Tropical endomyocardial fibrosis: an overview

Tropical endomyocardial fibrosis is the commonest form of endemic restrictive cardiomyopathy that affects mainly children and adolescents, and is geographically restricted to some poor areas in the tropical and subtropical regions of the world such as Africa, Latin America and Asia including southern districts of India especially in the coastal belt of Kerala state. Sub-endocardial fibrosis affecting the apices and the inflow tracts of the right or left ventricle, or both; and varying degree of atrioventricular valve regurgitation defines the disease. Chronic systemic venous hypertension and severe pulmonary hypertension are characteristic features of right ventricular and Left ventricular endomyocardial fibrosis respectively. Due to lack of resources for research in the disease endemic areas, the exact epidemiology, etiology and pathogenesis remain unknown, and the natural history is incompletely understood. Various infections and toxic factors were postulated regarding its etiology. During the last few years, incidence of the disease has decreased considerably because of the significant improvement in the living standards of the people with the corresponding decline in the childhood malnutrition, infections, worm infestations and associated eosinophilia. It is a condition with high morbidity and mortality, for which no effective therapy is available. However, surgical management improves the natural history of this disease to some extent. We have conducted a systematic review of the most intriguing aspects of epidemiology, natural history, clinical picture and management of endomyocardial fibrosis, proposing new ways to increase research into this challenging and neglected cardiovascular disease. We relied primarily on articles in the MEDLINE database with either ‘‘endomyocardial fibrosis’’ or ‘‘endomyocardial sclerosis’’ in the title.

A study of Helicobacter pylori infection in diabetes mellitus

Background: Helicobacter pylori is the most common bacterial infection in human beings. The aim was to study the association of Helicobacter pylori infection in patients of diabetes mellitus. Design of the study was observational analytic cross sectional study.Methods: A total of 69 subjects were studied. Of these 30 were non diabetics and 39 were diabetics, with disease duration more than 1 year. The serological diagnosis of H. pylori was made by Anti- Helicobacter pylori antibody test. Antral biopsies of all diabetic patients were taken during endoscopy and subjected to histological examination.Results: The mean age for the diabetics was 48.9±9.86 years and that of non-diabetics was 47.9±9.16 years. The majority of the subjects belonged to fifth and sixth decades. There was conspicuous male preponderance in both the diabetics and the nondiabetics group, more attributable to the selection bias. Serum samples of all the subjects were tested for the presence of IgG against Helicobacter pylori. Helicobacter pylori was positive in 40% of non-diabetics and 64.1% of diabetics X2 = 3.96, p value=0.047 (p<0.05) i.e. the prevalence of Helicobacter pylori in diabetics is significantly higher than that in non-diabetics. Histological examination of antral biopsies (known to be the gold standard method of diagnosing Helicobacter pylori) was performed in all diabetics and comparison of the type of diabetes, duration of diabetes, and level of glycaemia and complications of diabetes were made in patients of diabetes with and without Helicobacter pylori. This study showed patients with IDDM had higher positivity (75%) than those of NIDDM (67.6%). The mean duration of diabetes with Helicobacter pylori group was 7.85+3.93 years, and higher than that of diabetics without Helicobacter pylori which was 5.83±2.52. The mean fasting blood sugar was 192±60.3 mg/dl in diabetics with Helicobacter pylori group and was higher than that of diabetics without Helicobacter pylori group which was 167±37.1mg/dl. The mean post prandial blood sugar in diabetics with Helicobacter pylori group was 318±78.4mg/dl and was more than that of diabetics without Helicobacter pylori group in whom it was 280±49.7mg/dl. The two diagnostic modalities viz serological and histological identification of Helicobacter pylori correlated well with each other. It was observed that serological diagnosis by Anti- Helicobacter pylori antibody test is 80% sensitive and 75% specific.Conclusions: The prevalence of Helicobacter pylori is higher in diabetics than the non-diabetics. The prevalence of Helicobacter pylori infection had no significant correlation with duration of diabetes, type of diabetes, glycaemia levels of diabetics and complications of diabetics. The serological diagnosis of H. pylori was made by Anti- Helicobacter pylori antibody test, by Biochem Immuno systems ITALIA SPA ELAGEN Helicobacter pylori IgG Kit. This ELISA technique is 80% sensitive and 75% specific

Hemichorea as a presentation of acute rheumatic fever: a case report

Chorea is a major manifestation of acute RF and is the only evidence of RF in approximately 20% of cases. We report on a 15-year-old boy who presented with transient right side involuntary jerky movements, apical systolic murmur, sinus bradycardia, arthralgia, elevated antistreptolysin O titer and ESR, who was diagnosed with acute rheumatic fever and improved with haloperidol, prednisolone, digoxin, aspirin and furosemide and was given benzathine penicillin prophylaxis for future RF. Patient is faring well in follow up visits. We present our case because of its rarity

