complexes and narrow complexes, at 170 bpm and at 85 bpm, respectively; the wide QRS complexes were similar to those of the ECG at admission. Moreover, a regular atrial activity at 340 bpm was detectable. These findings were consistent with an atrial flutter intermittently conducted to the ventricle through an accessory pathway and the atrioventricular node, with a 2:1 and a 4:1 atrioventricular conduction, respectively. The following day, after a washout period of procainamide, a preexcited sinus rhythm was documented in a new ECG (Figure 3). During the stay, the patient underwent an electrophysiology study in which a posterior left-sided accessory pathway was located and ablated successfully. This case remarks the limitation of ECG algorithms to differentiate VT and preexcited SVT. These algorithms may orient the initial diagnosis, but an accessory pathway should always be ruled out by the analysis of sinus rhythm ECG after a washout period of antiarrhythmic drugs. Read the complete case report at: http://circ.ahajournals.org/content/137/13/1407 | |||||||||||||||||||||||
62 | 81370834-ad2c-11e9-a2a3-2a2ae2dbcce4 | Radial-Artery vs Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery | The present study was published in NEJM. Authors performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts. At follow-up angiography the use of radial-artery grafts was also associated with a significantly lower risk of occlusion. As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction and a lower incidence of repeat revascularization but not a lower incidence of death from any cause. Study concludes that as compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. Read more: https://www.nejm.org/doi/full/10.1056/NEJMoa1716026? | |||||||||||||||||||||||
63 | 81370b2c-ad2c-11e9-a2a3-2a2ae2dbcce4 | Torsades de Pointes related to fluoxetine after a multiple drug overdose | Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. One such case has been published in the Journal of Intensive Care. A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l. Read more here: https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0329-1 | |||||||||||||||||||||||
64 | 81371a18-ad2c-11e9-a2a3-2a2ae2dbcce4 | Penetrating 'ice pick' injury extending into pulmonary artery! | Penetrating thoracic traumas have a wide spectrum, ranging from mild traumas to life-threatening injuries. This paper illustrates a 40-year-old male with a penetrating pulmonary artery injury that was successfully treated with emergency surgery. The patient visited local hospital by foot complaining of moving object on his chest and was found that an ice pick was penetrating the man's left chest. An ambulance took the patient to our emergency department. Computed tomography of the chest showed linear metallic density in the pulmonary trunk and a small amount of pericardial fluid. Emergency surgery for removal of the object and repair of the pulmonary artery was performed. The ice pick had been stuck in the main pulmonary artery through the pericardium without any injury to the left lung or internal thoracic artery. Postoperative course was uneventful. Highlights • A chest stab wound can have various clinical presentations ranging from no intrathoracic injury to life-threatening, extensive damage to the great vessels. • Early removal of the foreign body is recommended to prevent further damage to the heart. • Emergency physicians should seriously consider psychiatric consultation to prevent repeated suicidal attempts. Read in detail here: https://pxmd.co/zT0at | |||||||||||||||||||||||
65 | 81371efa-ad2c-11e9-a2a3-2a2ae2dbcce4 | Unique branching pattern of aortic arch in a patient with aortopulmonary window | Aortic arch (AA) anomalies are usually associated with congenital heart disease. Variations such as aberrant subclavian artery have significance if shunt surgery is planned. Other variations may be clinically insignificant or present with respiratory or oesophageal symptoms. Demonstration and understanding of arch anomalies are crucial for managing as well as improving our understanding of their embryological basis. This presentation illustrates an unusual branching pattern of AA in a patient with an aortopulmonary window in which five arteries independently arose from the AA. CT imaging appearance of the anomaly is illustrated. A brief description of the embryological basis and significance of the anomaly is presented. https://goo.gl/qfpe6h | |||||||||||||||||||||||
66 | 81372cf6-ad2c-11e9-a2a3-2a2ae2dbcce4 | Overtreating hypothyroidism: link to atrial fibrillation | For patients who take medication to treat hypothyroidism, being treated with too much medication can lead to an increased risk of atrial fibrillation, a common heart rhythm disorder associated with stroke, a new study of more than 174,000 patients has found. The findings were presented at the American Heart Association Scientific Session conference. "We know patients with hypothyroidism have a higher risk of atrial fibrillation, but we didn't consider increased risk within what's considered the normal range of thyroid hormones," said lead researcher author of the study. "These findings show we might want to re-consider what we call normal." In the new study, researchers surveyed the electronic medical records of 174,914 patients treated at Intermountain Healthcare facilities whose free thyroxine (fT4) levels were recorded and who were not on thyroid replacement medication. Researchers then took what's considered a normal range of fT4 levels, divided it into four quartiles, then looked at those patients' records for a current or future diagnosis of atrial fibrillation. They found a 40% increase in existing atrial fibrillation for patients in the highest quartile of fT4 levels compared to patients in the lowest, and a 16% increase in newly developing atrial fibrillation during 3-years of follow up. These findings, suggest that the optimal healthy range of fT4 should be reconsidered and redefined. The study also found that fT4 should be measured, along with thyroid-stimulating hormone (TSH), which is more commonly tested for in patients with irregular thyroid hormone levels but was not helpful within the normal range in refining risk. Read more here: https://pxmd.co/G06U5 | |||||||||||||||||||||||
67 | 8137326e-ad2c-11e9-a2a3-2a2ae2dbcce4 | Sjogren's Syndrome with Polyserositis, Gastrointestinal Findings and Ascending Aortic Aneurysm | Sjögren’s syndrome (SS) is an autoimmune disease with glandular and extraglandular manifestations. Pleural and pericardial effusions in association with SS are rare. Similarly, ascites is rare and it can occur in SS when combined with primary biliary cirrhosis (PBC). Inflammatory Abdominal Aortic Aneurysm together with SS has been described only in one case. We report herein the case of a 70-year-old man with SS presenting with polyserositis (pleural and pericardial effusion and ascites) and gastrointestinal manifestations (atrophic gastritis and candida esophagitis) and ascending aorta aneurysm. SS was diagnosed based on xerophthalmia, xerostomia, extraglandular manifestations, positive results for the Schirmer test, ocular surface staining score, histopathologic examination of labial buccal mucosa revealing focal lymphocytic sialadenitis and unstimulated salivary flow rate. The only positive autoantibody was against smooth muscle cells (ASMA).... https://www.omicsonline.org/open-access/sjogrens-syndrome-with-polyserositis-gastrointestinal-findings-and-ascendingaortic-aneurysm-2329-9495-1000193.php?aid=88811 | |||||||||||||||||||||||
68 | 81374452-ad2c-11e9-a2a3-2a2ae2dbcce4 | De Winter pattern: a forgotten pattern of acute LAD artery occlusion | The De Winter ECG pattern was reported as an indicator of acute left anterior descending (LAD) coronary artery occlusion and is considered an anterior ST-elevation myocardial infarction (STEMI) equivalent. The key diagnostic features include ST-depression and peaked T-waves in precordial leads, and it can be seen in around 2% of patients with anterior myocardial infarction. Published in BMJ, the authors report a case of a 77-year-old woman with history of treated hypertension and hypercholesterolaemia. She presented to the emergency department with a typical acute chest pain, almost 1 hour after symptom onset. An ECG was immediately obtained and revealed sinus bradycardia at 45 bpm, with 1–2 mm ST-depression at the J point that continued into a wide, tall, positive, symmetrical T-wave in leads V2–V6, and a 0.5 mm ST-elevation in lead aVR. She was immediately transferred to our primary coronary intervention (PCI) centre. The ECG monitoring on arrival at the catheterization laboratory displayed persistent ST-depression and tall T-waves in precordial leads. Coronary angiography showed a culprit lesion in the proximal LAD artery, which was occluded (TIMI-0 flow). The remaining coronary arteries exhibited non-significant disease. Primary PCI of the proximal LAD artery was performed 145 min after STEMI diagnosis. A drug-eluting stent was implanted with good clinical and angiographic result (TIMI-3 flow). The Wellens’ syndrome is another example of an unrecognised high-risk presentation of anterior ischaemia, and it is characterised by deeply inverted or biphasic T waves in multiple precordial leads. In conclusion, missing these high-risk ECG patterns as reversible severe ischaemia may lead to undertreatment of patients with a STEMI, and implies negative effects on morbidity and mortality. Learning points • The De Winter ECG pattern typically displays tall T-waves, but the static nature and characteristic ST-depression differentiates this pattern from hyperacute T-waves. • The De Winter ECG pattern and the Wellens’ syndrome should prompt the suspicion of a proximal left anterior descending occlusion, as both are considered anterior ST-elevation myocardial infarction equivalents. • The immediate recognition of these ECG changes is essential for referring patients to urgent reperfusion therapy and may have important prognostic implications. Read more here: http://casereports.bmj.com/content/2018/bcr-2018-226413.full | |||||||||||||||||||||||
69 | 81374fe2-ad2c-11e9-a2a3-2a2ae2dbcce4 | DVT and pulmonary thromboembolism in a paediatric patient: A challenging case | The following case has been published in the Journal of Postgraduate Medicine. Deep vein thrombosis and pulmonary thromboembolism are rare and life threatening emergencies in children. The authors report an 11-year old child who presented with acute complaints of high grade fever, pain in the left thigh and inability to walk and breathlessness since 6 days. On physical examination, there was a diffuse tender swelling of the left thigh, tachypnea, tachycardia with hyperdynamic precordium and bilateral basal crepitations. Ultrasonography and venous doppler of lower limbs showed mild effusion of left hip joint and thrombus in the left common femoral vein and left external iliac vein suggesting a diagnosis of septic arthritis with thrombophlebitis. The tachypnea and tachycardia which was out of proportion to fever and crepitations on auscultation prompted suspicion of an embolic phenomenon. Radiograph of the chest revealed multiple wedge shaped opacities in the right middle zone and lower zone suggestive of pulmonary embolism and left lower zone consolidation. For corroboration, CT pulmonary angiography and CT of abdomen was performed which revealed pulmonary thromboembolism and deep venous thrombosis extending up to infrarenal inferior vena cava. On further workup, MRI of hips showed left femoral osteomyelitis and multiple intramuscular abscesses in the muscles around the hip joint. Blood culture grew methicillin resistant Staphylococcus aureus. Antibiotics were changed according to culture sensitivity and there was a dramatic response. After four weeks of anticoagulation and antibiotics the child became asymptomatic and thrombus resolved. Major Takeaway:- - Thus, it is crucial to consider methicillin resistant Staphylococcus aureus infection as an important infection when we encounter such a clinical scenario. - This case report highlights an unusual and potentially life threatening presentation of a virulent strain of a common pathogen, which when diagnosed was completely amenable to treatment. Read about the case in detail here: https://pxmd.co/qDCYp | |||||||||||||||||||||||
70 | 81375d5c-ad2c-11e9-a2a3-2a2ae2dbcce4 | Younger age at diabetes diagnosis is linked to higher risk of heart disease, stroke but lower risk of cancer death: Study | While type 2 diabetes (T2D) was once considered a disease largely confined to older people, the global epidemic of obesity and overweight has seen diagnoses rocket in young adults, adolescents and even appear in young children. New research published in the journal Diabetologia shows that the earlier a person is diagnosed with T2D, the higher their risk of death from heart disease and stroke, but, unusually, the lower their risk of death from cancer. In almost all countries of the world, diabetes rates are increasing substantially in younger adults, aged 20-45 years. Rates are also continuing to increase in adults over 45 years old, however not as sharply as in younger adults. The increase in the younger adults means there is a steadily growing pool of diabetes patients who are exposed to diabetes for a longer period in their lives. The study analysed the data of 743,709 Australians with T2D who were registered on Australia's National Diabetes Services Scheme (NDSS) over a 15-year period between 1997 and 2011. All-cause mortality and mortality due to cardiovascular disease (CVD), cancer and all other causes were identified. The average (median) age at T2D diagnosis was 59 years, and a total of 115,363 deaths occurred during the study period. The authors say: "An earlier diagnosis of type 2 diabetes -and thus a longer duration of disease -was associated with a higher risk of all-cause mortality, primarily driven by cardiovascular disease (CVD) mortality." The data revealed that for two people of the same age, the one with a 10-year earlier diagnosis (equivalent to 10 years' longer duration of diabetes) had a 20% to 30% increased risk of all-cause mortality and about a 60% increased risk of CVD mortality. The effects were similar in men and women. Other interesting findings from the study include that for mortality due to cancer (all cancers and colorectal and lung cancers), earlier diagnosis of type 2 diabetes was associated with lower mortality compared with diagnosis at an older age. While this may appear unusual, the authors point out that "it is possible that following a diagnosis of diabetes, people have more frequent contact with the healthcare system, which may increase the likelihood of any present but undiagnosed cancer being detected." Read more at: https://goo.gl/dv2sAs | |||||||||||||||||||||||
71 | 81376126-ad2c-11e9-a2a3-2a2ae2dbcce4 | Blunt chest trauma, a clinical chameleon: BMJ Review | The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury. However, on admission to emergency departments symptoms might be missing or may not be clearly associated with the injury. Accurate diagnostics and early management in order to prevent serious complications and death are essential for patients suffering a BCT. Optimal initial diagnostics includes echocardiography or CT, Holter-monitor recordings, serial 12-lead electrocardiography and measurements of cardiac enzymes. Immediate diagnostics leading to the appropriate therapy is essential for saving a patient’s life. The key aspect of the entire management, including diagnostics and treatment of patients with BCT, remains an interdisciplinary team involving cardiologists, cardiothoracic surgeons, imaging radiologists and trauma specialists working in tandem. Source: http://heart.bmj.com/content/104/9/719 | |||||||||||||||||||||||
72 | 81376248-ad2c-11e9-a2a3-2a2ae2dbcce4 | “Superdominant” Left Anterior Descending Artery Continuing as PDA | The present case has been reported in the journal Cardiology Research. A 32–year-old male chronic smoker, non-hypertensive and non-diabetic, presented with acute onset retrosternal pain of 4-h duration with profuse sweating in primary health center. On examination, pulse was 80/min and blood pressure was 120/70 mm Hg. Electrocardiography (ECG) revealed ST segment elevation in inferior leads. Patient was thrombolysed with intravenous streptokinase 15 lacs IU over one hour and then referred to tertiary care center for further management and coronary intervention. Patient laboratory parameters showed elevated cardiac enzymes. Chest radiograph showed no abnormality. Echocardiography revealed basal inferoseptal and inferior wall hypokinesia with left ventricle ejection fraction of 45%. Coronary angiogram revealed PDA as a continuation of the LAD beyond the crux and the RCA, although normal in origin, was diminutive and terminated on the lateral wall of the right ventricle. LCX artery was also non-dominant. The LAD had plaque in mid-LAD course. Intravascular ultrasound study (IVUS) showed insignificant plaque (30% lesion) in mid LAD. Hence, it was decided to keep him on medical therapy. Read in detail here: https://pxmd.co/13RaB | |||||||||||||||||||||||
