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   2013| October  | Volume 5 | Issue 10  
    Online since October 30, 2013

 
 
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REVIEW ARTICLES
The effects of β - glucan on fish immunity
Vaclav Vetvicka, Luca Vannucci, Petr Sima
October 2013, 5(10):580-588
DOI:10.4103/1947-2714.120792  PMID:24350069
Administration of glucans through immersion, dietary inclusion or injection has been found to enhance many types of immune responses, resistance to bacterial and viral infections and to environmental stress in many fish species. Although the efficacy of the glucan varies with types and administration, glucan used as an immunomodulatory and mostly immunostimulatory additive has been found satisfactory in eliciting immunity in commercial aquaculture. Development of more efficient administration methods will facilitate the routine and prophylactic use of glucans as natural immunostimulants of fish. Using a PubMed search, this review has an extensive literature on glucan in fish immunity.
  3,312 749 26
Primary prevention of variceal bleeding: Pharmacological therapy versus endoscopic banding
Zeid Karadsheh, Harmony Allison
October 2013, 5(10):573-579
DOI:10.4103/1947-2714.120791  PMID:24350068
Variceal bleeding is one of the most feared complications in patients with liver cirrhosis. It continues to be a leading cause of death among patients with liver cirrhosis. Although its prognosis has improved over the last several decades, it still carries substantial mortality. Preventing variceal bleeding has been extensively studied and evaluated in several studies in the recent years and the comparison between the different modalities available to prevent variceal bleeding has been an area of discussion. Currently the two most widely used modalities to prevent variceal bleeding are pharmacologic (non-selective beta-blockers [NSBB]) and endoscopic (variceal band ligation [VBL]) which have replaced sclerotherapy in the recent years. In addition to NSBB and recent carvedilol, different other medications have been evaluated including isosorbide mononitrates, spironolactone and angiotensin blocking agents. Comparing the outcomes and adverse effects of these two modalities has been evaluated in different studies. Some studies have showed superiority of VBL until recently, when carvedilol has been included, however; overall mortality has been similar in most trials. Despite that, NSBB remain the first line treatment, as they are cheaper and relatively effective in preventing both esophageal and gastric bleeding. The following sections discuss the primary prevention of variceal bleeding with a focus on NSBB, carvedilol and VBL.
  3,152 672 4
ORIGINAL ARTICLES
Clinical predictors of acute kidney injury following snake bite envenomation
Mrudul V Dharod, Tushar B Patil, Archana S Deshpande, Ragini V Gulhane, Mangesh B Patil, Yogendra V Bansod
October 2013, 5(10):594-599
DOI:10.4103/1947-2714.120795  PMID:24350071
Background: Snake bite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is as important cause of mortality in patients with vasculotoxic snake bite. Aims: This study was to evaluate the clinical profile of snake bite patients and to determine the predictors of developing AKI following snake bite. Materials and Methods: Two hundred and eighty-one patients with snake envenomation were included. Eighty-seven patients developed AKI (Group A) and 194 (Group B) did not. History, examination findings and investigations results were recorded and compared between the two groups. Results: In group A, 61 (70.11%) patients were male and in group B, 117 (60.30%) patients were male. Out of 281 patients, 232 had cellulitis, 113 had bleeding tendencies, 87 had oliguria, 76 had neuroparalysis, and 23 had hypotension at presentation. After multivariate analysis, bite to hospital time (P = 0.016), hypotension (P = 0.000), albuminuria (P = 0.000), bleeding time (P = 0.000), prothrombin time (P = 0.000), hemoglobin (P = 0.000) and total bilirubin (P = 0.010) were significant independent predictors of AKI. Conclusions: AKI developed in 30.96% of patients with snake bite, leading to mortality in 39.08% patients. Factors associated with AKI are bite to hospital time, hypotension, albuminuria, prolonged bleeding time, prolonged prothrombin time, low hemoglobin and a high total bilirubin.
  2,341 513 8
REVIEW ARTICLES
Malignancy and idiopathic inflammatory myopathies
Patompong Ungprasert, Narandra K Bethina, Christine H Jones
October 2013, 5(10):569-572
DOI:10.4103/1947-2714.120788  PMID:24350067
Association between idiopathic inflammatory myopathies (IIMs) and malignancy is well known and has been extensively reported in the literature. However, in the recent years, several new studies were published allowing us to better understand the clinical characteristics and pathophysiology of cancer-associated IIMs. We conducted a literature review of cancer-associated IIMs focusing on new data that was published in the recent years.
  2,174 620 6
CASE REPORTS
Bilateral putaminal hemorrhages: Serious complication of methanol intoxication
Nitipong Permpalung, Wisit Cheungpasitporn, Daych Chongnarungsin, Travis M Hodgdon
October 2013, 5(10):623-624
DOI:10.4103/1947-2714.120804  PMID:24350079
Context: Methanol intoxication is a life-threatening condition. Hallmark of clinical presentations include severe wide anion gap metabolic acidosis with very high serum osmolar gap and visual complication. Case Report: We report a case of severe methanol intoxication with bilateral putaminal hemorrhage, an uncommon serious complication. A 56-year-old man presented with altered mental status. Fundus examination showed optic disc edema. Arterial Blood Gas (ABG) revealed severe anion gap metabolic acidosis with osmolal gap. Head computed tomography (CT) showed hypodense lesions in basal ganglia bilaterally. Hemodialysis and intravenous fomepizole were initiated. Serum methanol level was significantly elevated. Unfortunately, patient was lethargic 2 weeks after discharge. Repeated CT of head demonstrated new putaminal hemorrhages. Conclusion: Bilateral putaminal hemorrhage is an uncommon but serious complication in methanol intoxication. Clinicians should have high index of suspicion for putaminal hemorrhage when patients with recent methanol intoxication present with altered mental status.
  2,225 256 3
RESEARCH ARTICLE
Onset of orolingual angioedema after treatment of acute brain ischemia with alteplase depends on the site of brain Ischemia: A meta-analysis
Josef Yayan
October 2013, 5(10):589-593
DOI:10.4103/1947-2714.120794  PMID:24350070
Background: Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effects, including the development of orolingual angioedema (OA). Although, OA is a rare side-effect, it is thought to be life-threatening and is difficult to treat. Until date, little is known about this condition and a better understanding of OA may contribute to improve the morbidity and mortality amongst patients that develop this condition. Materials and Methods: Using the PubMed and Medknow databases, we searched for peer reviewed published articles on OA after alteplase administration in 1950-2012. We gathered demographic data and investigated the relationship between the location of OA, neurological symptoms and the site of cerebral ischemia. In addition, we studied the effects of hypertensive premedication on OA development. We identified 19 published manuscripts that fulfilled our search criteria. These manuscripts reported 41 cases of OA after alteplase administration. Results: We found that this condition is associated with cerebral ischemia (P < 0.012) and that 65.9% (n = 27) of patients who developed OA had a hypertensive drug as a premedication. Conclusions: Although OA is a rare side-effect of alteplase, it can occur depending upon the localization of acute cerebral ischemia.
  1,788 353 8
ORIGINAL ARTICLES
Tropical pyomyositis
Bitoti Chattopadhyay, Mainak Mukhopadhyay, Atri Chatterjee, Pijush Kanti Biswas, Nandini Chatterjee, Nirod Baran Debnath
October 2013, 5(10):600-603
DOI:10.4103/1947-2714.120796  PMID:24350072
Background: Tropical pyomyositis is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. Though primarily a disease of tropics, it is increasingly being reported from temperate regions in immunosuppressed patients. However, India has only few sporadic case reports. Aims: The aim of this study is to evaluate the causative organisms, clinical presentations, diagnostic modalities, treatment protocols and outcome data in tropical pyomyositis patients. Subjects and Methods: The study was carried out in Nilratan Sircar Medical College and Hospital, Kolkata over 3 years (July 2010 to June 2013). A total of 12 patients were diagnosed with tropical pyomyositis (confirmed with aspiration and culture of pus from muscle). All the investigation and treatment data were recorded systematically. Results: The presenting feature was high fever and myalgia in all 12 patients. Quadriceps femoris was the most commonly involved muscle (50%); followed by iliopsoas (25%). Culture of the aspirate showed Staphylococcus aureus in nine patients (75%), Klebsiella pneumonia in one patient (8.33%) and no growth in two patients (16.67%) even after tubercular and fungal culture. Conclusions: Tropical pyomyositis can affect immune-competent individuals. S. aureus is the most commonly cultured organism. Immediate initiation of appropriate antibiotics and surgical debridement are required to avoid complications. The prognosis remains excellent if promptly treated.
  1,661 326 6
Correlation of severity of coronary artery disease with insulin resistance
Mukund P Srinivasan, Padmanabh K Kamath, Poornima A Manjrekar, B Unnikrishnan, Aishwarya Ullal, Mohammed Faheem Kotekar, Chakrapani Mahabala
October 2013, 5(10):611-614
DOI:10.4103/1947-2714.120799  PMID:24350075
Background: Insulin resistance (IR) has known to be associated with coronary artery disease (CAD), but the assessment of severity of the CAD based on IR in type 2 diabetes mellitus has not been established in detail. Aims: The aim of our study was to establish the correlation between IR and the severity of CAD in type 2 diabetes mellitus. Materials and Methods: In a cross-sectional study design, 61 consecutive patients with type 2 diabetes mellitus who underwent coronary angiogram for the evaluation of CAD were recruited. Fasting blood glucose, fasting insulin levels, systolic blood pressure and total cholesterol/high density lipoprotein-cholesterol ratio were determined. Homeostasis model assessment-IR (HOMA-IR) was correlated with severity of CAD, which was measured by modified Gensini Score. Results: There was a significant correlation between log HOMA-IR and severity of CAD (r = 0.303, P = 0.009) in diabetic patients. Correlation of the Gensini Score with other known risk factors was not significant. Conclusions: The results of our study indicate that we might able to predict the severity of CAD by measure of IR.
