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  Citation statistics : Table of Contents
   2015| October-December  | Volume 27 | Issue 4  
    Online since January 27, 2016

 
 
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CASE REPORTS
Hemorrhagic bronchial mucosa syndrome
Amit Panjwani
October-December 2015, 27(4):151-153
DOI:10.4103/1110-7782.174944  
Flexible fiberoptic bronchoscopy is a commonly performed procedure that helps in the management of pulmonary disorders. Complications during this procedure are uncommon. An elderly man was subjected to fiberoptic bronchoscopy for the evaluation of his respiratory disorder. He had no clinical, biochemical, or hematological signs of coagulopathies. During the procedure, he developed hemorrhagic bronchial mucosa syndrome after a bout of uncontrolled severe coughing. This is an extremely rare complication of this procedure. A description of this condition and its mechanism is discussed here.
  1 1,347 129
Haemorrhagic shock due to spontaneous splenic haemorrhage complicating antiplatelet therapy: endovascular management
Garge S Shaileshkumar, Keshava N Shyamkumar, Ahmed Munawwar, Purushothaman Vijayan, Perakath Benjamin
October-December 2015, 27(4):154-156
DOI:10.4103/1110-7782.174948  
Spontaneous splenic haemorrahge and rupture is a rare but life-threatening condition requiring urgent diagnosis and treatment. Splenic haemorrhage and rupture precipitated by thrombolytic or antiocoagulant therapy has been reported frequently in the literature, but only two cases due to ticlopidine and one case due to salicyclate have been reported. We report the case of a 54-year-old man with haemorrhagic shock due to spontaneous splenic haemorrhage and rupture following dual antiplatelet (aspirin and clopidogrel) therapy. He was successfully treated with selective angioembolization of the bleeding branch of the splenic artery.
  - 652 83
Secondary parkinsonism due to osmotic demyelination syndrome: a case report
Waseem R Dar, Najeeb U Sofi, Muzamil Latief, Imtiyaz A Dar, Moomin Hussain
October-December 2015, 27(4):157-159
DOI:10.4103/1110-7782.174950  
Hyponatremia is a common medical problem often found in the elderly and is due to poor intake, medical comorbidities, and medications. Central to the management of this condition is the use of normal and hypertonic saline, besides the use of supplementary salt in diet and limited water intake. However, correction has to be slow; this depends upon whether the patient has acute or chronic hyponatremia. Rapid correction produces a myriad of clinical manifestations, commonly called as osmotic demyelination syndrome. The demyelination is pyramidal in most instances; the basis pontis is usually the frequent location. Extrapyramidal demyelination occurs in 10% of cases. Here, we present a form of extrapyramidal demyelination (i.e. secondary parkinsonism) secondary to osmotic demyelination syndrome, which has rarely been reported in the literature.
  - 878 118
CME
Questions and a guide to answers
Hoda Atya, Hoda Al-Rawi
October-December 2015, 27(4):160-166
DOI:10.4103/1110-7782.174952  
  - 554 76
ORIGINAL ARTICLES
Sevelamer hydrochloride and coronary artery calcification in chronic hemodialysis patients: a new mechanism of action
Bahaa Eldin Zayed, Hussein El-Fishawy, Amal R Al-Shihaby, Mohamed A Salem, Usama A.A. Sharaf El Din, Mona Mansour
October-December 2015, 27(4):133-138
DOI:10.4103/1110-7782.174928  
Background The non-calcium-based phosphate binder sevelamer hydrochloride was developed to provide chronic kidney disease patients with a polymer capable of managing hyperphosphatemia without an increase in the calcium load. These beneficial effects were postulated as the mechanism of decreased progression of vascular calcification observed with such compounds. Our objective was to investigate the effect of low-dose sevelamer hydrochloride against calcium carbonate as phosphate binders on the coronary artery calcification score (CCS) and the fibroblast growth factor 23 (FGF23) level in patients receiving regular hemodialysis for more than 1 year, in a trial to find out a novel mechanism for the decreased vascular calcification observed during sevelamer use. Patients and methods A total of 80 hemodialysis patients were allocated into two groups each of 40 patients. The first group received sevelamer hydrochloride 2400 mg/day (group 1), whereas the second continued on calcium carbonate 1500 mg/day (group 2). For each patient, coronary artery calcification was estimated twice, once before admission to the study and again at the end of the study period using noncontrast computed tomography. Serum calcium, phosphorus, intact parathyroid hormone (PTH), lipids, and FGF23 were also assessed in these two situations. Results Beside the significant decrease in serum calcium and phosphorus levels after the use of sevelamer for 6 months, there was a significant decrease in levels of FGF23 and the rate of CCS progress in group 1. Serum levels of total and low-density lipoprotein cholesterol decreased significantly in group 1. The serum PTH level did not show a significant change in either group. CCS showed a significant positive correlation with FGF23, but there was no significant correlation with serum calcium, serum phosphorus, or serum PTH in both groups. Conclusion Sevelamer hydrochloride suppressed the progression of coronary artery calcification, and decreased the FGF23 level significantly. The significant correlation between the serum FGF23 level and the CCS in the absence of any significant correlation between the latter on the one hand and the serum calcium, the serum phosphorus, or the serum PTH on the other might highlight a novel mechanism of action of sevelamer on the CCS.
