Association of vitamin D deficiency and VDBP gene polymorphism with the risk of AMI in a Pakistani population

OBJECTIVE: To investigate the relationship of vitamin D deficiency and risk of AMI in a Pakistani population, and to find out any associationbetween vitamin D binding protein (VDBP) genotypes and risk of AMI in this population.METHODS: In a comparative cross-sectional study, 246 patients (age: 20-70 years; 171 males and 75 females) with first AMI were enrolled with informed consent. Similarly, 345 healthy adults (230 males and 115 females) were enrolled as controls. Their fasting serum samples were analyzed for 25 (OH) vitamin D, lipids and other biomarkers using kit methods, while DNA was analyzed for VDBP genotypes using PCR-RFLP based methods. Chi-squared test and logistic regression were used for association of vitamin D deficiency and VDBP genotypes with AMI.RESULTS: Mean serum concentration of 25(OH) vitamin D was significantly lower in AMI patients compared to healthy subjects (p=0.015) and percent vitamin D deficiency was higher in AMI patients compared to healthy subjects (p=0.003). VDBP IF-IF genotype was positively associated with the risk of AMI in subject above 45 years after adjusting for potential confounders [OR = 9.86; 95% CI=1.16 to 83.43].CONCLUSION: Vitamin D deficiency and VDBP IF-IF genotype are associated with AMI in Pakistani adults

Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations

A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmia

Dengue and malaria infections in pregnancy: Maternal, fetal and neonatal outcomes at a tertiary care hospital

Background: Malaria and dengue cause major morbidity in developing nations and are more severe in pregnancy. Maternal, fetal, and neonatal outcomes in pregnant patients infected with dengue or malaria were studied.Methods: The medical records of pregnant women admitted with either dengue or malaria infections from 2011-2015 to this hospital were reviewed. Clinical outcomes and laboratory tests were examined.Results: Of 85 women, 56%, 21%, and 22% had contracted dengue, malaria, and multiple infections, respectively. Pregnant women who had contracted dengue fever alone were more likely to present to the hospital at an earlier gestational age (24 weeks, p = 0.03). Women with multiple infections, were more likely to deliver earlier (30 weeks, p \u3c 0.01). Women with malaria were more likely to have low birth weight deliveries (mean birth weight 2394 g, p = 0.03). The incidence of in-hospital deaths among the cohort was 7%.Conclusion: It is imperative to develop guidelines to screen for and diagnose dengue and malaria in pregnancy

Novel Repair of Clamshell Thoracotomy Sternal Dehiscence after Lung Transplant: A Case Report

Bilateral transverse thoracosternotomy, or “clamshell” thoracotomy, can be complicated by dehiscence. A 65-year-old male underwent lung transplantation via clamshell thoracotomy, with subsequent sternal dehiscence on postoperative day 11. Upon repair, the previous sternal wires had pulled through, so a Sternal Talon connected to a Recon Talon was utilized to re-approximate the inferior sternum. On follow-up at 3 months, the patient recovered well. Use of the Sternal Talon provides an effective technique for repairing transverse sternal dehiscence

Colonic Interposition for Salvage Esophagectomy with Supercharging

This video shows a case in which a colonic interposition is performed to restore enteric continuity after a failed Ivor-Lewis esophagectomy in a sixty-one-year-old male. This initial surgery was performed to treat distal esophageal cancer. Because of a leak after the index esophagectomy, the patient required a cervical diverting esophagostomy. The video authors demonstrate the reconstruction technique utilizing a retrosternal approach for passage of an isoperistaltic segment of transverse colon, followed by supercharging the conduit with additional arterial inflow and venous outflow.  To begin, an exploratory laparotomy was performed, followed by mobilization of the transverse colon after identification of the middle colic vessels. Next, the existing cervical esophagostomy was taken down, followed by left sternoclavicular joint resection. After creation of a retrosternal tunnel, the conduit was passed from the abdomen into the neck, where a hand-sewn coloesophageal anastomosis was performed. The anastomosis was “supercharged” via a microvascular anastomosis between the left internal mammary artery and middle colic artery, in addition to microvascular venous anastomosis using a portion between the left internal mammary vein and colonic recipient vein (1, 2). Subsequently, an end-to-side stapled cologastric (distal conduit) anastomosis with pyloroplasty was performed, followed by an end-to-side stapled colocolonic anastomosis to restore intestinal continuity.  In conclusion, a colonic interposition using isoperistaltic transverse colon via retrosternal passage is a viable technique for a salvage esophagectomy when complications arise from a standard esophagectomy. It may be possible to consider supercharging the conduit with additional arterial inflow and possibly venous outflow to decrease risk of anastomotic complications. Reference(s) Yasuda T, Shiraishi O, Iwama M, Makino T, Kato H, Kimura Y. Novel esophageal reconstruction technique via transmediastinal route from posterior to anterior mediastinum after esophagectomy. J Thorac Cardiovasc Surg. 2018;156(2):859-866. Schraufnagel DP, Ahmad U, Raja S. Supercharged through a tunnel, is it an action movie? No, it’s a novel esophageal reconstruction! J Thorac Cardiovasc Surg. 2018;156(2):867-868.</p