  1,547 341 7
Ribosomal protein s6-ps240 is expressed in lesional skin from patients with autoimmune skin blistering diseases
Ana Maria Abreu Velez, Paul B Googe, Michael S Howard
October 2013, 5(10):604-608
DOI:10.4103/1947-2714.120797  PMID:24350073
Background: The in situ signaling transduction within skin biopsies from patients affected by autoimmune skin blistering diseases is not well-characterized. Aim : In autoimmune skin blistering diseases, autoantibodies seem to trigger several intracellular signaling pathways and we investigated the presence of the phosphorylated form of ribosomal protein S6-pS240 within autoimmune skin blistering diseases biopsies. Materials and Methods: We utilized immunohistochemistry to evaluate the presence of S6-pS240 in lesional skin biopsies of patients affected by autoimmune skin blistering diseases including patients with an endemic and nonendemic pemphigus foliaceus (non EPF), with bullous pemphigoid (BP), pemphigus vulgaris (PV), dermatitis herpetiformis (DH), and the respective controls. Results: Most autoimmune bullous skin diseases biopsies stained positive for S6-pS240 around lesional blisters, including adjacent areas of the epidermis; and within upper dermal inflammatory infiltrates, and/or mesenchymal-endothelial cell junctions within the dermis. Conclusions: We document that S6-pS240 is expressed in lesional areas of skin biopsies from patients with autoimmune skin blistering diseases, as well as on eccrine glands and piloerector muscles. Thus, the role of this molecule in autoimmune skin blistering diseases warrants further study.
  1,216 218 4
CASE REPORTS
Leaking heart: Ticking time bomb!
Punnaiah Marella, Hassan Hussein, Naveen Rajpurohit, Rajeev Garg
October 2013, 5(10):620-622
DOI:10.4103/1947-2714.120802  PMID:24350078
Context: Cardiac rupture is a very important but under-recognized complication of acute myocardial infarction and usually happens within a week of the event. Sometimes it can be subacute and may not be typical of an acute blow out rupture. Hence careful evaluation is needed as a missed or delayed diagnosis can be fatal. An emergent echocardiogram may aid in immediate diagnosis. Surgery is the only treatment option and is mandatory despite the high mortality risk. Case Report: An elderly male presented with dizziness and hypotension. Based on the timeline of his symptomatology, electrocardiographic abnormalities and labs, a subacute cardiac rupture was suspected in the emergency room itself. A high index of suspicion is needed to diagnose cardiac rupture. Conclusion: Subacute cases can be missed easily as presentation may not be dramatic. They can rapidly progress to a blowout rupture increasing mortality risk heavily even with surgical treatment.
  1,219 182 2
Mycobacterium tuberculosis infection within a warthin tumor: A case report and literature review
Murat Ulusan, Yasin Abul, Sule Bakir
October 2013, 5(10):617-619
DOI:10.4103/1947-2714.120801  PMID:24350077
Context: The co-existence of tuberculosis and a Warthin tumor in the parotid gland is extremely rare. Case Report: A 46-year-old male presented with a mass in the left parotid region of 6-month duration. The patient's history was only remarkable for a facial swelling, night sweats and a 38.5 C° fever. A 2 × 3-cm mobile, non-tender, mass with a smooth surface was palpated on left parotid tail. CT examination showed a well-defined 30 mm in diameter tumor mass in the left superficial lobe of the parotid gland. A superficial parotidectomy was performed. The final pathological diagnosis of the parotidectomy specimen was reported as a Warthin tumor and epitheloid granulomas with caseification necrosis. Purified protein derivative (PPD) was 30 mm in enduration. Two weeks after the antituberculosis treatment fever declined to normal values and night sweats decreased. Conclusion: Tuberculosis can also be seen in parotid tumors which can coexist or mimic pleomorphic adenoma, Warthin tumor.
  981 226 -
COMMENTARY
Insulin resistance and atherosclerosis: Is it time to measure homa-ir to predict coronary artery disease?
Lakshmi Kannan, Arthur Chernoff
October 2013, 5(10):615-616
DOI:10.4103/1947-2714.120800  PMID:24350076
  895 202 2
Towards understanding mechanisms of autoimmune bullous skin diseases
Rafal P Krol, Atsushi Yasukochi, Takashi Hashimoto
October 2013, 5(10):609-610
DOI:10.4103/1947-2714.120798  PMID:24350074
  795 158 -
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