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  Citation statistics : Table of Contents
   2015| December  | Volume 7 | Issue 12  
    Online since December 30, 2015

 
 
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ORIGINAL ARTICLES
A pilot study of the inability to fit hands around neck as a predictor of obstructive sleep apnea
Peter J Edmonds, Lee C Edmonds
December 2015, 7(12):553-557
DOI:10.4103/1947-2714.172843  PMID:26942131
Background: Considering the high estimates of undiagnosed and untreated obstructive sleep apnea (OSA), there is a need for simple and accurate diagnostic tests. Neck circumference has long been correlated with OSA, but its usefulness as a diagnostic tool has been limited. Aims: We proposed to evaluate the value of a simple neck grasp test to help identify OSA. We hypothesized that the inability of a patient in a sleep clinic to fit their hands around their neck is predictive of OSA. Materials and Methods: A retrospective review of medical records of patients evaluated in a general sleep clinic was performed. Easy sleep apnea predictor (ESAP) positive was defined as the inability to place the hands around the neck with digits touching in the anterior and posterior. ESAP negative was the ability to place hands around the neck. Positive for OSA in this symptomatic sleep clinic population was defined as an apnea-hypopnea index (AHI) of ≥5. Results: A total of 47 subjects (36% female) had ESAP data available, which were reviewed. The mean age was 51.6 years (SD 14.4, range 29-81 years). The mean body mass index (BMI) was 38.8 (SD 9.9, range 20.4-69.5). Review showed 87.2% (N = 41) tested positive for OSA by AHI of ≥5. The sensitivity and specificity of ESAP were 68.3% and 100%, respectively. The positive predictive power was 100% and the negative predictive power was 31.6%. Conclusion: As we hypothesized, ESAP positive (inability to span neck) was predictive of OSA in a population of sleep clinic patients. An ESAP positive test was 100% predictive of the presence of OSA (AHI of ≥5). ESAP shows promise for ease of clinical use to predict the presence of OSA in a general sleep clinic population.
  2 1,546 565
CASE REPORTS
Cortical hemiballism: A case of hemiballismus associated with parietal lobe infarct
Pragya Shrestha, Janak Adhikari, Dilli Poudel, Ranjan Pathak, Paras Karmacharya
December 2015, 7(12):572-574
DOI:10.4103/1947-2714.172850  PMID:26942135
Context: Hemiballismus is characterized by involuntary, irregular, large amplitude, and violent flinging movements of limbs. Stroke (middle and posterior cerebral artery) remains the most common etiology with 2/3 being lacunar. Lesions outside the substantia niagra (STN) can cause hemiballism, and only a minority by STN lesions, unlike the classical belief. Compared to those arising from STN, cortical hemiballismus is usually less severe with a good prognosis. Case Report: A 61-year-old man presented with sudden onset involuntary flinging movements of his right upper extremity accompanied by numbness and tingling. Past medical history was significant for stroke 2 years back with no residual deficits. Vitals signs were blood pressure of 165/84 mm Hg, and heart rate - 82 beats/min. Irregular, arrhythmic, jerky flinging movement, and decreased sensation to light touch in right upper extremity was noted. Magnetic resonance imaging of the brain revealed acute posterior left parietal lobe infarction. He was treated with aspirin and atorvastatin. Thrombolytic therapy was offered but declined. The movements resolved spontaneously over the next 2 days. No further episodes occurred at 3-month follow-up. Conclusion: Lesions affecting various areas outside the STN can cause hemiballism and usually carries a good prognosis with spontaneous resolution. Acute thrombolytic therapy may be considered on an individual basis. Treatment with antipsychotics can be useful for severe and recurring symptoms.