73 | 81376c98-ad2c-11e9-a2a3-2a2ae2dbcce4 | Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock | Published in the American Journal of Emergency Medicine, the authors report the case of a life-threatening shock mimicking successively anaphylactic, cardiogenic, and septic shock, which was finally related to disulfiram-ethanol reaction. A 65-year-old man was referred ICU for shock. This patient reported no medical history except chronic alcohol abuse and was strictly asymptomatic until lunchtime, when he drunk 500 mL of wine. Half an hour later, he suddenly fainted and was transferred to the emergency department. Consciousness almost returned to normal, but blood pressure was 80/60 mm Hg, heart rate was 110 beats per minute, whereas respiratory rate was 25 breaths per minute and oxygen saturation 99% as he was breathing room air. Temperature was 36°C. Medical examination was only remarkable for diffuse erythema on his chest and face, without mucosal swelling or pruritus. Anaphylaxis was nonetheless suspected, and the patient immediately received intravenous epinephrine (0.1 mg) and aggressive intravenous fluid resuscitation. Worsening circulatory failure required high-dose (0.8 ?g/kg per minute) norepinephrine infusion. ECG was suggestive of acute myocardial infarction on ECG (Fig..), but coronary angiography was strictly normal. Because of hypothermia (35.5°C) and intense shivering, a toxic shock syndrome was evoked, and intravenous broad-spectrum antibiotics combining ceftriaxone and clindamycin were started. The patient was then transferred to the ICU. Laboratory results revealed metabolic acidosis (pH 7.33; bicarbonates, 17.2 mmol/L; and arterial blood lactate, 8.7 mmol/L), but procalcitonin, high-sensitivity troponine, and other routine laboratory tests were strictly within normal ranges. Blood ethanol concentration was 0.9 g/L 6 hours after ingestion. Whole-body computed tomographic scan was unremarkable. Transthoracic echocardiography revealed a hyperkinetic left ventricle without other abnormality. Further interrogation revealed that the patient erratically self-medicated with disulfiram and that he had ingested 500 mg of disulfiram 1 hour before alcohol intake. His circulatory status dramatically improved, and norepinephrine was gradually weaned within 2 hours after ICU admission. Cutaneous manifestations, lactic acidosis, and ECG abnormalities also resolved within 6 hours. All bacteriological samples remained sterile, and antibiotics were discontinued. The patient was discharged home the day after, without any medication. The diagnosis of severe “disulfiram ethanol reaction” (DER) was retained. Lessons learnt:- - This case emphasizes the need to include drug interaction in the differential diagnosis of any shock, to avoid unnecessary and invasive procedures or therapeutics. - Especially, DER should be suspected in an alcoholic patient presenting with miscellaneous manifestations mimicking anaphylaxis, complicated myocardial infarction, or toxinic shock. - Emergency physicians and medical specialists should be aware of this life-threatening condition because of its misleading presentation. Read in detail here: https://pxmd.co/dkNHU | |||||||||||||||||||||||
74 | 813793bc-ad2c-11e9-a2a3-2a2ae2dbcce4 | Sudden cardiac death due to the Wolff-Parkinson-White syndrome | The Wolff–Parkinson–White syndrome (WPW) is a benign heart disease with accessory pathways, which can result in cardiac arrhythmias. The purpose of this case report, published in the journal Medicine is to introduce a rare case of sudden cardiac death (SCD) with a mild myocardial bridge and a history of WPW. A 25-year-old man with known WPW syndrome died at night while sleeping. Diagnosis of WPW syndrome is based on typical electrocardiogram findings with a documented dysrhythmia before the victim's death. At autopsy, no traumatic injury or common poisons were found, only a slight myocardial bridge was detected. Whole exome sequencing was performed and several genetic variations related to SCD were identified. It was considered that the cause of death in this case was SCD in which arrhythmia might play an important role. Lesson learned:- This case highlights SCD can occur in WPW patients with mild or unrecognized structural abnormality. Postmortem genetic examination can assist the diagnosis of sudden cardiac death, especially when no lethal structural abnormality is found in the decedent. Read in detail here: https://pxmd.co/LZTXo | |||||||||||||||||||||||
75 | 8137a5e6-ad2c-11e9-a2a3-2a2ae2dbcce4 | Coronary Artery Aneurysms - Applied Radiology | A 9-year-old girl with known systemic lupus erythematosus (SLE) presents with increasing chest pain. The pain is pleuritic in nature and a pulmonary etiology is suspected. An initial non-contrast CT scan of the chest showed no significant findings within the lungs to explain the patient’s symptoms. However, a soft-tissue abnormality containing a thin rim of calcification was identified within the pre-aortic space. This abnormality was indeterminate, but possible etiologies included vascular or lymphatic abnormalities. The next day, an ECG-gated, contrast-enhanced CT of the heart was performed. This image showed focal dilatation of the proximal right coronary artery (RCA), just distal to the origin of the artery corresponding to the soft-tissue abnormality identified on the non-contrast CT scan. The focal dilatation within the proximal right coronary artery contained a small amount of nonocclusive mural thrombus, as well as a thin rim of calcification. A few smaller areas of focal dilatation were identified within the distal right coronary artery. Within the proximal left anterior descending artery, there was a small focal dilation as well as a more fusiform dilation located just distally. She was diagnosed with Multiple coronary artery aneurysms secondary to systemic lupus erythematosus https://goo.gl/g5u7Hm | |||||||||||||||||||||||
76 | 8137b572-ad2c-11e9-a2a3-2a2ae2dbcce4 | Pericardiocentesis can be nasty! | Pericardiocentesis is a challenging procedure, not uncommonly associated with iatrogenic complications. Pneumothorax, epicardial coronary vasculature injury, injury to intracardiac structures and valves, chamber puncture and great vessel injury or perforation, air embolism, and puncture of the peritoneal cavity or abdominal viscera have all been reported at the hands of unwary clinicians. In the case published in the Annals of Cardiac Anesthesiology, a planned therapeutic pericardiocentesis ended up with a pigtail inadvertently threaded into the main pulmonary artery. Transesophageal echocardiography showed introducer sheath puncturing the right ventricular (RV) free wall and the pig tail catheter rail roaded into the main pulmonary artery, both of which had to be surgically extracted after sternotomy. Risk factors that predict difficulty in performing pericardiocentesis must be readily identified and use of adjunctive imaging is sine qua non for patient safety during the procedure. Morbidity associated with such dreaded complications is completely avoidable with an insight into the possibility of their occurrence and appropriate use of the available technology. Read in detail about the case here: https://pxmd.co/vPltP | |||||||||||||||||||||||
