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   2014| July-August  | Volume 6 | Issue 4  
    Online since July 12, 2017

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Morphology of papillary muscles in human adults: A cadaveric study
Mamatha Hosapatna, Anne D Souza, M Aswin Das, Supriya , Vrinda Hari Ankolekar, Antony Sylvan D Souza
July-August 2014, 6(4):168-172
Introduction: The papillary muscles (PM) play an important role in ventricular overextension. The variability in the number, shape and location of papillary muscle of the right and the left ventricle is important for the surgeon in reparative procedures, papillary muscle dysfunction, mitral valve replacement and use of mitral valve homograft for mitral/tricuspid replacement. Materials and Methods: The study was conducted using 15 formalin fixed adult human hearts. The presence, number, shapes, length, number of additional heads of the papillary muscles were observed. The presence of moderator band (MB) was noted and its level of attachment to the anterior PM was observed. Results: Double anterior and posterior PM were found in few cases. The length of PM was longer in the left ventricle when compared to the right ventricle which was statistically significant. In the right ventricle cone-shaped PM was observed in the majority of the cases whereas flat topped PM was observed in 2 cases. In the left ventricle all the PM were cone shaped. In majority of the cases (N=13) the MB was attached to the lower third of the PM whereas in one case each it was attached to the upper third and to the middle third respectively. Conclusions: The morphology and morphometry of the papillary muscles of both ventricles and moderator band were defined. These may help cardiac surgeons during surgical procedures conducted for correction of their defects.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  488 76 1
Homocysteine and hematological indices in hemodialysis patients
Maged M Yassin, Abdel Monem H Lubbad, Ahmed J Abu Taha, Nabil M Saadallah
July-August 2014, 6(4):173-179
Objectives: To explore the relationship between homocysteine and various hematological indices in hemodialysis patients. Patients and Methods: This casecontrol study comprised 60 hemodialysis patients and 60 healthy controls matched for gender and age. Hemodialysis duration was 3.2±2.9 year at frequency of 2.6±0.6/week. Hypertension and diabetes were the most common selfreported disorders among the hemodialysis patients. Results: Serum homocysteine was significantly higher in hemodialysis patients than in controls (50.8±9.7 vs. 13.1±3.7 μmol/l, P=0.000). White blood cell (WBC) and platelet (PLT) counts were significantly higher in hemodialysis patients than in controls [(7.18±2.37 ×109/L and 266.3±111.9 ×109/L vs 5.95±1.37 ×109/L and 222.0±54.1 ×109/L) with P=0.017 and P=0.045, respectively]. In contrast, red blood cell (RBC), hemoglobin, and hematocrit were significantly lower in hemodialysis patients (3.1±0.5 ×1012/L, 8.9±1.5 gm/dl and 26.3±4.6%) than in controls (4.0±0.4 ×1012/L, 12.8±1.6 gm/dl and 45.0±4.6%) with P=0.000. Prothrombin time (PT) and international normalized ratio (INR) were significantly higher in hemodialysis patients compared to controls (16±3 sec and 1±0 vs. 14±0 sec and 1.0±0.1, P=0.000), whereas activated partial thromboplastin time (APTT) was significantly decreased in hemodialysis patients (25±5 vs 33±2 sec, P=0.000). Homocysteine correlated directly with WBC count (r=0.338, P=0.008) and PLT count (r=0.369, P=0.000) whereas inverse correlations were found between homocysteine and RBC count (r=- 0.648, P=0.000), hemoglobin (r=-0.733, P=0.000) and hematocrit (r=-0.836, P=0.000). In addition, homocysteine showed direct correlations with PT (r=0.564, P=0.000) and INR (r=0.657, P=0.000) and inverse correlation with APTT (r=-0.690, P=0.000). Conclusion: Serum homocysteine was significantly higher in hemodialysis patients compared to controls. Homocysteine correlated directly with WBC count, PLT count, PT and INR, and inversely with RBC count, hemoglobin, hematocrit and APTT.
