02/23/2018
Research Article

Role of Serum Magnesium levels in Asthmatic with children

Somashekar AR*, Ramakrishnan KG, Seyyed Vanitha Gowda

Objective: To determine the association between serum magnesium level and asthma, by establishing the difference in serum magnesium level between children with asthma and controls.

Method: Serum magnesium levels of 44 children with acute asthma and 44 controls of the age group of 6-16 years was determined and statistically compared. Lung function tests (FEV1%) were done and correlated with serum magnesium levels using Pearson’s comparison coefficient.

Results: The mean serum magnesium value of cases (1.9136±0.44) is lower than the controls (2.0042±0.26), with 32 cases showing a deficiency of serum magnesium. Pearson’s correlation coefficient, reveals positive correlation between FEV1% with serum magnesium levels, r=0.819, P<0.001.

Conclusions: This study reveals that the serum magnesium levels, even if in normal range, are statistically lower amongst asthmatics. It also brings out the relationship between magnesium levels and lung function tests, showing an improvement in the latter with increase in the former.

02/22/2018
Clinical Image

The Death of a Baby from the Congenital Anomalies of the Urinary Tract

Astrit Gashi M*, Gent Sopa, Ilir Kadiri, Majlinda Balaj and Petrit Pupa

A 36-year-old woman pregnant, G2 P1, presented at 27 weeks of gestation after two previous visits elsewhere, as an outpatient in a gynecological clinic. An ultrasound examination revealed bilateral hydronephrosis. Also, ureteral dilation and bladder overdistension was present (Figures 1-3). We evaluated that the cause was a urinary tract obstruction. Specifically, we are dealing with posterior urethral valves. The anteroposterior diameter of the pelvis on a transverse view of the abdomen was 6 mm. The amniotic fluid index (AFI) was 3 cm, so, oligohydramnios. Fetal Biometry responds to the 27th week of gestation. The sex of the fetus was male. Following identification of urinary tract dilation, a detailed anatomic scan was performed to exclude the presence of associated extra-renal anomalies. After corticosteroid regimens, at week 30 of pregnancy, due to the fetal diagnosis previously determined and now anhydramnios, with the informed consent of both parents, are deciding to end a pregnancy with Caesarean section. On 17.07.2017, at 8:45 AM, the baby of the male sex is born, with body weight 1700 grams, and Apgar score was; 7 in the first minute, 8 in the fifth minute. Shortly after birth, because of the prematurity and the manifestation of the signs of Infant respiratory distress syndrome (IRDS), the baby is transferred to the Neonatal Intensive Care Unit. The treatment started according to the protocol with fluid, antibiotic therapy, and surfactant administration. Even despite therapy, the condition is constantly worsening the baby is intubated and passes on mechanical ventilation. The baby’s condition continues to worsen even further until cardiac arrest, even despite reanimation measures, the baby died within a few hours.

02/23/2018
Research Article

Radiological assessment of exposure doses and radon exhalation rates of building materials in Saudi Arabia

Mohsen B Challan* and Atteyat A Labib**

In the present work, samples of building material are analyzed for their naturally occurring radioisotope activity such as uranium, radium, and radon. The radon emission rates, and the annual effective doses, “AED”, are also investigated.The activity of twenty-four samples, taken from the local markets of Saudi Arabia, was determined using the "Sealed-cup Technique” and Solid State Nuclear Track Detectors, "SSNTD.” The uranium concentration activity of the samples is found to vary from 0.62 to 4.68 ppm with an average of 1.92±0.42 ppm. The radium concentration varies from 0.61 to 4.64 Bq·kg−1, with an average of 1.91±0.42 Bq·kg−1, the radon concentration in the samples varies from 42.29 to 319.97 Bq·m−3 with an average of 131.53±28.94 Bq·m−3. The value of the dissolved radon concentration in the collected samples varies from 12.99 to 98.97 Bq·m−3 with an average of 40.41±8.89 Bq·m−3. The mass exhalation rates are found to vary from 1.54 to 11.65 mBq·kg−1·h−1, with an average of 4.79±1.05 mBq·kg−1·h−1, while the surface inhalation rates vary from 76.97 to 582.35 mBq·m−2·h−1, with an average of 239.38±52.66 mBq·m−2·h−1. The AED due to indoor uses varies from 1.07 to 8.07 mSv·y−1, with an average of 3.32±0.73 mSv·y−1. The AED due to indoor plus outdoor uses varies from 1.47 to 11.10 mSv·y−1, with an average of 4.56±1.0 mSv·y−1. The results of this study show that the values obtained for most samples are within the internationally accepted recommended values. Therefore, these samples can be used as building materials as they do not pose a major risk to humans.

