Intracardiac melanoma metastases on 18F-FDG PET-CT-a case report and review of literature with imaging features.

Cutaneous malignant melanoma is one of the few malignancies that can metastasize to the heart. It is important not to miss cardiac metastases on imaging as they are often clinically asymptomatic, but if present and undiagnosed could lead to significant cardiac compromise, arrhythmias, congestive heart failure, cardiac tamponade or transient ischaemic attacks. Identifying intracardiac metastases on imaging often requires a multimodality approach as they can evade detection due to cardiac motion artefact; be confused with intracardiac thrombus, or be misinterpreted as a normal/anatomical finding. We present an interesting case report of asymptomatic intracardiac melanoma metastases, initially identified on staging 18-fludeoxyglucose positron emission tomography-CT and eventually confirmed on cardiac MRI. The latter was able to differentiate myocardial metastases from tumour thrombus. We also review the relevant literature.

Mannose-Binding Lectin Levels and Carotid Intima-Media Thickness in Type 2 Diabetic Patients.

INTRODUCTION: Mannose-binding lectin (MBL) activates complement system and has been suggested to play a role in vascular complications in diabetics. Carotid intima-media thickness (cIMT) detects subclinical atherosclerosis. We evaluated the association of MBL and IMT in type 2 diabetic (T2DM) patients. METHODS: Serum MBL levels and cIMT were measured in a total of 103 diabetics and in 98 age-matched healthy controls. RESULTS: There was no significant difference in MBL level in T2DM versus controls. As expected, IMT was significantly higher in T2DM patients than in controls (P = 0.001). In T2DM, the lowest cIMT was seen in patients with normal MBL level (500-1000) while cIMT continuously increased with both high MBL and absolute MBL deficiency states. This was especially significant in high MBL versus normal MBL T2DM patients (P = 0.002). According to multiple regression analysis the main predictors of IMT in T2DM are age (P < 0.003), ApoA level (P = 0.023), and the MBL (P = 0.036). CONCLUSIONS: Our results suggest a dual role of MBL as a risk factor for cIMT in T2DM. MBL may also be used as a marker of macrovascular disease, as both low and high levels indicate the susceptibility for atherosclerosis in T2DM.

Tension pneumocephalus: a case report with review of literature.

Tension Pneumocephalus (PC) was described 50 years ago. A case of pneumocephalus (PC) following cervical epidural injection in a 50-year-old male worsened by air travel and manifested as tension pneumocephalus, confirmed by advanced neuroimaging, is reported for the first time along with literature review. The patient underwent emergent frontal burr hole evacuation and air gushed under pressure. The patient recovered well and is stable during a follow-up of 12 months. Presenting features and clinical course along with Mount Fuji sign, Peaking sign, and air bubble sign observed in this case are described. Also, the importance of considering neurosurgical and spinal procedures leading to PC have to be considered by practitioners before issuing fitness certificate before air travel, as PC is likely to get transformed to tension PC and can cause an in-flight emergency.

Acute renal failure in acute poisoning: prospective study from a tertiary care centre of South India.

BACKGROUND: Cases of people presenting with poisoning are likely to develop acute renal failure (ARF), which may be due to multiple mechanisms/aetiologies. These cases need careful observation and appropriate treatment. OBJECTIVE: To find the risk of ARF among acute poisoning cases, identify the underlying causes and to analyse the outcome. MATERIAL AND METHODS: In this prospective study with nested case control, 1,250 cases admitted to the Poison Control, Training and Research Centre of Government General Hospital, Madras Medical College were monitored and evaluated for development of ARF. Patients with history of diabetes/hypertension, known chronic kidney disease, chronic NSAID therapy, those on drugs that increase serum creatinine by inhibiting creatinine secretion and other co-morbid illnesses were excluded. Data were interpreted after subjecting them to bivariate logistic regression and then step wise multivariate analysis. RESULTS: Thirty-two cases developed ARF. Twenty-four were due to snake bite, the rest due to chemical poisons. Chances of developing ARF were greater (6.15%) among the poisoning due to bites and stings than chemical poisoning (0.9%). Five in the former and seven in the latter expired. Among cases bitten by snakes, only 22 (7%) cases bitten by Russell Viper Daboia russelii developed renal failure. Copper sulphate and rat killer poisonings were the commonest causes of chemical induced ARF, dichromate, indigenous medicines and vasmol 33 (paraphenelyne diamine) were the least causes for ARF. None of the patients with organophosphate developed ARF nor did any of the 150 admitted for overdose of medicines developed ARF. CONCLUSION: The risk of ARF among the cases of poisoning was 2.5%. The outcome of ARF among bites and stings was better than chemical poisoning, and the difference was highly significant (p= 0.005, OR = 0.04-1.0, 95% CI = 0.004-0.38). Early recognition and appropriate measures reduce the occurrence of ARF.