77 | 8137ba9a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Left shoulder pain from spinal epidural haematoma: BMJ case report | A 66-year-old man with medical history of old myocardial infarction and on daily aspirin presented to the emergency department with sudden onset of severe left shoulder pain. He reported no prior trauma and denied cold sweat, vomiting, chest or back pains. At the time of initial evaluation, cardiac and neurological examinations were normal and there was no tenderness over the shoulder joints or the spine. A diagnosis of acute myocardial infraction or aorta dissection was first suspected. However, ECG, serum troponin T concentration and contrast-enhanced CT of the chest showed negative results. The patient was admitted to the emergency department under the diagnosis of possible acute coronary syndrome. But, several hours later, he suddenly developed mild weakness of the left upper and lower extremities without facial muscle involvement. Urgent MRI revealed cervical spinal epidural haematoma (SEH) with spinal cord compression mainly to the left side. The patient underwent decompression laminectomy. Aspirin was considered as a contributing factor to the development of haematoma and thus it was discontinued for a week. The patient was restarted with aspirin 1 week after the operation since we considered it was important to prevent myocardial infarction and the patient agreed with our plan. He was discharged home free from neurological symptoms after a course of rehabilitation. Learning points • Shoulder pain without tenderness could be a referred pain or a neuropathic pain. • Left shoulder pain could be a symptom suggestive of spontaneous epidural haematoma of the cervical spine in patients on daily aspirin. Read more here: http://casereports.bmj.com/content/2018/bcr-2018-226159.full | |||||||||||||||||||||||
78 | 8137c1ca-ad2c-11e9-a2a3-2a2ae2dbcce4 | Frank's sign: Cutaneous marker of cardiovascular disease | The present case has been reported in the Journal of Clinical and Preventive Cardiology. A 60-year-old man with long-standing hypertension on irregular drug intake presented with right-sided hemiplegia, nausea, and vomiting. Clinical examination was consistent with a left-sided cerebrovascular accident and imaging corroborated the clinical findings. The patient was initially managed in the Intensive Care Unit and later in the ward conservatively. He was noted to have bilateral Frank's sign on general examination. Frank's sign is described as “a prominent crease in a lobule portion of the auricle.” This diagonal ear lobe crease has been considered to be a cutaneous marker of coronary and carotid atherosclerosis. It is said to be a dermatological indicator of premature aging and loss of dermal and vascular fibers. Several cases associate Frank's sign with ischemic heart disease and ischemic strokes, but this is probably the first case where it has been noticed in a patient with hypertensive hemorrhagic cerebrovascular event. Learning Point:- - Frank's sign should alert the clinicians toward an underlying cardio-cerebrovascular disease, and an evaluation directed at it should be done in patients presenting with the same. Source: https://pxmd.co/LKONa | |||||||||||||||||||||||
79 | 8137d408-ad2c-11e9-a2a3-2a2ae2dbcce4 | Pulmonary artery sarcoma mimicking PE: BMJ case report | A 62-year-old woman with diabetes presented with progressive exertional dyspnoea, chest pain and palpitation for several months. She had no history of leg oedema, fever, bodyweight change and general weakness. Therefore, she received associated exams at cardiovascular outpatient department. Transthoracic echocardiogram showed right atrium and ventricle dilatation with severe pulmonary hypertension. Besides, a thrombus-like mobile mass was noted at right ventricle and pulmonary artery (figure 1, video 1). Pulmonary embolism, as one of the life-threatening conditions, was the tentative diagnosis, and she was transferred to the emergency department. Chest CT revealed multifocal filling defects at right ventricle, main pulmonary artery trunk and bilateral pulmonary arteries with several lung nodules. Primary tumour or metastasis was the final impression by image study. Finally, the patient underwent surgery, which confirmed the mass to be pulmonary artery intimal sarcoma, not a large thrombus. Learning points • The diagnosis of pulmonary artery sarcoma should be considered in patients who present with pulmonary embolism, especially poor response to anticoagulant therapy. • Thrombus and mass are difficult to differentiate, even with transthoracic echocardiogram and chest CT. • Team work should be organised for final diagnosis, involving echo specialist, cardiovascular surgeon and radiologist. Read more here: http://casereports.bmj.com/content/2018/bcr-2018-226999.full | |||||||||||||||||||||||
80 | 8137db56-ad2c-11e9-a2a3-2a2ae2dbcce4 | Quadricuspid Aortic Valve: A Rare Congenital Cause of Aortic Insufficiency - JCIS | Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly causing aortic regurgitation usually in the fifth to sixth decade of life. Earlier, the diagnosis was mostly during postmortem or intraoperative, but now with the advent of better imaging techniques such as transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases are being diagnosed in asymptomatic patients. This article presents a case of a 39-year-old male who was found to have QAV, with the help of TEE, while undergoing evaluation for a diastolic murmur. The patient was found to have Type B QAV with moderate aortic regurgitation. The importance of diagnosing QAV lies in the fact that majority of these patients will require surgery for aortic regurgitation and close follow-up so that aortic valve replacement/repair is done before the left ventricular decompensation occurs. https://goo.gl/4HtqCD | |||||||||||||||||||||||
81 | 8137edda-ad2c-11e9-a2a3-2a2ae2dbcce4 | Roth Spots in Infective Endocarditis: NEJM case report | A 34-year-old man presented to the eye emergency department with reduced vision in the right eye that had developed that morning. He was well, apart from episodes of dizziness and dyspnea after exercise during the previous 4 months. These episodes had started 1 week after the patient had undergone a dental treatment. Previous extensive investigations had been inconclusive. His retinal appearance and symptoms prompted referral to the cardiology team, which admitted him that day. He was afebrile but had a pansystolic murmur and a solitary splinter hemorrhage on the right thumb. Echocardiography revealed moderate-to-severe mitral-valve regurgitation, with thickening and signs of vegetations. The ejection fraction was 65%. The other values were normal. Four sets of blood cultures yielded Streptococcus viridans, and intravenous antibiotics were started immediately. His symptoms improved, and his visual acuity gradually improved from 20/200 at presentation to 20/20 8 months after presentation. His right fundal appearance is shown, at presentation (Panel A), 3 days later (Panel B), and 3 months later (Panel C). The presence of white-centered hemorrhages (Roth spots) should prompt the consideration of possible infective endocarditis. A comparison of Panel A and Panel B (3 days apart) shows how quickly such spots can change. Monitoring of the patient's mitral-valve regurgitation, which was started after complete resolution of the endocarditis, is ongoing. Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1312093 | |||||||||||||||||||||||
82 | 8137fa0a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Aortic Dissection | An 81-year-old man with no documented medical history presented to the emergency department with suprapubic pain and urinary retention resulting from benign prostatic hyperplasia. He was incidentally found to have an elevated troponin I level, at 0.17 ng per milliliter (normal value, <0.08). He reported no chest or back pain or shortness of breath. There was no evidence of ischemic changes on electrocardiography. Chest radiography showed widening of the mediastinum. Transthoracic echocardiography showed aneurysmal dilatation and a dissection flap in the ascending aorta (video). Computed tomographic angiography of the thorax and abdomen revealed an ascending aortic aneurysm (Panel A, blue arrows) and a type I DeBakey aortic dissection. The dissection involved the ascending aorta (Panel B, white arrow), aortic arch (Panel C, blue arrow) and descending aorta (Panels B and C, red arrows) terminating just below the origin of the renal arteries. Several branch vessels were involved as well, including the right brachiocephalic artery, left subclavian artery (Panel C, green arrow) and superior mesenteric artery... http://bit.ly/2tMni3r | |||||||||||||||||||||||
