Severe primary hypothyroidism presenting as polymorphic ventricular tachycardia / Hipotiroidismo primario grave que se presenta como taquicardia ventricular polimórfica

Abstract Introduction: Hypothyroidism may have various cardiovascular manifestations due to morphological, functional and electrical alterations in the heart. The usual electrocardiographic findings being sinus bradycardia, low voltage complexes, and slowed intraventricular conduction. Hypothyroidism manifesting as polymorphic ventricular tachycardia has only been reported in a few case reports. Clinical case. A 60-year-old lady presented to us in the emergency department in an unresponsive and unconscious state and electrocardiogram showed a polymorphic ventricular tachycardia. After initial resuscitation with direct current cardioversion and supportive care, she found to have severe hypothyroidism and responded well to thyroid replacement therapy. Conclusion. Polymorphic ventricular tachycardia is a life threatening emergency that can have various etiologies. Polymorphic ventricular tachycardia secondary to primary hypothyroidism is a rare presentation but it is treatable and reversible with thyroid replacement therapy. In patients presenting with QT interval prolongation and ventricular tachycardia, hypothyroidism should be one of the differential diagnosis.

Resumen Introducción: El hipotiroidismo puede presentar diferentes manifestaciones cardiovasculares dadas por alteraciones morfológicas, funcionales y eléctricas en el corazón, siendo los hallazgos electrocardiográficos usuales son la bradicardia sinusal, los complejos de bajo voltaje y la conducción intraventricular lenta. El hipotiroidismo manifestado como taquicardia ventricular polimórfica solo se ha descrito en unos pocos reportes de caso. Caso clínico: Se trata de una mujer de 60 años que acudió que acurdió al servicio de urgencias en un estado inconsciente y sin respuesta a estímulos, y el electrocardiograma reveló taquicardia ventricular polimórfica. Luego de la reanimación inicial con cardioversión con corriente directa y tratamiento sintomático se le encontró un hipotiroidismo grave, el cual se trató con terapia de reemplazo con hormona tiroidea. y se obtuvo una buena respuesta Conclusión. La taquicardia ventricular polimórfica es una emergencia vital que puede tener varias etiologías. La taquicardia ventricular polimórfica secundaria a un hipotiroidismo primario es una presentación poco común, pero es tratable y reversible con la terapia de reemplazo con hormona tiroidea. En los pacientes que presentan una prolongación del intervalo QT y taquicardia ventricular, es pertinente incluir el hipotiroidismo en el diagnóstico diferencial.

Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization

Background: The distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery. Methods: Total of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization. Results: The mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p < 0.001). Females had significantly smaller radial artery diameter as compared to males at right conventional access site (2.42 ± 0.36 mm vs 2.60 ± 0.34 mm; p < 0.001) and distal access site (2.09 ± 0.38 mm vs 2.27 ± 0.39 mm; p < 0.001). The diameter of the right dRA was not significantly correlated with age (r2 linear ¼ 0.002, p ¼ 0.0475) but was positively correlated with height and weight (r2 linear ¼ 0.076, p ¼ <0.001 and r2 linear ¼ 0.005, p ¼ <0.001) and negatively correlated with BMI (r2 linear ¼ 0.076, p ¼ 0.519). Conclusions: This study has shown the size of right dRA 2.27 þ 0.39 mm in males and 2.09 þ 0.38 mm in females. Diabetes, hypertension, height and weight are important predictors of dRA diameter

Telemedicine during coronavirus disease-19 pandemic: a paradigm shift in cardiovascular care / La telemedicina durante la pandemia del COVID-19: un cambio de paradigma en la atención cardiovascular

Abstract Introduction: Severe acute respiratory syndrome due to coronavirus disease (COVID-19) has overwhelmingly affected the health-care systems globally. Delivering cardiovascular care has become unusually difficult both for caregivers and physicians in these unprecedented times. Methods: We briefly reviewed how cardiac care can be delivered to patients while limiting the exposure of both patients and healthcare workers through telemedicine services. We made a comparison at our institute of outpatient services through routine and telemedicine visits. Results: We found that telemedicine can be an equally effective alternative cardiac care during the times of pandemic with no significant difference in patients profile admitted through telemedicine services. Conclusions: We concluded that telemedicine can prove to be an effective tool in delivering cardiac care by limiting exposure of both patients and physicians with better triage of cardiac patients in the situation of COVID-19 pandemic and may complement to regular cardiac care in routine times.

