Outdoor and indoor air pollution poses a significant cardiovascular risk, and has been associated with atherosclerosis, the main underlying pathology in many cardiovascular diseases. Although, it is well known that exposure to air pollution causes pulmonary disease, recent studies have shown that cardiovascular health consequences of air pollution generally equal or exceed those due to pulmonary diseases. The objective of this article is to evaluate the current evidence on the emerging role of environmental air pollutions in cardiovascular disease, with specific focus on the types of air pollutants and mechanisms of air pollution-induced cardiotoxicity. Published literature on pollution was systematically reviewed and cited in this article. It is hoped that this review will provide a better understanding of the harmful cardiovascular effects induced by air pollution exposure. This will help to bring a better understanding on the possible preventive health measures and will also serve regulatory agencies and researchers. In addition, elucidating the biological mechanisms underlying the link between air pollution and cardiovascular disease is an essential target in developing novel pharmacological strategies aimed at decreasing adverse effects of air pollution on cardiovascular system.
Air pollution; Atherosclerosis; Cardiovascular diseases
Pseudoexfoliation syndrome is a primarily ophthalmological disorder caused by deposition of whitish-gray protein on the lens, iris, and multiple other eye tissues. There is increasing evidence over the previous years that pseudoexfoliation syndrome is a systemic disorder with various extraocular manifestations and has recently been linked to several cardiovascular disorders. The present article aims to summarize the current knowledge on cardiovascular implications of this well-described clinical entity.
Cardiovascular; Coronary disease; Pseudoexfoliation syndrome
Pneumomediastinum (PM) is defined as the presence of free air in the mediastinal cavity. It is often regarded as a revealing sign of a more serious medical condition. PM is broken down into two categories, one, with an instigating event, referred to as secondary PM. The other is when free air is discovered in the mediastinal cavity without a clear etiology, referred to as spontaneous pneumomediastinum (SPM). Often misdiagnosed due to the vague nature of presenting symptoms, SPM must be part of the differential diagnosis of a chest pain patient to expedite discovery and if necessary, management. A MedLine/PubMED search was performed identifying all relevant articles with “SPM” in the title. Six case series were reviewed to determine what clinical scenario constitutes a possible case of SPM. Results showed that almost all patients with SPM exhibited some chest pain, but Hamman’s crunch was present in only one-fifth of patients. Patients with certain pre-existing pulmonary diseases showed a greater propensity for the presence of free air in the mediastinal cavity. SPM must be diagnosed and managed promptly due to rare, but serious complications and any chest pain with an unknown etiology should contain SPM in the differential diagnosis.
Chest pain; Mediastinal emphysema; Spontaneous pneumomediastinum; Subcutaneous emphysema
Allergic rhinitis is a skewed immune reaction to common antigens in the nasal mucosa; current therapy is not satisfactory and can cause a variety of complications. In recent decades, the incidence of allergic rhinitis is increasing every year. Published studies indicate that probiotics are beneficial in treating allergic rhinitis. This review aims to help in understanding the role of probiotics in the treatment of allergic rhinitis. We referred to the PubMed database as data source. This review focuses on the following aspects: The types of probiotics using in the treatment of allergic rhinitis, approaches of administration, its safety, mechanisms of action, treating results, and the perspectives to improve effectiveness of probiotics in the treatment of allergic rhinitis. This review reports the recent findings regarding the role of probiotics in the treatment of allergic rhinitis. Probiotics are a useful therapeutic remedy in the treatment of allergic rhinitis, but its underlying mechanisms remain to be further investigated.
Allergy rhinitis; Bacteria; Mechanism; Probiotics; Theurapeutics
Female feticide, skewed sex ratio, and its attendant social evils have grave ethical undertones for medical professionals and our commitment to save lives. A concerted effort by all is essential against female feticide.
This study was to assess the knowledge of female feticide, declining sex ratio, and corrective measures among medical interns.
Materials and Methods:
A cross-sectional study was conducted among 79 medical interns. Data werecollected with the help of predesigned structured questionnaire. Chi-square tests, Kruskal-Wallis tests, and Z tests were used to test the significance level.
Knowledge of current sex ratio was significantly better among female interns than male interns. Majority of interns opined that creating awareness is an effective measure to combat declining sex ratio and only 33 interns had correct knowledge regarding all measures. Only 37.9% of interns knew all the legal indications for use of prenatal diagnostic techniques. However, 81% of interns were aware of punishments mentioned for violation of the Act. Mean score of knowledge was 22.06 among males and 24.4 among females.
The findings in our study underline the need to sensitize doctors regardingevery aspect of Pre-Conception and Prenatal Diagnostic Techniques Act and selective sex determination.
Female feticide; Interns; Sex ratio
This preliminary publication describes acute temperature effects after manual Khalifa therapy.
The goal of this study was to describe temperature distribution and the effects on surface temperature of the knees and feet in patients with completely ruptured anterior cruciate ligament before and immediately after the manual therapy.