[ABSTRACT]   Full text not available  [PDF]
  429 61 -
Clinical characteristics, management and outcome of patients admitted with acute stroke in Benghazi, Libya
Anwaar Bennour, Fathia Ehmoda, Salah Bo-Shaala
July-August 2014, 6(4):159-167
Background: Stroke is the second leading cause of chronic disability and death in the world. Educating the public and physicians about stroke-related symptoms are critical success factors in early stroke treatment. Aim: This study was carried out in order to assess acute stroke management strategies in a teaching hospital. Patients and Methods: The study included all consecutive patients admitted to the general medical ward during the period of March to November 2008 who had a diagnosis of acute stroke. The total number was 217 patients, presumed to have stroke during their initial evaluation in the emergency room. However, ward evaluation confirmed only 193 patients to have a diagnosis of acute stroke (sudden onset of any neurological deficit). Brain imaging was performed in 167 out of the 193 patients. Results were obtained for 140 patients. Results: The age of those with clinical and radiological evidence of acute stroke (n=140) was 65±12 years. Sixty-five were females. The median time elapsed between the onset of symptoms and the arrival to the hospital was 12 hours (range: 1-336 h). Females presented earlier than males (19 hours versus 35 hours; p<0.05). Forty-eight patients (34%) presented within the first four hours and 71 (51%) arrived after eight hours, whilst 8 patients (6%) were not able to determine the time of onset of symptoms. The mean time for brain image from hospitalization was 3.5±2.3 days with no gender difference. Ischemic infarction was reported in 104/140 (74%) patients, intracerebral hemorrhage was reported in 16 (11%) patients and brain ischemia with hemorrhagic transformation was reported in 14 (10%). Normal brain images were found in 6 (5%) patients. 108 patients (78%) received in-hospital aspirin treatment with a mean time to start aspirin 1.2±1.4 days. The mean length of stay in hospital was 7.5±3.7 days. Ninety-nine (80%) of the patients were discharged on aspirin. The in-hospital outcome was assessed by the Rankin Disability Status scale as static course (in 107 patients; 85%), improvement of neurological function (in 10 patients; 8%), deterioration of neurological function (in 1 patient; 1%), or death (in 8 patients; 6%). Conclusion: Hospital arrival and performance of brain image were both delayed. Delayed arrival was attributed to lack of ambulance with direct transportation to the acute care hospital, waiting at the emergency department, and public's unawareness of stroke symptoms. The delay in performing brain image is the limited access to CT/MRI facility on site and out of hours. Public and professional education campaign coupled with an effective acute treatment strategies are urgently needed.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  425 55 3
Experience with nasotracheal intubation: Description of the procedure and outcomes
Wael Abdulla Sadaqa, Dina Abujaber
July-August 2014, 6(4):185-188
Background: Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia. The procedure for intubation involves achieving neuromuscular blockade followed by passing the endotracheal tube (ETT) into the trachea. Objectives: Our hypothesis was that the nasopharyngeal passage of the endotracheal tube can be facilitated by the finger of a sterile glove acting as a pathfinder. Patients and Methods: We performed a randomized controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, the tip of the ETT was inserted into the finger of a sterile glove before the ETT was inserted into the more patent nostril. In the control group (n=40), the gloves finger was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter: 7.0 mm). In the intervention group (n=40), the finger of a sterile glove was kept in position. The tip of the endotracheal tube is inserted into the gloves finger. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx when the gloves finger was removed and intubation completed. Results: The pathfinder technique reduced the incidence (p<0.001), and severity (p = 0.001) of bleeding, decreased tube contamination with blood and mucus (p< 0.001), and diminished postoperative nasal pain (p=0.035). Conclusion: Our study results suggest that nasopharyngeal passage of the endotracheal tube can be facilitated by (a sterile gloves finger) acting as a pathfinder.
[ABSTRACT]   Full text not available  [PDF]
  406 61 -
Type 1 diabetes presenting after bariatric surgery: A medical paradox leading to a delayed diagnosis and diabetic ketoacidosis
Khadija Hafidh, Saira Abbas
July-August 2014, 6(4):189-192
The relationship between type 2 diabetes and obesity is well established;however obesity at onset of type 1 diabetes is fairly uncommon. We present a19 year old man who was diagnosed with type 1 diabetes after considerable weight loss following bariatric surgery. This unexpected medical paradox may have led to the delayed recognition of the type of diabetes resulting in decompensation into diabetic ketoacoidosis.
[ABSTRACT]   Full text not available  [PDF]
  404 50 -
Percutaneous distal limb perfusion via portable, miniaturized, extracorporeal membrane oxygenation resuscitation
Bryan A Whitson, Ranjit John, Sylvester M Black, Alan K Berger
July-August 2014, 6(4):193-195
As extracorporeal membrane oxygenation systems become miniaturized, their role for rapid implementation, as an adjunct to resuscitation and high-risk percutaneous interventions, grows. We describe a percutaneous approach to short term mechanical circulatory support, in the setting of cardiogenic shock, which employs a percutaneous, self-contained, distal limb perfusion system. We feel that this technique is highly important for both interventional cardiologists and cardiothoracic surgeons as well.
[ABSTRACT]   Full text not available  [PDF]
  392 49 -
Vancomycin creep and daptomycin minimum inhibitory concentration in methicillin-resistant staphylococcus aureus
Ashwaty Nandakumar, Anil Kumar, Kavitha R Dinesh, Shamsul Karim
July-August 2014, 6(4):180-184
Objective: To determine the in vitro activity of daptomycin and vancomycin against 50 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from blood and pus specimens. Material and methods: Fifty consecutive MRSA were isolated from pus (n=25) and blood (n=25) were included in the study. Oxacillin susceptibility was determined by cefoxitin disc diffusion, green colored colonies on chromogenic media. Susceptibility testing for 18 antimicrobial agents was determined by a disc diffusion method. The minimum inhibitory concentration (MIC) of daptomycin and vancomycin was determined by the Etest as recommended by the Clinical and Laboratory Standards Institute (CLSI). Results: Antibiotic susceptibility pattern of the MRSA isolates showed that 38% were multi-drug resistant overall and 52% in blood and 24% in pus isolates when expressed separately. The MIC50 and MIC90 of daptomycin were 0.08 and 0.09 mg/L and of vancomycin were 1.2 mg/L and 1.3 mg/L, respectively. Ten percent of the isolates had vancomycin MIC of 2 mg/L which is the upper limit of CLSI breakpoint for sensitive isolates. None of the isolates showed intermediate susceptibility or resistance to vancomycin or daptomycin. Conclusion: Creeping MIC of vancomycin is a matter of concern and MIC of 1.5–2 mg/L of vancomycin in MRSA increases the risk of development of complicated bacteraemia. MIC's of vancomycin should be reported for all S. aureus isolates and should be used to guide treatment. Otherwise, daptomycin can be considered as an alternative antibiotic for therapy of MRSA infections in India.
[ABSTRACT]   Full text not available  [PDF]
  377 52 -