  - 875 1,168
Noninvasive predictors of large esophageal varices: is there an emerging role of aspartate aminotransferase-to-platelet ratio index in hepatocellular carcinoma?
Heba Sedrak, Rania Khalifa, Ahmed Elkafrawy, Hany Elewa
October-December 2015, 27(4):139-146
DOI:10.4103/1110-7782.174935  
Background and aim Variceal size has been identified to be closely related to variceal bleeding. Repeated endoscopic examinations have a great burden on endoscopic units and cost-implication issues. Our aim was to evaluate the role of AST to platelet ratio index (APRI) in predicting the existence of large esophageal varices (EV) in hepatitis C virus-related liver cirrhotic patients. Patients and methods Seventy four patients with liver cirrhosis were prospectively recruited. Laboratory data, CTP, MELD and APRI, also ultrasonographic and endoscopic findings are performed and investigated whether associated with the size and bleeding of EV. Results Patients were divided into two groups; group 1 with small varices and group 2 with large varices. Group 2 had significantly prolonged prothrombin time, splenomegaly, ascites, higher Child score compared to group 1. CTP was associated with variceal bleeding (P = 0.028). While APRI was a poor predictor both for the presence of LVs and bleeding yet it revealed favorable results with bleeding EVs in patients with HCC with AUC (0.61). APRI was a good predictor for the presence of HCC and number of focal lesions with AURC (0.651, 0.61 respectively). Conclusion Splenomegaly, CTP, ascites could be used as noninvasive predictors for large EVs. However, at the moment, these tests could not substitute for endoscopy. Although APRI is a poor predictor for the size and bleeding of EV, yet it might have a role in prediction of HCC and number of focal lesions.
  - 1,016 215
Incidence of 'headache attributed to temporomandibular disease' in patients with clicking sound in the region temporomandibular joint
Caner Sahin, Ceyhun Varim, Cengiz Karacaer, Bilgehan A Acar, Turkan Acar, Ali Tamer
October-December 2015, 27(4):147-150
DOI:10.4103/1110-7782.174940  
Introduction We aimed to investigate the headache complaint and features in patients referred to ear nose throat clinics with pain in the temporomandibular joint (TMJ) region. Materials and methods Forty-seven patients with complaints of a clicking sound in the TMJ region and pain were included in our study. Patients completed a questionnaire on the headache and the nature of the pain. The patients were asked to mark the level of pain on a visual analogue scale. Results Of a total of 47 patients, 28 were women (59.6%) and 19 were men (40.4%); their age ranged from 19 to 56 years (mean=30.5±9.8 years). There were 33/47 patients with cephalalgia in the head region, except TMJ disorders (70.2%); 12 of these were bilateral and 21 were unilateral. In all, 14/47 patients described pain only in the TMJ region (29.8%). Four patients described at least one experience of jaw locking in their life time (4/47). Visual analogue scale scores of the patients were 3.9±1.7. The nature of the pain was also analyzed. Conclusion TMJ 2014 consortium network showed that headache attributed to TMD may be in associated with cephalalgia. The rate of headache is higher in patients with TMJ disorders. TMJ disorders should also be kept in mind in the differential diagnosis of cephalalgia considering the quality of life of patients.
  - 823 152
REVIEW ARTICLE
The management of constipation-related functional gastrointestinal disorder (constipation-predominant irritable bowel syndrome)
Amal F Radwan, Nagwa R Ahmed, Eman A Sultan
October-December 2015, 27(4):127-132
DOI:10.4103/1110-7782.174926  
The terminology constipation-related functional gastrointestinal disorders was applied to embrace two conditions - constipation-predominant irritable bowel syndrome (IBS-C) and chronic constipation - because of the similarity in the etiology between the two conditions. The cardinal symptoms of IBS-C are abdominal pain or discomfort associated with constipation. The current symptom-based Rome III criteria are used to confirm the diagnosis. Many patients with IBS-C initially treat their symptoms with lifestyle modifications and exclusion diets, together with treatment of symptoms such as constipation by using fiber supplements, over-the-counter laxatives, or probiotics. Less commonly, the patients may also undergo various forms of psychotherapy. Despite these therapeutic modalities, many IBS patients are disappointed with their symptomatic response. There are several drugs that are being proposed for its treatment in the future, one of which is linaclotide, a 14-amino acid synthetic peptide that improves stool frequency and consistency and intestinal transit. Four-week treatment with Bifidobacterium lactis showed superior results when compared with placebo in decreasing the abdominal distention and improving orocecal and colonic transit.
  - 1,806 3,207
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