Resumen Introducción: El síndrome respiratorio agudo grave dado por el COVID-19 ha afectado de manera abrumadora a los sistemas de salud a nivel mundial. La prestación de servicios de atención cardiovascular se ha tornado inusualmente difícil tanto para los cuidadores como para los médicos en estos tiempos inéditos. Métodos: Realizamos una revisión breve de cómo se puede brindar atención cardíaca a los pacientes a la vez que se limita la exposición tanto de pacientes como del personal de la salud a través de los servicios de telemedicina. Comparamos los servicios ambulatorios habituales con las visitas de telemedicina en nuestro instituto. Resultados: Encontramos que la tele medicina puede ser una alternativa igualmente efectiva de atención cardíaca durante tiempos de pandemia, sin ninguna diferencia significativa en el perfil de los pacientes ingresados a través de los servicios de telemedicina. Conclusiones: Concluimos que la telemedicina puede convertirse en una herramienta efectiva para proporcionar atención en salud cardíaca al limitar la exposición tanto de pacientes como de médicos con un mejor triage de pacientes cardíacos en el contexto de la pandemia por COVID-19, y puede llegar a ser un complemento de la atención cardíaca habitual en tiempos normales.

Study of Efficacy of Tramadol as an Adjuvant to Lignocaine in Intravenous Regional Anesthesia at a Tertiary Care Teaching Centre

Introduction: Tramadol is a central analgesic with an opioid agonistic activity with some selectivity for µ-receptors. Several studies showed that tramadol is beneficial as an additive to local anesthetics in different regional nerve blocks including infiltration, caudal block, brachial plexus block and IVRA. However, the existing data on its role as an additive for IVRA are conflicting. Therefore, a prospective, randomized controlled trial was conducted to determine efficacy of Tramadol (100mg) as an intra-operative, post-operative and pre-emptive analgesic as an adjuvant to lignocaine in IVRA. Materials and Methods: Present study was   carried   out   in   80   patients   undergoing   upper arm orthopedic surgery at Sharda Hospital, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India. All patients selected were planned for forearm surgeries, of ASA Grade I or II, aged 16-60 years. Patients received 0.5% lignocaine 40 ml in one group and we added Tramadol 100 mg in the other group. All the patients were monitored for onset of effect, quality of anesthesia, post op analgesia after deflation of tourniquet, time of first analgesic drug and number of analgesic drug required in first 24 hrs. Results: Onset of sensory analgesia was significantly earlier in group B (59.7±23.8 sec v/s 196.3±42.7) while onset of motor paralysis was similar in both groups. The post-operative analgesia was significantly longer in group B (304.7 ± 87.9 mins) then group A (12.6 ± 5.1 mins). Accordingly the number of analgesics consumed in post-operative first 24 hours was significantly less in group B (1.2±0.6) then group A (2.9±0.8). Conclusion: Tramadol has favorable effects as an adjuvant to lignocaine for IVRA. Tramadol substantially shortens the onset of sensory block, improves patient’s tolerance of tourniquet, prolongs the duration of analgesia after deflation of tourniquet and reduces the postoperative analgesic consumption.

Intraosseous mucoepidermoid carcinoma of the mandible - a rare case report

Introduction: Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The majority of these tumors arises in the parotid and minor salivary glands but may rarely develop intraosseously. Primary intraosseous mucoepidermoid carcinoma (PIOC) of the jaw bones is an extremely rare malignant salivary gland tumor. Very few cases have been reported in the literature to date. Case report: The current manuscript highlights clinical and radiographic features of a rare case of PIOC in a 32 year old Indian female patient. Conclusion: All the dental practitioners should be aware of the protean features of central MEC. These lesions should be included in the differential diagnosis of unilocular and multilocular radiolucent lesions of the jaws. An early and accurate diagnosis is important so that the neoplastic transformation must be identified and treated effectively.

Masseteric cysticercosis: an uncommon appearance diagnosed on ultrasound

Introduction: Cysticercosis occurs when man is infested by the larvae of Taenia solium. Cysticercosis involving the maxillofacial region is not only an uncommon event, but also represents a difficulty in clinical diagnosis. Objective: The present manuscript highlights masseteric cysticercosis as a differential diagnosis of chronic maxillofacial swellings and the role of high resolution sonography as an important noninvasive and non-ionizing imaging modality. Case report: We present a case of masseteric cysticercosis in an eight year old Indian boy, its clinical features, the imaging modalities required and adequate management of the case. Conclusion: Cysticercosis should always be a part of the differential diagnosis of maxillofacial swellings. A thorough case history, clinical examination, proper investigations and conservative treatment forms the mainstay for management of affected patients.

Synthesis of Some Novel Heterocyclic 1,2,4-triazolo [3,4-b][1,3,4] Thiadiazole Derivatives as Possible Antimicrobial Agents.

A series of 6-aryl-3- (3,4–dialkoxyphenyl) -[1,2,4]triazole [3,4-b][1,3,4] thiadiazole (7a-7o) were synthesized by condensing 4-amino-5-(3,4-dialkoxyphenyl)-4H-[1,2,4]- triazole-3-thiol (6) with various aromatic carboxylic acids in the presence of phosphorous oxychloride through one-pot reaction. The structures of these newly synthesized compounds were confirmed on the basis of IR, 1H NMR and mass spectral studies. All the synthesized compounds were screened for their antimicrobial activity against a variety of microorganisms.