02/16/2018
Case Report

Posterior Reversible Leukoencephalopathy Syndrome in a patient after second dose of Rituximab for treatment of resistant Thrombotic Thrombocytopenic Purpura

Sabaa Asif*, Sumbal Nasir Mahmood and Osama Kunwer Naveed

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX). She did not responded and due to worsening thrombocytopenia and persistent hemolysis was administered Rituximab as an adjunct therapy. She tolerated the first dose well, however 48 hours after the second dose she developed uncontrolled HTN of 190/110 associated with generalized tonic clonic seizures and altered sensorium requiring intubation and mechanical ventilation. MRI findings were suggestive of PRES. Seizures did not get controlled with conventional therapy and patient underwent two consecutive cycles of PEX to remove the drug which resolved the seizures.

However, the patient developed Ventilator associated pneumonia (VAP) and sepsis and expired after family withdrew ventilator support.

02/12/2018
Case Report

May we feed cancer?

Maria Grazia Spurio*

The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally.

Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.
The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally.
Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.

02/16/2018
Research Article

Design and validation of an Index to predict the development of Hypertensive Cardiopathy

Alexis Alvarez-Aliaga*, Andrés Jose Quesada-Vazquez, Alexis Suarez-Quesada and David de Llano Sosa

Introduction: The high morbidity and mortality by hypertensive cardiopathy demand the construction and validation of tools to stratify the risk of developing this condition.

Objective: To design and validate an index, based on risk factors, that permits to predict the development of hypertensive cardiopathy in patients with a diagnosis of essential arterial hypertension.

Methods: A prospective cohort study was done in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 1st, 2010 to December 31, 2016. Internal and external validity and the internal consistency of the index were determined.

Results: The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p<0.0005) and calibration (p=0.751) were adequate.

Conclusions: The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk.

02/09/2018
Case Report

Large perforating Submandibular Stone-A Case Report

Faaiz Alhamdani*

Salivary stone (sialothiasis) is a calcifying concentration within the ductal system of salivary gland [1]. The majority of salivary calculi occur in the submandibular gland duct because of its length, upward course and the thicker mucus [2].

Submandibular salivary stone is a common cause for recurrent submandibular gland swellings [3]. Recurrent obstruction of salivary flow is the main cause for salivary gland swellings, which makes salivary gland removal in some of these cases inevitable, despite the considerable advances in salivary gland calculi management [4-6]. Large salivary stones (>10 mm) are relatively uncommon [7-9]. Reviews of cases of giant salivary stone were attempted by different authors [7,10,11]. However, the review done by [12], was the most comprehensive one. They reported 90 cases of giant salivary stones between 1942 and 2014. Apart from 8 cases included in their review, all the reported stones were between 30-65 mm in size.

Submandibular salivary gland stones perforating the floor of the mouth, reported in the literature, are even less common. In the last decade 7 cases have been described. The reported cases with perforating submandibular stones were large (≥22 mm). Table 1 summarises the features of the reported cases.

 
 
Submandibular salivary gland stones perforating the floor of the mouth, reported in the literature, are even less common. In the last decade 7 cases have been described. The reported cases with perforating submandibular stones were large (≥22 mm). Table 1 summarises the features of the reported cases.