  1 1,632 214
ORIGINAL ARTICLES
Clinical manifestations and predictors of thrombocytopenia in hospitalized adults with dengue fever
Akshatha Rao Aroor, Rama Prakasha Saya, Ajitha Sharma, Anuroop Venkatesh, Rhea Alva
December 2015, 7(12):547-552
DOI:10.4103/1947-2714.172841  PMID:26942130
Background: India is one of the seven identified Southeast Asian countries reporting frequent outbreaks of dengue fever (DF). Aims: This study was to analyze clinical and laboratory profile and predictive markers of thrombocytopenia and length of hospital stay in DF. Materials and Methods: This record-based retrospective study conducted in a coastal district of Karnataka, South India, included all dengue cases in adults aged >18 years, admitted during period of January 2011 to December 2014. Multivariate logistic regression analysis was carried out to compute odds ratio (OR) and 95% confidence interval (CI) to assess independent associations of variables with low platelet count and longer duration of hospital stay. Results: Among 207 dengue immunoglobulin M (IgM) antibody confirmed cases (mean age of 36.94 ± 14.61 years), 143 (69.1%) were males and 64 were females. The mean duration of illness and hospital stay were 4.94 ± 3.58 days and 5.98 ± 2.58 days, respectively. Abdominal symptoms included nausea and vomiting (53.6%), abdominal pain (25.1%), and diarrhea (13.5%). Bleeding manifestations were seen in 24 (11.6%) cases and fluid accumulation was revealed in 18 (8.7%) cases. The mean platelet count was 110,159.42 ± 68,397.32 (cells/mm 3 ). Low platelet count on admission was associated with the presence of rash (OR = 0.43, 95% CI 0.23-0.81), high aspartate aminotransferase (AST) levels (OR = 3.14, 95% CI 1.58-6.23), high alanine aminotransferase (ALT) levels (OR = 2.91, 95% CI 1.55-5.47), and low albumin levels (OR = 4.48, 95% CI 1.02-19.75). The duration of hospital stay was associated with diarrhea (OR = 0.4, 95% CI 0.18-0.9), abdominal pain (OR = 0.52, 95% CI 0.27-1.00), ascites (OR = 0.26, 95% CI 0.09-0.69), and low hemoglobin (OR = 0.46, 95% CI 0.25-0.86) level on admission. Conclusions: Though thrombocytopenia on admission was associated with the presence of rash, high AST and ALT levels, and low albumin levels, it was not predictive of length of hospitalization. Duration of hospital stay was longer with the presence of diarrhea, abdominal pain, ascites, and low hemoglobin level on admission.
  1 1,750 400
REVIEW ARTICLE
Histomolecular structural aspects of high endothelial vessels in lymph node and its significance in oral cancer and metastasis
Chandrasekar Poosarla, Arvind Babu Rajendra Santosh, Swetha Gudiseva, Indira Meda, Venkat Ramana Reddy Baddam
December 2015, 7(12):540-546
DOI:10.4103/1947-2714.172839  PMID:26942129
Molecular cancer research studies focus on identifying diagnostic, screening, and metastatic indicators, and monitoring therapeutic responses. Migration of tumor cells and lymphocytes are important aspects in metastasis. High endothelial vessels are specialized histological structures identified in the blood vessels in lymphoid organs, which allow the migration of lymphocytes. In the recent decades, the role of high endothelial vessels is being addressed in cancer metastatic research. This review article is to highlight the histological and molecular structural aspects of high endothelial venules (HEVs) in the lymph node, and to demonstrate the role of HEVs in oral cancer metastasis, specifically oral and pharyngeal squamous cell carcinoma. The literature for the present paper were searched from the data sources such as Medline/PubMed, CINAHL plus, and gray literature sources from inception to May 2015. Searches were conducted using both free texts and medical subject headings related to the title of the present paper. Only the full text manuscripts of the search results that support the objective(s) of the paper and papers written in English were included. HEVs are unique structures that are identified in the lymphocytes and primarily assist in the lymphocytic migration from the blood stream into the lymph node. Understanding the histomolecular characteristics of HEV will allow researchers to develop novel therapeutic approaches in cancer tissues.