83 | 8137fb54-ad2c-11e9-a2a3-2a2ae2dbcce4 | Tamoxifen-induced hypertriglyceridemia causing acute pancreatitis - JPP | Tamoxifen has both antagonistic and agonistic tissue-specific actions. It can have a paradoxical estrogenic effect on lipid metabolism resulting in elevated triglyceride and chylomicron levels.This can cause life-threatening complications like acute pancreatitis. This article reports a case of severe hypertriglyceridemia and acute pancreatitis following tamoxifen use. A 50-year-old diabetic lady was on tamoxifen (20mg/day) hormonal therapy for breast cancer. Within 3 months of starting therapy, she developed hypertriglyceridemia and acute pancreatitis. Laboratory values include: Serum amylase 778 IU/L, total cholesterol 785 mg/dL, triglycerides 4568 mg/dL and high-density lipoproteins (HDL) 12 mg/dL. Tamoxifen was substituted with letrozole and atorvastatin started. There was a prompt reversal of the adverse effects. Effects on lipid profile must be considered while initiating tamoxifen in predisposed individuals as the consequences are life threatening. https://goo.gl/aiJaz1 | |||||||||||||||||||||||
84 | 81380cd4-ad2c-11e9-a2a3-2a2ae2dbcce4 | Cardiac inflammatory myofibroblastic tumor in interventricular septum #1stOfItsKind | Cardiac inflammatory myofibroblastic tumor (IMT) is a rare primary cardiac tumor which is currently considered as a low-grade neoplasm. The tumor has a predilection in infants and adolescents and primarily occurs as an endocardial-based cavitary mass. However, cardiac IMT that only involves the interventricular septum in middle-aged adults is extremely rarely reported. Considering its infrequency, published in the journal Medicine, the authors report a rare clinical case, with the aim of sharing our experience during the diagnostic procedures. A 45-year-old, previously healthy female, with no medical history was admitted to the outpatient clinic due to the identification of an abnormal radiographic finding during a routine health examination. Transthoracic echocardiography (TTE) revealed a 3.5 cm × 4.0 cm × 4.5 cm heterogeneous mass in the interventricular septum. Color Doppler echocardiography detected sparse blood flow signals inside the mass. MRI confirmed a hyperintense T2-weighted, isointense T1-weighted mass. Three-dimensional (3D) TTE demonstrated a spherical mass in the middle part of the interventricular septum. Postoperative histopathological examinations revealed a mesenchymal tumor composed of scattered spindle myofibroblasts with a myxoid atypia, associated with infiltration of lymphocytes and plasma cells. Complete tumor resection was successfully performed via median sternotomy under general anesthesia. After surgery, the patient recovered successfully. The patient was in good general health without any clinical symptoms. The echocardiographic examination at the 12-month follow-up period revealed normal function of the heart, and there was no evidence of tumor recurrence. Key takeaways:- - Echocardiography plays a critical role in establishing the primary diagnosis of cardiac IMT and evaluating regular follow-up examinations. - Complete surgical resection of the mass is considered the first-line treatment despite the absence of symptoms. Read in detail here: https://pxmd.co/OrXzU | |||||||||||||||||||||||
85 | 813811ca-ad2c-11e9-a2a3-2a2ae2dbcce4 | An interesting presentation of pheochromocytoma | Pheochromocytoma is a rare cause of hypertension, but it could have severe consequences if not recognized and treated appropriately. Pheochromocytoma classically presents with paroxysms of hypertension and adrenergic symptoms including classic triad of episodic headache, sweating, and tachycardia. The clinical presentation of pheochromocytoma can mimic a number of other medical conditions including migraine, cardiac arrhythmias, myocardial infarction, and stroke, thus making the diagnosis of pheochromocytoma difficult, and treatment is directed toward presenting issue rather than underlying problem in such patients. Published in the recent issue of Indian Journal of Critical Care Medicine, the authors present a case of a 41-year-old male patient who presented with cerebellar infarct and found to have aortic thrombi and later developed acute myocardial infaction during same hospitalization. To the best of authors knowledge, this is the first reported case of this kind. A 41-year-male presented with 6 h history of sudden onset dizziness, vomiting, and difficulty in walking. His BMI was 28.3. On evaluation, he was conscious, oriented with heart rate 81/min regular, blood pressure 220/120 mmHg, and normal temperature. Examination was relevant for the presence of gaze-evoked nystagmus, impaired finger-nose test, trucal, and gait ataxia. MRI brain showed acute left cerebellar infarct. He was shifted to Intensive Care Unit on labetalol infusion. His past medical history was not significant except the diagnosis of hypertension 1 year back for which he was not taking any treatment. His admission laboratory values were significant for leukocytosis and high fasting sugar but normal glycosylated hemoglobin and lipid profile. On the next day, he complained of severe chest pain with radiation to upper back, so clinical suspicion of dissection was made and computed tomography (CT) aortogram done which revealed no evidence of dissection, but four small floating thrombi in the ascending aorta near junction with arch measuring 10–11 mm along with well-defined round-to-ovoid soft-tissue density lesion measuring 4.1/3.1 cm in the left suprarenal region. He was initiated on enoxaparin and warfarin in addition to oral labetalol, perindopril, aspirin, atorvastatin, and nitroglycerin. At this time, there was no evidence of active coronary ischemia based on echocardiography, electrocardiogram, and troponin results and CT neck and cerebral angiography were unremarkable. He was investigated for hormonal excess in view of adrenal mass and hypertension. On 5th day while awaiting hormonal report, he developed chest pain and neck pain again. This time electrocardiogram revealed fresh changes in precordial leads (biphasic T-waves in V2–V4), positive and rising troponin, and new onset of regional wall motion abnormality in anterior wall and septum confirming non-ST elevation myocardial infarction. He was started on bisoprolol, and labetalol was stopped. The patient refused for coronary angiography and requested to go back to his home country for further management. The patient left for his home country on the same day and lost to follow-up. On 6th day, laboratory investigation reports confirmed pheochromocytoma as his plasma metanephrines, and urinary catecholamines were significantly elevated. His plasma-free metanephrine level was 76 pg/ml and urinary dopamine and norepinephrine 512 ug/g creat and 126 ug/g creat, respectively. Read the complete case report at: https://goo.gl/oBbSwe | |||||||||||||||||||||||
86 | 8138153a-ad2c-11e9-a2a3-2a2ae2dbcce4 | Severe Cardiac Adverse Effects with IV Metoclopramide: a case report | Published in Drug Safety-Case Reports, the authors present a case of severe bradycardia and hypotension in a patient after receiving intravenously administered metoclopramide. An 83-year-old female was sent to the emergency room because of persistent nausea, vomiting and weight loss of 5 kg in 1 month. Analyses of the nausea by abdominal ultrasound, thoracal and abdominal computed tomography (CT) scan and gastroscopy did not provide an explanation for her symptoms. Her medical history included hypertension, osteoarthritis and depressive disorder, and her cardiac history consisted of supraventricular extrasystoles and mild hypertension. Her kidney function and serum electrolytes were normal. She took perindopril 2 mg once a day, mirtazapine 10 mg once a day, acetaminophen 500 mg three times a day and temazepam 10 mg once a day. A routine electrocardiogram (ECG) showed normal sinus rhythm with a frequency of 72 beats per min (bpm) without conduction disorders. Because of severe nausea, she received 10 mg of metoclopramide intravenously. The rate of injection was not registered, but we assume a slow speed (over at least 3 min) in accordance with the hospital protocol. Shortly afterwards, she turned pale, started transpiring and became briefly unconscious. The heart monitor showed a bradycardia of 40 bpm and blood pressure of 69/44 mmHg. A second ECG was performed at that time, 15 min after the first ECG, and showed a nodal escape rhythm with retrograde atrial activation with normal QRS and QT duration. She was immediately given intravenous sodium chloride (0.9%) and her heart rate and blood pressure normalised within 20 min. A rechallenge with metoclopramide was not performed. The severity of the adverse drug reaction was rated as severe (level 5) on the Modified Hartwig and Siegel Severity Assessment Scale. According to the preventability assessment using the Schumock scale, the adverse drug reaction was rated as unpreventable. Read more here: https://link.springer.com/article/10.1007/s40800-018-0090-3 | |||||||||||||||||||||||