02/19/2018
Research Article

Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control in Mexico

Hector Galvan Oseguera, Martin Rosas Peralta*, Jose Manuel Enciso Munoz and ANCAM group for HBPM

Hypertension remains the most common modifiable cardiovascular risk factor, however, control of hypertension rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve the control of hypertension. Home BP monitoring is now defended evenly for the evaluation and management of hypertension. This paper shows the experience of the National Association of Mexican Cardiologist in a group of patients with hypertension under drug treatment to evaluate the control in a real world clinical practice in Mexico. One hundred and fifty one patients were included. They were followed during two weeks with three home measurements at day (8:00, 14:00 and 20:00hr). An Ambulatory blood pressure of 24hr was performed at the middle of study. At the end of the study 36% (54/151) patients still uncontrolled by systolic blood pressure (>135 mmHg) and 31% by diastolic blood pressure similar results were detected by ambulatory blood pressure. During afternoon and night uncontrolled values were more common. Home blood pressure monitoring, results in a better form to detect uncontrolled patients and help clinical judgment to adjust pharmacological therapy. This practice should be recommended in Mexico.

02/14/2018
Opinion

Adrenal insuffi ciency in Bilateral Adrenal Metastasis implemented SBRT

Yasemin Benderli Cihan*

Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex.Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1-4].

02/09/2018
Mini Review

Which is the best? Palliative Radiation Therapy to Spleen or Splenectomy

Yasemin Benderli Cihan*

Spleen is one of the most important organ of the reticuloendothelial system and coordinates the immune response. Splenectomy is performed for hypersplenism, and staging of hematological malignancy.  In conservatively followed patients, radiation therapy can be used to reduce hypersplenism symptoms. Splenectomy or palliative radiotherapy to spleen may probably cause an immune suppressive condition. This may probably local and systemic complications.

02/09/2018
Letter to the Editor

Autologous grafts in radiotherapy received breast cancer patients

Yasemin Benderli Cihan*

German surgeon, Vincenz Czerny, transplanted a patient’s own lipoma located in the hip to it’s breast after gland excision due to mastitis in 1895. Dr. Vincenza reported that for at least a year he didnt observe any problem on the operated breast [1].Injection of adipose tissue to the breast has been used in breast cancer patients during breast reconstruction and lumpectomy. And in cases of revision autologous tissues are used for reconstruction. In clinical practice, many breast cancer patients apply to the clinics mostly after radiotherapy for reconstruction. Rigotti et al used purified autologous lipoaspirates in breast cancer patients with late term complications of radiation therapy and observed increase in neovascularization and wound healing [2]. Panettiere and colleagues compared aesthetic and functional features of fat grafts in radiotherapy received breast cancer patients and control group. In the fat graft group, all clinical symptoms and aesthetic scores were significantly higher than the control group [3].

02/09/2018
Opinion

Place of beta-radiation in the etiology and treatment of cataract

Yasemin Benderli Cihan*

Among eye diseases, cataract is the most commonly encountered lens disease and the leading cause of reduced vision. Cataract caused by radiation develops due to neck & head, central nervous system tumors, eye localized tumors and total body irradiation. Today, the only treatment of cataract is surgery.

Beta radiation is seen to have an important place both in the etiology and treatment of cataract. Beta-radiation creates cataract in the lens as an adverse effect. However, beta radiation implementation is used for delay or prevention of cataract in glaucoma surgery. Effects of beta-radiation on the etiology and treatment should be supported by further prospective clinical studies.

02/07/2018
Case Report

The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid

Ayse Gul Kocak Altintas*, Cagri Ilhan and Mehmet Citirik

Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the efficacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporeflective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-inflammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustained-release dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profile.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the first reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-inflammatory drugs. 