Materials and Methods:
Ten male patients were investigated with thermal imaging. An infrared camera operating at a wavelength range of 7.5-13 μm was used. Temperature was analyzed at three locations on both knees and in addition on both feet.
The study revealed that baseline temperature of the injured knee differed from that of the untreated control knee. After the therapy on the injured knee, the surface temperature was significantly increased on both knees (injured and control). There were no significant changes in the temperature of the feet.
Further studies using continuous thermal image recording may help to explain the details concerning the temperature distribution.
Anterior cruciate ligament; Khalifa therapy; Knee; Temperature; Thermal imaging
The spectrum of liver dysfunction in children with dengue infection is wide and has been associated with disease severity.
This study was undertaken to estimate the range of hepatic involvement in dengue infection in children.
Materials and Methods:
This study assessed the biochemical and clinical profile of hepatic involvement by dengue virus in 120 children with serologically positive dengue fever (DF), aged 2 months to 14 years.
All cases were grouped into DF without warning signs (Group 1), DF with warning signs (Group 2) and severe dengue (Group 3) according to revised World Health Organization 2009 criteria. The spectrum of hepatic manifestations included hepatomegaly (80.8%), hepatic tenderness (46.3%), jaundice (60%), raised aspartate transaminase (AST), alanine transaminase (ALT) and prolonged prothrombin time (41.7%) and reduced serum albumin (56%).
Hepatic dysfunction was observed more in Groups 2 and 3. There was 84.4% and 93.75% ALT and AST elevation respectively in Group 2 and 94.5% and 95.9% ALT and AST elevation respectively in Group 3 and fulminant hepatic failure was observed in Group 3. Therefore in a child with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic.
Liver function tests; Severe dengue
Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.
The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.
Materials and Methods:
A cross-sectional clinical note review of 672 HIV-1 patients’ files admitted from January 1 st 2004 to December 31 st 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.
The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).
The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.
Cerebrospinal fluid; Cluster of differentiation 4; Cryptococcal meningoencephalitis; Headaches; Human immunodeficiency virus/acquired immunodeficiency syndrome
Influenza virus infection is a common respiratory pathogen. Emerging of new atypical influenza is usually a big public health threat. H7N9 bird flu is the newest atypical influenza virus infection that has just been reported since early 2013. The emerging of this new disease occurred in China and becomes the present focus for possible worldwide pandemic. In this specific article, the author will discus and describe on epidemiology, symptomatology, pathology, diagnosis, treatment, and prevention of this new bird flu. The literature researching by PubMed and Google is used for data gathering in this collective review.
Bird; Emerging; H7N9; Influenza
Prion diseases are a group of neurodegenerative disorders characterized by accumulation of abnormal prion proteins in the central nervous system. The prions resist conventional sterilization procedures especially when infected tissue becomes dried onto metal or glass surfaces. This article, a review of literature collected using Pubmed as search engine, describes the oral manifestations of prion diseases in addition to studying the possibility of cross contamination in the dental office. The article emphasizes the importance for dentists to be aware of these diseases, to identify the high-risk patients by obtaining adequate medical history and to know the appropriate deactivation procedures to be followed.
Contamination; Deactivation; Oral; Prions
Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT).
Computed tomography; Diffusion weighted magnetic resonance imaging; Magnetic resonance imaging; Pott's spine; Radiography; Tuberculosis
Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis.
To evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy.
Materials and Methods:
This was a prospective and randomized study. For patients assigned to early group, laparoscopic cholecystectomy was performed as soon as possible within 72 hours of admission. Patients in the delayed group were treated conservatively and discharged as soon as the acute attack subsided. They were subsequently readmitted for elective laparoscopic cholecystectomy 6-12 weeks later.
There was no significant difference in the conversion rates, postoperative analgesia requirements, or postoperative complications. However, the early group had significantly more blood loss, more operating time, and shorter hospital stay.
Early laparoscopic cholecystectomy within 72 hours of onset of symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.
Acute cholecystitis; Cholecystectomy; Laparoscopic
Several reports have described worse perioperative outcomes of laparoscopic gastric bypass procedure during learning curve, which improved after completion of one-year fellowship training.
The aim of this study was to evaluate the immediate impact of fellowship training on perioperative complications and outcomes of various bariatric procedures.
Materials and Methods:
One hundred initial patients who underwent laparoscopic gastric banding, laparoscopic Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch by a single fellowship trained surgeon were analyzed.
Overall average Body Mass Index (BMI) of the patients was 45.9 kg/m2, age was 47.5 years, and the American Society of Anesthesiologist Score was 2.89. There were no intraoperative, major 30-day complications, or open conversions. Average operative time was 62 minutes in gastric banding, 160 minutes in gastric bypass, 119 minutes in vertical sleeve gastrectomy, and 320 minutes in biliopancreatic diversion. Length of stay ranged from 0.5 day after gastric banding to 3.9 days after biliopancreatic diversion. The perioperative complications and outcomes are comparable with those reported by experienced surgeons. No mortality occurred in this series.