87 | 81381ac6-ad2c-11e9-a2a3-2a2ae2dbcce4 | Extreme scoliosis from CKD-MBD resulting in respiratory failure and death | The present case has been reported in BMJ. A 64-year-old man presented to the hospital because of dyspnoea. Twenty years ago, he had started peritoneal dialysis (PD) for chronic kidney disease. He had been diagnosed with secondary hyperparathyroidism 7 years before his presentation to our hospital, with an intact parathyroid hormone (PTH) 1227 pg/mL (normal range 10–60 pg/mL), calcium level of 10.1 mg/dL (normal range 8.8–10.5 mg/dL), phosphorus level of 5.5 mg/dL (normal range 2.4–4.1 mg/dL) and alkaline phosphatase level of 377 IU/L (normal range 140–338 IU/L). His medications included cinacalcet. Ultrasonography showed a 5-milimetre nodule at the lower pole of the parathyroid, but 99mTc-hexakis2- methoxyisobutylisonitrile (MIBI)scintigraphy revealed no abnormal accumulation. The patient’s intact PTH increased to 2606 pg/mL 6 years prior to presentation. At that time, the patient deferred parathyroidectomy. A year later, he switched from PD to haemodialysis. Intact PTH remained elevated to more than 4000 pg/mL. His thorax became scoliotic curving to the left. He had experienced dyspnoea on exertion for 1 year, presenting to our hospital for an exacerbation of these symptoms. His vital signs on presentation were as follows: body temperature 36.1°C, blood pressure 88/40 mm Hg, heart rate 108/min, a respiratory rate of 24/min and an ambient air oxygen saturation of 88%. His chest examination revealed bilateral diffuse inspiratory crackles. His arterial blood gas analysis values were: pH 7.14, pCO2 89.6 mm Hg, HCO3- 29.8 mEq/L. Chest radiography demonstrated cardiomegaly and remarkable thoracic deformity. His echocardiography revealed mild mitral and severe tricuspid regurgitation with probable pulmonary hypertension. The patient was diagnosed with type 2 respiratory failure and pulmonary hypertension due to severe thoracic deformity. He was intubated and placed on mechanical ventilation for 2 days. After receiving 75 mg of cinacalcet, the patient recovered and was discharged home in 2 weeks. A month later on repeat admission, he died secondary to pneumonia and an exacerbation of his pulmonary hypertension. Learning points • Untreated chronic kidney disease-mineral bone disorder (CMD-MBD) causes life-threatening bone deformity. • Repeated education and proper medications are needed for management of CKD-MBD including adjustment of calcium, phosphorus and hormonal abnormalities. Read more here: https://pxmd.co/jSVWQ | |||||||||||||||||||||||
88 | 813826e2-ad2c-11e9-a2a3-2a2ae2dbcce4 | Aortic intramural haematoma associated with pulmonary artery periadventitial haematoma | The present case paper appears in BMJ case reports. A 54-year-old man who has a medical history of untreated hypertension presented to the emergency department with sudden onset of back pain and sweat. His back pain suddenly started while he was washing the dishes. The pain was sharp, continuous and radiating to his chest. His vital signs were normal and physical examination revealed neither heart murmur nor pulse deficit. Laboratory test revealed elevated D-dimer level of 2.5 µg/mL (reference range <0.5 µg/mL), but normal troponin-T level. Electrocardiography was normal. Chest X-ray showed widened mediastinum. Non-contrast enhanced CT revealed crescentic high attenuation sign along the aortic wall from the ascending to the descending aorta, whereas contrast-enhanced CT demonstrated a hypoattenuating aortic wall, with no evidence of dissection. The haematoma was extended along the aortopulmonary connective sheath. The patient was transferred to the tertiary hospital and underwent the replacement of ascending aorta. He had an uneventful postoperative course. Learning points • Contrast-enhanced CT and also non-contrast enhanced CT should be performed for the patients with suspected acute aortic syndrome. • Pulmonary artery periadventitial haematoma is one of the complications of Stanford type A intramural haematoma (IMH). • The management of type A IMH is basically surgical intervention. Read more at: http://casereports.bmj.com/content/2018/bcr-2018-224853.full | |||||||||||||||||||||||
89 | 81382c6e-ad2c-11e9-a2a3-2a2ae2dbcce4 | DDD pacemaker for severe heart failure-alternate to CRT | The following case report appears in the Indian Heart Journal. A 77-yr old diabetic diagnosed as dilated cardiomyopathy since about 2years presented to the emergency department with sudden onset severe breathlessness and was in a circulatory collapsed state. He was immediately put on ventillatory support and initial high doses of parenteral Inotropes. His ECG showed sinus tachycardia and LBBB with QRS duration of 160 ms. Echocardiography showed dilated LV with global hypokinesia and left ventricular ejection fraction [LVEF] of 15%–18%. Later he could be weaned off the ventilator but was dependent on inotropic support. The biochemical parameters stabilized. He demonstrated no atrial or ventricular arrhythmias. His earlier echocardiography showed dilated left ventricular and LVEF of 20% and coronary angiography revealed normal coronaries. He had been on full medical treatment and the need for CRT device was strongly explained to the patient but the financial constraints prevented it to be implanted. After explaining the pros and cons a Dual Chamber Pacemeker [DDD] was implanted with Right Atrial [RA] – isolated Left Ventricular [LV] pacing, using J curve atrial [isoflex 52 cm is1] lead for right atrum and S curve LV bipolar [isoflex 86 cm is 1] lead for LV pacing via Coronary sinus and into the left postero-lateral coronary vein. AV synchrony and LV pacing were tested. The lead parameters were atrial capture 0.5 V and impedence 473 ohm and the Left Ventricular capture was 0.7 V and impedence 648 ohm. The ECG revealed change from LBBB to RBBB. Using Echo-Doppler guidance Pacemaker AV interval was set at 90 msec. His hemodynamics showed an encouraging immediate increase in the central pressures and showed a change in the contours of the pressure waves from a bifid to sharp upstroke. The inotropic support was immediately withdrawn. Patient showed remarkable clinical improvement and the Echocardiography post implantation showed disappearance of IVS jerky movement and LVEF of 30% ?35%. Patient was discharged in 2 days and in the followed up regularly at two weeks interval. At the end of four months patient is completely asymptomatic,and ECG repeatedly showed RA sense and LV pacing. Echocardiography showed at four months a decrease in LV dimensions and global LVEF of 50%–55%. Patient is not only has now a good exercise tolerance but also has a normal social life. Read in detail here: https://pxmd.co/ARhGF | |||||||||||||||||||||||
90 | 81383164-ad2c-11e9-a2a3-2a2ae2dbcce4 | A Rare Case of Primary Meningococcal Myopericarditis in a 71-Year-Old Male - CRIC'17 | We describe a case of primary meningococcal C pericarditis with myocardial involvement in a 71-year-old male that is thus far the oldest patient with isolated meningococcal pericardial disease and only the third patient with primary meningococcal myopericarditis described in English literature.Patient was successfully treated by full sternotomy and surgical drainage combined with intravenous ceftriaxone. Mild symptoms unresponsive to anti-inflammatory treatment and leukocytosis may guide clinicians towards the correct diagnosis. It is important to recognize this cause of pericarditis as the relatively mild clinical presentation may rapidly progress into tamponade and right-sided heart failure.... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149593/ | |||||||||||||||||||||||