02/08/2018
Research Article

Reaction of Psidium guineense and Psidium guajava genotypes to infection of Meloidogyne enterolobii

Romulo M de Moraes Filho*, Edilton de Albuquerque Cavalcanti Jr., Jackeline Gade A Rossiter, Angelica Virginia Valois Montarroyos and Luiza Suely Semen Martins

Psidium guajava (guava) is an important crop and economic resource in many tropical countries and Brazil stands out as one of its major commercial producers. The guava crop has been severely attacked by the plant parasitic nematode Meloidogyne enterolobii which has caused drastic reduction of productivity and, in some cases, even total loss of cultivated areas.The use of resistant rootstocks that are tolerant to these soil pathogens can be a low-cost solution to this pathogen, which has established itself as one of the major constraints for the cultivation of guava in Northeast Brazil. The objective of this work was to evaluate the reaction of P. guajava and P. guineense to M. enterolobii infection under greenhouse conditions, with an infection period of 60 days. 12 P. guineense, and 4 P. guajava were evaluated. The host response to the nematode infection was evaluated according to the following parameters: gill index (GI), reproductive factor (RF), and reduction of reproductive factor (RRF). Considering the RRF criteria, the P. guineense genotypes, AR1, AR3, AR4 and AR10 were considered resistant. The RF index was considered inadequate to evaluate resistance in the 60 days period, due the slow development of the parasite in P.guineense.

02/06/2018
Case Report

Trauma to the neck: Manifestation of injuries outside the original zone of injury-A case report

Alexander Christakis, Brian Tashjian, Anne M Gilroy and Stephen O Heard*

A 53-year-old male presented to the Emergency Department (ED) with multisystem trauma and respiratory distress following a blunt-force injury to his anterior left neck. CT imaging showed extensive subcutaneous emphysema and pneumomediastinum. A chest X-ray showed elevation of the left hemidiaphragm suggesting phrenic nerve injury which was confirmed by bedside ultrasonographic examination of the left hemidiaphragm. Flexible bronchoscopy demonstrated tracheal rupture. The patient was treated supportively and recovered without surgical treatment. Trauma-induced hemidiaphragmatic paralysis is rarely reported. This case represents a clinical scenario with demonstrable anatomic correlations, and a clinical reminder that phrenic nerve injury should be included in the differential diagnosis of respiratory distress in a trauma patient.

02/06/2018
Research Article

Differences between traditional Visualization and Virtual reality on motor performance in novel climbers

Barca Martín A, Ochoa de Ocariz LA, San Juan-Sanchez I and De la Vega R*

This paper analyses the effect of virtual reality visualization (VRV) on climbers, with respect to the traditional visualization methodology. The study sample was made up of 21 novel climbers: Control Group CG (N=7), Traditional Visualization Group TVG (N=7) and Virtual Reality Group VRG (N=7).In order to implement the mental imagery through virtual reality, a 360º Ricoh Theta S camera and a pair of Woxter Neo VR1 goggles were used. The data analysis was carried out with a simple ANOVA of three means. No statistically significant differences were found. The results are discussed and future lines of research are established.

02/02/2018
Research Article

Electrocardiographic criteria in founder mutations related to Arrhythmogenic cardiomyopathy

Stefan Peters*

Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women>30 years for sudden cardiac death prevention.The mutation increases the stiffness of the cell nucleus thus producing the massive loss of cardiomyocytes [2]. P.Arg14del phospholamban mutations cause biventricular arrhythmogenic cardiomyopathy with predominant heart failure, and in some cases, secondary sudden cardiac death [3]. Both founder mutations have characteristic electrocardiographic appearance, together with typical ECG manifestations of arrhythmogenic cardiomyopathy like right precordial T-wave inversions, terminal activation delay and epsilon waves in right precordial leads. Typical ECG manifestations in TMEM43 mutations are poor R-wave progression in right precordial leads (Figure 1), often associated with T-wave inversions in lateral leads [4]. Typical ECG manifestations in phospholamban mutations are low voltage ECG [5], more than complete right bundle branch block [6], epsilon waves in right precordial leads and in lead aVR [7] and right precordial T-wave inversions (Figure 2). Atrial fibrillation occurs frequently.