Bariatric fellowship ensured skills acquisition for new surgeons to safely and effectively perform various types of bariatric operations, with minimal perioperative complications and excellent outcomes.
Complications; Fellowship; Impact; Outcomes
Anthropometric and socioeconomic factors are known to influence peak expiratory flow rate, but the effect of altitude has not been established decisively, due to conflicting results of various studies.
This study was conducted to evaluate the effect of altitude on peak expiratory flow rate of healthy school children.
Materials and Methods:
A cross-sectional study was conducted in which the peak expiratory flow rate of a group of 290 school children (140 male and 150 female), aged 7-14 years, residing in Shimla (altitude 2150 meters), were compared with the results obtained in an age- and sex-matched control group, consisting of 280 school children (138 male and 142 female), residing in Patiala (altitude 278 meters). Mini Wright Peak Flow Meter was used for the study.
The mean peak expiratory flow rate value of boys at high altitude (265 ± 92.6 L/min) was significantly higher than those in plain areas (245 ± 82.1 L/min). Similarly, the mean peak expiratory flow rate of highlander girls (250.4 ± 70.2 L/min) was significantly higher than girls of plains (232.6 ± 65 L/min).
The study suggests that besides anthropometric and socioeconomic factors, altitude is an important determinant of lung function.
Altitude; Lung function; Peak expiratory flow rate; School children
In forensics, the mouth allows for a myriad of possibilities. Lip print on glass or cigarette butt found at crime scenes may link to a suspect. Hence, a dentist has to actively play his role in personal identification and criminal investigation.
To investigate the uniqueness of the lip print patterns in relation to gender, ABO blood groups and intercommissural distance (ICD).
Materials and Methods:
The study was conducted on 208 randomly selected students. The lip print of each subject was obtained and pattern was analyzed according to Tsuchihashi classification. The blood group and ICD at rest position was recorded for each.
The study showed that Type II (branched) lip pattern to be most prominent. The B+ blood group was the most common in both genders and the ICD is higher in males. The lip print pattern does not show any correlation between ABO blood groups, gender, and ICD.
The lip print pattern shows no correlation with gender, ABO blood groups, or ICD. Further studies with larger samples are required to obtain statistical significance of this correlation.
Blood groups; Competent lips; Intercommissural distance; Lip prints
Human immunodeficiency virus (HIV) associated lymphoma is an important public health concern; however, the epidemiological data available from India is sparse.
The present study was carried out at a tertiary cancer care center in South India to analyze the scenario of HIV-associated lymphoma.
Materials and Methods:
This was a retrospective observational study conducted at our center, on consecutive patients diagnosed with HIV-associated lymphoma, from January 2008 to December 2012.
A total of 44 patients were diagnosed with HIV-associated lymphoma, of which 18 opted for treatment. There were 11 males and 7 females in the study population. Median interval from the diagnosis of HIV infection to diagnosis of lymphoma was 18 months. Median CD4 count at the time of lymphoma diagnosis was 218/mm3. Five patients had Hodgkin's lymphoma, and the rest had non-Hodgkin's lymphoma. Five out of 18 (28%) patients in the present study expired during treatment. Ten (55.5%) patients are alive and lymphoma free, with a median follow up of 18 months.
More than half of our treated patients are lymphoma free with a median follow up of 18 months; hence treatment of patients with HIV-associated lymphoma should be encouraged.
Acquired immunodeficiency syndrome; Adriamycin bleomycin vinblastine dacarbazine; CD4 count; Human immunodeficiency virus; Lymphoma; Rituximab cyclophosphamide doxorubicin vincristine and prednisolone
We are introducing a novel in vivo technique to document cellular calcium deposits, which reflect a snapshot of the effect of calcium wave propagation. This technique however is not advocated enough to replace the accuracy and resolution of the confocal laser technique. Light microscopy equipment, calcium chelators and a histological calcium staining kit are essential.
The purpose of this study is to introduce the use of standard light microscopy to display in vivo ionic cellular calcium deposits.
Materials and Methods:
Oxalic Acid (OA) (100 millimol) was the calcium chelator used in the study. This substance was injected into the dog right atrial tissue in vivo in an area of 1 cm2. Samples were fixed and stained by the calcium specific von Kossa protocol.
Results and Conclusions:
Histological slides demarcated the intracellular calcium as black dots. Heterogeneity of calcium deposits mimicked images of both, the calcium sparks and calcium waves theories. This light microscopy technique could expand the number of experimental studies in the function of cellular calcium physiology.
Calcium chelation; Calcium waves; Cell membranes; Cellular gap junction; In vivo chelation; Intercellular calcium propagation; Light microscopy method; Von Kossa