  1 2,444 804
CASE REPORTS
New right bundle branch block as a criterion for emergent coronary angiography
Jonah M Pozen, Anit K Mankad, John T Owens, Ion S Jovin
December 2015, 7(12):569-571
DOI:10.4103/1947-2714.172849  PMID:26942134
Context: ST-segment elevations in two or more contiguous leads or new left bundle branch block (LBBB) on electrocardiography (ECG) in a patient with acute onset chest pain are diagnostic criteria for acute myocardial infarction (AMI) and generally warrant urgent coronary angiography and cardiac catheterization. However, the significance of new right bundle branch block (RBBB) without other acute ECG changes is unclear and is currently not considered a criterion. Case Report: We present a patient with chest pain, positive biomarkers of myocardial necrosis and isolated new right bundle block on ECG. He was diagnosed with AMI but did not undergo urgent reperfusion therapy in the absence of ST-segment elevations or new LBBB. However, angiography ultimately demonstrated complete coronary occlusion. Conclusion: The established criteria for emergent catheterization may prove to be more sensitive with the inclusion of the presence of new RBBB on ECG.
  - 1,423 297
COMMENTARY
Metabolic signatures of oxidative stress in the red blood cells: Editorial commentary
Ezekiel Uba Nwose
December 2015, 7(12):567-568
DOI:10.4103/1947-2714.172847  PMID:26942133
  - 857 89
LETTERS TO EDITOR
HIV/AIDS prevention and control in India: Achievements and future Challenges
Harshal T Pandve, Purushottam A Giri
December 2015, 7(12):575-576
DOI:10.4103/1947-2714.172853  PMID:26942136
  - 1,476 178
Endometrial cancer and the role of statins
Ammar Humayun, Muhammad Shahzeb Khan, Syed Arish Haider, Mohammad Hussham Arshad, Ekta Golani
December 2015, 7(12):577-579
DOI:10.4103/1947-2714.172855  PMID:26942137
  - 978 147
ORIGINAL ARTICLES
Metabolic signatures of oxidative stress and their relationship with erythrocyte membrane surface roughness among workers of manual materials handling (MMH)
Subrata Ghosh, Muktish Acharyya, Titlee Majumder, Anandi Bagchi
December 2015, 7(12):558-566
DOI:10.4103/1947-2714.172846  PMID:26942132
Background: Brickfield workers in India perform manual materials handling (MMH) and as a result, are at a high risk of developing oxidative stress. This results in an alteration of the various markers of metabolic oxidative stress at the cellular level. Since red blood cell (RBC) is the central point where oxygen, glucose-6-phosphate dehydrogenase (G-6-PD), and glutathione (GSH) are involved, the surface roughness and its alteration and modeling with respect to workers exposed to MMH may be considered as helpful determinants in predicting early damage to the cell and restoring better health to the exposed population, that is, the worker exposed to stress. Hence, nanometric analysis of the surface roughness of the RBC may serve as an early indicator of the stress-related damage in these individuals. Aims: The purpose of the study was to identify early red blood corpuscular surface damage profile in terms of linear modeling correlating various biochemical parameters. Linear modeling has been aimed to be developed in order to demonstrate how individual oxidative stress markers such as malondialdehyde (MDA), G-6-PD, and reduced GSH are related to the RBC surface roughness [root mean square (RMS)]. Materials and Methods: Conventional analysis of these biochemical responses were evaluated in MMH laborers (age varying between 18 years and 21 years) and a comparable control group of the same age group (with sedentary lifestyles). Peak expiratory flow rate (PEFR) and RBC surface analysis by atomic-force microscopy (AFM) and correlated scanning probe microscopy (SPM-analytical software) with corresponding image analysis were performed immediately after completion of standardized exercise (MMH) at the brickfield. Results: A number of correlated significances and regressive linear models were developed among MDA, G-6-PD, GSH, and RBC surface roughness. Conclusion: It appears that these linear models might be instrumental in predicting early oxidative damages related to specific occupational hazards.
  - 1,425 151
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