91 | 81383290-ad2c-11e9-a2a3-2a2ae2dbcce4 | Paradoxical embolism causing myocardial infarction | In this case report, published in the Journal of Medical Case Reports, the authors present a case of a likely paradoxical embolism in a young patient with no significant risk factor for coronary artery disease that initially presented with shortness of breath and bilateral calf pain that was found to have a deep vein thrombosis. There was a development of a pulmonary embolism that we believed due to right ventricular strain resulted in an embolus crossing into the arterial system via an intracardiac shunt causing a myocardial infarction via a distal occlusion of the right coronary artery. Patient was treated with full dose anticoagulation and a patent foramen ovale (PFO) closure was recommended. The authors hypothesized that due to right ventricular strain, there was increased right-sided pressure, and the change in pressure gradient in the right into the left atrium caused the sudden reversal of blood flow direction, which allowed the emboli to travel into the left circulation. Eventually, the embolus lodged into distal RCA causing myocardial infarction. Read in detail here: https://pxmd.co/UrMGo | |||||||||||||||||||||||
92 | 8138389e-ad2c-11e9-a2a3-2a2ae2dbcce4 | Galloping Heart: NEJM case report | A 62-year-old man with a long-standing history of uncontrolled hypertension presented to the emergency department with chest pain. His blood pressure was 168/103 mm Hg. The left ventricular point of maximal impulse (PMI) was visible and prominent at the midclavicular line in the fifth intercostal space. On palpation, the PMI was found to be diffuse and laterally displaced, with presystolic outward movement of the cardiac apex and a double apical impulse. A prominent S4 sound was heard on cardiac auscultation. A wooden stick (coffee stirrer) taped to the chest wall over the PMI allowed for clear visualization of the double apical impulse (Video). The S4 sound is created by the vibrations of the left ventricle during atrial contraction as blood is ejected into a stiff, noncompliant ventricle and is best heard over the apex, with the bell of the stethoscope, owing to the low frequency of the sound. When the first and second heart sounds are normal, the S4 sound resembles that of the fast gait of a horse and so is often called a gallop. Diseases that lead to a noncompliant ventricle and a loud S4 sound include hypertension, aortic stenosis, and hypertrophic cardiomyopathy. An echocardiogram showed concentric left ventricular hypertrophy. The patient’s chest pain was attributed to symptomatic hypertension. The pain abated after treatment with antihypertensive medication. Source: http://www.nejm.org/doi/full/10.1056/NEJMicm1614250 | |||||||||||||||||||||||
93 | 81383cc2-ad2c-11e9-a2a3-2a2ae2dbcce4 | Sustained intraoperative bradycardia revealing Sengers syndrome : A case report | Hypertrophic cardiomyopathies (HCM) are uncommon disorders in childhood. They are often asymptomatic and can present as cardiac arrest. During pre-anaesthetic assessment, if bilateral congenital cataracts are present, the clinician should suspect Sengers Syndrome and search for an associated cardiomyopathy. The association of bilateral congenital cataracts, hypertrophic cardiomyopathy and lactic acidosis characterises Sengers syndrome. A recent case report published in the Indian Journal of Anaesthesia describes the case of a 6-month-old infant, who scheduled for congenital cataract surgery. There were no particular functional signs, and clinical examination was essentially normal; in particular, there was no heart murmur or signs of heart failure. The child had a mild rhinopharyngitis without fever or rales. After induction of anaesthesia with sevoflurane, the infant received intravenous 2 ?g/kg of fentanyl and 3 mg/kg of propofol. At the moment of intubation, incomplete laryngospasm occurred, so anaesthesia was deepened by administrating 30 mg of Propofol, which permitted an easy intubation. However, bradycardia (heart rate 55 bpm) occurred and persisted despite administration of atropine. External cardiac massage was initiated and 100 ?g of epinephrine IV administered, which resulted in restoration of an efficient circulation. Surgical procedure was completed on the right eye within fifteen minutes, and the patient was transferred to the Intensive Care Unit. Transthoracic echocardiogram (TTE) showed a hypertrophied left ventricle (LV) for the age, with abnormal trabeculations, and apical hypokinesis of the LV. There was no obstruction to systolic ejection or associated congenital heart disease. The chest X-ray showed cardiomegaly.The patient was administered low dose dobutamine and norepinephrine, which improved contractility without causing dynamic LV outflow tract obstruction. Extubation was carried out 2 h postoperatively, and noninvasive ventilation was applied. The patient improved, but a moderate lactic acidosis persisted. Pre-anaesthetic assessment of children is based generally on anamnestic data and clinical examination, usually without the need for further investigations. During the neonatal period, even careful clinical examination detects only 45% of HCM. It may remain silent and cause cardiac arrest in the operating room. The existence of a bilateral congenital cataracts, even in asymptomatic infants, should trigger the anaesthetist to order a TTE before anaesthesia. Read the complete case report at: https://goo.gl/dDGBFE | |||||||||||||||||||||||
94 | 81383df8-ad2c-11e9-a2a3-2a2ae2dbcce4 | Combined ST elevation in a case of acute MI: How to identify infarct-related artery? | Combined ST elevation in anterior and inferior ECG leads in acute myocardial infarction is not a rarity. It is both interesting and challenging to indentify the infarct related culprit artery. International Journal of Applied and Basic Medical Research, the authors report the case of a middle-aged male with acute myocardial infarction whose admission ECG showed ST elevation in lead II, III, aVF as well as from V1-V3. 90% of such cases are due to single vessel occlusion- majority due to proximal RCA occlusion and the remaining due to mid to distal LAD occlusion. ECG features to differentiate between these two vascular occlusions are discussed. In this case at hand, lead III ST elevation of 2.5 mm and V2/V3? 1 indicates proximal RCA as the IRA and the same has been confirmed by pre-discharge coronary angiogram. Read more about the case here: https://pxmd.co/AAyuR | |||||||||||||||||||||||
95 | 81384122-ad2c-11e9-a2a3-2a2ae2dbcce4 | Cardiovascular collapse with attempted pericardial drain withdrawal | Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As a treatment, a pericardial drain is often placed to evacuate the fluid. Published in the Annals of Pediatric Cardiology, the authors present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. A 4-year-old girl with a complicated medical history of developmental delay, myelomeningocele, hydrocephalus, neurogenic bladder, and recurrent urinary tract infections had a 2-month hospital stay for urosepsis and hemolytic uremic syndrome. This led to chronic renal failure. She was discharged on peritoneal dialysis. She was stable at home for approximately 2 months when she presented to an outside emergency department for seizure-like activity and fever. She was found to be in distress, tachycardic, and tachypneic, with a distended abdomen, but maintaining normal oxygen saturations on room air. She was given lorazepam, fosphenytoin, and antibiotics and transferred to the current facility. On arrival, a chest x-ray was performed that showed an enlarged cardiac silhouette suspicious for tamponade. For that reason, a transthoracic echocardiogram (TTE) was obtained. The TTE showed a moderate circumferential pericardial effusion with diastolic right atrial collapse suggestive of tamponade physiology. The patient was urgently taken to the catheterization laboratory. She remained hemodynamically stable during