Staphylococcus aureus septicemia presenting as disseminated intravascular coagulation - thrombotic thrombocytopenic purpura overlap and thrombus in inferior vena cava, right atrium and right ventricle: a case report

Staphylococcal sepsis following furunculosis and complicated by suspected deep vein thrombosis and septic inferior vena caval, right atrium, right ventricle emboli accompanied by disseminated intravascular coagulation (DIC) - thrombotic thrombocytopenic overlap in a 65 years old lady is presented. She was managed successfully with antibiotics and anticoagulation. The case is reported for its rarity and brings to light the vivid manifestations of septicemia specially staphylococcal

Miller Fisher syndrome/acute motor axonal neuronopathy overlap an atypical manifestation of malaria: a case report

Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures

Correlation of non alcoholic fatty liver disease in patients of coronary artery disease

Background: In NAFLD, increase in factor VIII and a reduction of protein C leads to the progression from steatosis to cirrhosi. The aim was to study the correlation of NAFLD with other associated risk factors of CAD.Methods: A total number of 100 patients of coronary artery disease were assessed for presence of NAFLD, dyslipidemia, metabolic syndrome & diabetes by various laboratory tests.Results: 46% of the CAD patients were found to have NAFLD. 69.6% patients of NAFLD were in the age group of 40-60 years. 21.7% were above 60 years. 91.1% of NAFLD patients were males. Half of the NAFLD patients were diabetic. 21.7% of NAFLD patients were found to have a total cholesterol level >200. Triglyceride level was also high among these patients (58.7%). All the NAFLD patients had LDL <100. 52.2% of them had metabolic syndrome.Conclusions: The study showed a direct correlation between NAFLD & CAD. Metabolic syndrome, diabetes, increased total cholesterol & triglyceride level were also associated with increased risk for CAD. However LDL level was not found to be associated with NAFLD risk

A study of clinico-microbiological profile and outcome of urinary tract infection in diabetic kidney disease in a tertiary care hospital

Background: this study was done to give insight about the clinical and microbiological profile of UTI in DKD and its therapeutic outcome. Methods: Patient known case of DKD presenting with signs and symptoms of UTI were included in study. Patients known case of diabetes having diabetic retinopathy and albuminuria with at least UACR of &gt;30 mg/gm of creatinine were considered as having DKD. Results: We found, most common presenting symptom was fever, present among 35 (47.29%) patients followed by increased frequency of urination among 30 (40.54%) patients. Burning micturition and dysuria/flank pain was present among 20 (27.02%) patients and 10 (13.51%) patients respectively, lower abdominal pain in 08 (10.81%) patients. 52 (70.27%) patients’ culture were sterile and 22 (29.73%) patients’ culture were non-sterile. Out of 22 patients of non-sterile cultures, 16 (72.72%) patients have lower UTI compared to 06 (27.27%) patients with Upper UTI. E. coli was the most common organism cultured in both types of UTIs. Fungal growth (Candida tropicalis) was seen in 03 (50%) patient, all were cases of upper UTI. Conclusions: The clinical and microbiological profile of UTI in DKD doesn’t differ from UTI in diabetics and non-diabetics except for prolonged and severe course of disease. The microbiological susceptibility also doesn’t differ much. Lower age is associated with lower UTI. Upper urinary tract involvement is associated significantly with progression of CKD. Involvement of upper urinary tract should be sought in UTI in diabetics and patient with DKD and if found should be aggressively treated

A rare case of lutembacher syndrome in a young female: a case report from a rural population of Western Uttar Pradesh, India

Lutembacher syndrome is a rare entity presenting with a combination of congenital atrial septal defect with acquired mitral stenosis. Lutembacher syndrome is reported to be more prevalent in developing countries where the incidence of rheumatic fever is high. We also came across with a young female with the similar clinical presentation in our hospital situated in a rural area in Western Uttar Pradesh, India. Keeping in mind its rare occurrence, we are presenting an overview of this syndrome including its various aspects and the problems faced by the patients in rural scenario.

A case of resolution of inferior wall myocardial infarction and varying degrees of atrioventricular block: a case report

Inferior wall myocardial infarction (IWMI) complicating with high degree atrioventricular (AV) block had been a subject of discussion for a long time. Also the transient nature of these AV blocks in the presence of IWMI is well known to us. However our case presented with IWMI with right ventricular MI (RVMI) and in complete heart block and subsequently post thrombolysis developed varying degrees of AV block and reverted back to sinus rhythm. We found it as an incidence not much reported and thus reporting the case herewith

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively