Hounsfield units in pseudo subarachnoid hemorrhage: worth looking for

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Clinical profile and complication of malaria hepatopathy

This study was designed to study the patient characteristics, presenting features and complications of malaria in patients with elevated liver enzymes and to compare these data to those of patients with normal liver enzymes. A convenient sample of 100 patients with malaria was selected from three tertiary care referral hospitals. Study subjects were divided into two groups: [1] patients [controls] with normal liver enzymes and [2] patients [cases] with >3 times the normal liver enzymes in the absence of an alternate explanation for such elevation. Patient characteristics, presenting features and complications of malaria in these two groups were studied. Data were collected using a semi-structured pretested proforma and were analyzed using the statistical analysis program SPSS, version 11.5 [SPSS, Inc., Chicago, IL]. The mean ages were 38.12 years for the cases and 35.20 years for the controls with a non-significant p value of 0.289. Males composed 82% of the cases that were diagnosed with malarial hepatopathy; the remaining 18% were females. Falciparum malaria was present in 56% of the cases, compared to 12% of the controls. Icterus was present in 66% of cases of malarial hepatopathy, compared to 32% of the controls. Of the 66% of these cases, 18.18% had serum bilirubin >3 mg%, whereas out of the 32% of the controls presenting with icterus, only 5.55% had serum bilirubin >3 mg% [p = 0.003]. Of the cases with malarial hepatopathy, 38% suffered from hypoglycemia, compared to 0% of the controls [p < 0.001]; 84% of the cases presented with thrombocytopenia, compared to 70% of the controls [p < 0.001]; 12% of the cases suffered from renal failure with serum creatinine levels >2 mg%, compared to 2% of the controls [p = 0.060]. Plasmodium falciparum infection [either alone or along with P. vivax] is the leading cause of malarial hepatopathy. Jaundice is a common clinical manifestation among these patients. Patients with malarial hepatopathy have increased incidences of hypoglycemia and thrombocytopenia. Malarial hepatopathy occurs in relation to severe infection, most of which are treated with parenteral artesunate

Priapism, pomegranate juice, and sildenafil: Is there a connection?

We report the development of low flow priapism in three patients related to simultaneous consumption of sildenafil with pomegranate [Punica granatum] [POM] juice. There were no other concurrent diseases, intake of drugs, and chemicals or other risk factors in these patients. We want to create awareness among patients and practitioners for recognition and timely intervention. Probable mechanisms are highlighted

Significance of the Intima-media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population

Ultrasound detected intima-media thickness [IMT] of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease [CAD] in asymptomatic individuals. Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population. A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test. At plaque-free regions, the carotid IMT was evaluated by B-mode ultrasonography and thoracic aorta IMT was evaluated by trans-esophageal echocardiography [TEE]. The significance of difference in means between two groups was analyzed using one-way ANOVA F-test and the significance of difference in proportions by Chi-square test. Multiple comparisons were done by Bonferroni t test. The correlation between IMT and severity of CAD was assessed by Spearman's method. There were 38 males and 2 females among cases with age 51.7 +/- 8.3 years, and 28 males and 2 females among control subjects with age 52.2 +/- 7.1 years. Increased carotid IMT was noted among 24 cases and 2 control subjects, and the association was significant for CAD [P<0.001, Chi-square=20.89, odds ratio [OR]=21.00, and 95% confidence interval [CI]=4.78-89.59]. Similarly, 19 cases and one control subject had abnormal IMT with positive correlation for CAD [P<0.001, Chi-square=16.39, OR=28.24, and 95% CI=4.06-163.21]. There was no association between IMT and diabetes, hypertension, or smoking; however, IMT was significantly associated with age and dyslipidemia. Also, there was no correlation between extent of IMT and severity of CAD. IMT of the carotid and thoracic aorta is strongly associated with risk of CAD in a South Indian population, and may be used as a non-invasive screening tool for coronary atherosclerosis in resource-limited settings. The presence of dyslipidemia influenced IMT and may be used as a tool to follow patients on hypolipidemic drugs

Cardiovascular complications in ciguatera fish poisoning: a wake-up call

Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity. Although cardiovascular symptoms are rare with ciguatoxin, we report two cases with bradycardia and hypotension. Fatality and long-term sequelae are not uncommon with ciguatoxin poisoning and educating the general population is essential