intravenous induction and endotracheal intubation. A 6-French pigtail catheter was placed in the pericardial space under ultrasound and fluoroscopic guidance and secured in place with a self-adhesive securement device specifically designed for percutaneous drainage catheters; 220 ml of serosanguineous fluid was drained. The patient stabilized and after 2 days, the pericardial drainage was minimal and a decision was made to discontinue the drain. The cardiologist attempted removal at the patient's bedside. The girl became unresponsive, had a decreased respiratory rate, and bradycardia. Chest compressions were initiated and the patient was ventilated via bag mask. Shortly thereafter, the patient started breathing spontaneously and had a palpable pulse. A bedside chest x-ray was performed in which the pigtail catheter appeared in the pericardial space but the exact orientation was unclear. The patient was then transferred to the operating room (OR) for TTE-guided withdrawal of the drain. A TTE was performed under general anesthesia showing minimal effusion but the exact location could not be determined. With the code cart available and the team prepared, another attempt to blindly remove the catheter was performed in the OR. The patient became profoundly hypotensive and bradycardic. External cardiac compressions were initiated. A 0.35 flex guidewire was passed into the catheter and the wire and catheter were advanced back into the chest several centimeters. The patient very quickly stabilized hemodynamically. The team felt the drain must be encircling a major vessel and decided to remove the catheter under direct visualization via sternotomy by a pediatric cardiothoracic surgeon. The catheter was found to course anteriorly and superiorly over the pulmonary artery and aorta and posteriorly and inferiorly under the heart. The pigtail portion was adjacent to the atrial appendage. Traction on the catheter resulted in complete occlusion of main pulmonary artery and severe reduction in pulmonary blood flow. An abrupt fall in end-tidal carbon dioxide was also noted. The drain was surgically removed without further complication. The patient recovered from this episode in the pediatric intensive care unit. Major takeaway:- This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain. Read more here: https://pxmd.co/IWB8X | |||||||||||||||||||||||
96 | 813844d8-ad2c-11e9-a2a3-2a2ae2dbcce4 | Cardiac myxoma with the characteristic 'tumor plop' | The present case has been reported in the current issue of NEJM. A previously healthy 47-year-old woman presented to her primary care physician with a 6-month history of worsening exertional dyspnea, progressive fatigue, and orthopnea. The physical examination was notable for sinus tachycardia, an abnormal heart sound initially thought to be an S3 gallop, and edema of both legs. A chest radiograph showed pulmonary venous congestion. Transthoracic echocardiography revealed a mass that was attached to the interatrial septum, with partial prolapse into the left ventricle obstructing the mitral-valve inflow during diastole (Panel A, arrow [LA denotes left atrium, and LV left ventricle], and video). The additional heart sound after the S2 was recognized as a characteristic “tumor plop.” The patient underwent excision of the left atrial mass (which measured 5.7 cm by 4.3 cm by 5.0 cm) (Panel B), resection of the interatrial septum, and reconstruction with a bovine pericardial patch. Pathological analysis confirmed the diagnosis of an atrial myxoma. Cardiac myxomas are the most common type of primary cardiac tumor in adults and usually occur in the left atrium. If the condition goes untreated, complications such as congestive heart failure, embolic stroke, and sudden death can occur. Surgical resection is the indicated therapy. A postoperative echocardiogram revealed a normal ejection fraction and no flow across the interatrial septum. The patient had an unremarkable postoperative course and was discharged home. Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1802693 | |||||||||||||||||||||||
97 | 813856e4-ad2c-11e9-a2a3-2a2ae2dbcce4 | Story of warfarin: From rat poison to lifesaving drug | The present article has been published recently in the Indian Journal of Vascular and Endovascular Surgery. It is more than six decades since warfarin came into clinical use, and it is interesting to note that the drug is still used in various clinical scenarios. Even more fascinating is the story of how a “rat poison” later on became a powerful oral anticoagulant, which saved endless human lives. Since we are entering an era of newer oral anticoagulants, it is good to look back into the discovery and development of warfarin, a drug that initiated the long journey of oral anticoagulants. In 1948, Link proposed that coumarin derivative should be used as a rodenticide. Among various modified forms of dicoumarol, compound 42 was found to be more effective and was named as “WARFARIN” — named from Wisconsin Alumni Research Foundation and the “arin” from coumarin. This poison caused internal hemorrhage within the rats, resulting in their death. Warfarin soon became the best-selling rat poison in America, and similar chemicals are still used in most mouse and rat poisons around the world. Continue reading here: https://pxmd.co/gieyt | |||||||||||||||||||||||
98 | 81385a72-ad2c-11e9-a2a3-2a2ae2dbcce4 | CCBs may increase risk for pancreatic cancer in postmenopausal women: New Research | Calcium channel blockers, specifically the short-acting form, appeared associated with increased risk for pancreatic cancer among postmenopausal women, according to a study presented at American Association for Cancer Research Annual Meeting. Researchers used data from the Women’s Health Initiative to assess how antihypertensive drugs and the soluble receptor for advanced glycation end product (sRAGE) may affect pancreatic cancer risk. The researchers collected data on medication usage from 145,551 postmenopausal women aged 50 to 79 years who were enrolled from 1993 to 1998 and did not have prevalent cancer at baseline. The investigators assessed four types of antihypertensive drugs: beta blockers, diuretics, angiotensin converting enzyme inhibitors and calcium channel blockers. Mean follow-up was 13.8 years. After adjustment for comorbid factors, women who had ever used short-acting calcium channel blockers demonstrated a 66% higher risk for pancreatic cancer compared with those who had ever used other antihypertensive drugs. Those who used calcium channel blockers for more than 3 years demonstrated a 107% higher risk than those who had ever used other antihypertensive drugs. These association remained significant after investigators accounted for competing risks. Read more here: https://www.healio.com/hematology-oncology/gastrointestinal-cancer/news/online/{efa4c934-a723-4d9f-9a79-52bad6e74c56}/calcium-channel-blockers-may-increase-risk-for-pancreatic-cancer | |||||||||||||||||||||||
99 | 81386102-ad2c-11e9-a2a3-2a2ae2dbcce4 | A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy | Case Presentation Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome. Learn more about the case and discussion that followed - http://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0255-5 | |||||||||||||||||||||||
100 | 81386b52-ad2c-11e9-a2a3-2a2ae2dbcce4 | Cervical Aortic Arch | A healthy 23-year-old woman was referred to our cardiology clinic for evaluation of a murmur and an increasingly pulsatile neck mass (Video), first noted 2 years before presentation. Physical examination revealed a prominent pulsation in the right side of the neck and an early diastolic murmur, grade 2/6, in the aortic position. Her blood pressure was 134/78 mm Hg in the right arm and 122/72 mm Hg in the left arm. No radial–radial or radial–femoral delay was appreciated. Transthoracic echocardiography revealed a bicuspid aortic valve with mild aortic regurgitation. Computed tomographic angiography (reconstructed image) revealed a cervical aortic arch with the left common carotid artery arising from the ascending portion (arrow 1) and the left subclavian artery arising from the descending aorta (arrow 2).The patient underwent reconstruction of the cervical arch, with adjustment to an intrathoracic position... http://bit.ly/2sBwRCB |