Propofol's derivative: a potential drug for erectile dysfunction?

Propofol, an intravenous anesthetic agent induces priapism in humans. We hypothesize the probable central nervous system and local mechanisms through which a similar molecule can be used as a therapy in erectile dysfunction. Previous literatures published over a period of 35 years (1976-2010) were searched using the key words, mechanisms were identified and discussed. In the central nervous system, propofol has an inhibitory effect on serotonin receptors and on gamma-aminobutyric acid A (GABA-A) receptors as well as a facilitatory action on N-methyl-D-aspartate (NMDA) mediated calcium response and agonistic action on dopaminergic D2 receptors, which might contribute towards maintaining erections. While in the penile tissue, propofol's action may be due to increased synthesis of nitric oxide (NO), the principal mediator of penile erection. In addition, it may also have inhibitory effect on thromboxane A2, a potent vasoconstrictor and stimulatory action on penile adenosine triphosphate (ATP) dependent potassium (K-ATP) channels, a potent vasodilator. In view of the above mechanisms, use of propofol or similar molecule in erectile dysfunction needs to be ascertained and evaluated.

Hypersexuality in a 28-year-old woman with rabies.

Unusual clinical presentations of rabies are well known. A case of rabies is reported in a 28-year-old female who presented with features of increased sexual desire and heightened sexual arousal without provocation. Health care providers should be aware that marked changes in sexual behavior may be related to infection due to rabies.

Associated movements in hemiplegic limbs during yawning.

BACKGROUND: Yawning is phylogenetically ancient and associated with a stereotyped behavioral pattern. OBJECTIVE: To describe the pattern of associated movements observed in hemiplegic limbs during yawning and its relationship to gender, laterality of hemiplegia and muscle tone. MATERIAL AND METHODS: An observational study was designed for 75 patients with newly detected anterior circulatory stroke due to ischemia or hemorrhage in the internal capsule region. The subjects were free from any arthropathy, autoimmune disease, muscular disorders and injury/deformity. RESULTS: There were 48 males and 27 females, whose median ages were 48 and 47 years, respectively. The median yawning onset times after stroke in males and females were 36 and 38 h, respectively. Associated movements in hemiplegic limbs during yawning were minimal and observed in 59 hemiplegics (78.6%); significantly more were seen in males (83%) vs. females (70%), left-sided (94%) vs. right-sided hemiplegics (64%), those with hypotonia (87%) vs. hypertonia (61%), and in the upper limbs (91%) vs. lower limbs (83%)and proximal (72%) vs. distal joints (29%), irrespective of limb. CONCLUSION: The appearance of associated movements in hemiplegic limbs indicates the return of ancestral function observed in quadrupeds. However, further studies are needed to ascertain the reasons for such variations and determine how to utilize these movements in rehabilitation programs.

Attitude and practice of medical students studying in Hungary and India toward health during overseas and domestic travel.

BACKGROUND: It is presumed that medical students are travelers who can take care of their health, and thus the present study was conducted to elicit the attitude and practice [AP] of medical students from two different countries toward travel health issues. OBJECTIVES: To elicit the attitude and practice of medical students from two different countries toward travel health issues and identify the reasons for any variations. MATERIAL AND METHODS: An anonymous pre-tested structured questionnaire consisting of socio-demographic details, travel aspects, travel health issues, and precautions [medicines carried, vaccination history, and pre-travel consultation] adopted was distributed to 250 foreign medical students studying at the University of Debrecen, Hungary [Group I] and another 250 native medical students in India [Group II]. Data were analyzed by simple descriptive statistics and Student t-test. RESULTS: A total of 428 students responded among total eligible population of 500; 228 [90.2%] in group I and 200 [80%] in group II. In 2008, 188 [82%] of the former and 33 [16.5%] of the latter groups traveled to international destinations. Among groups I and II, health problems were experienced by 73 [32%] and 65 [32.5%] students, respectively. During hospitalization, students of group I were admitted for one of the following illnesses such as severe asthma, dehydration, malaria, and tibial fracture, while two other students were admitted to the hospital with deep vein thrombosis [DVT]. During travel, the category of medicines carried by students belonging to group I/II were anti-diarrhoeal [75/19], anti-emetics [53/39], anti-giddiness [49/7], anti-histamines [55/12], anti-pyretics plus analgesics [197/70], anti-spasmodics [55/11], antibiotics [33/10], vitamin pills [84/0], and laxatives [47/6]; supportive items such as adhesive plaster [64/3], and thermometer [37/1]; personal protective materials viz., mineral water [165/88], hygienic food [100/132], insect repellents [86/14], special clothes such as full sleeves and cap [150/0], sun screen [160/14], and items against sexually transmitted diseases [159/0]; health documents such as medical insurance card [161/3], previous health records [40/0], immuno-prophylaxis [127/0], family physician's phone number [43/9] and pre-travel advice [57/2]. COMMENTS: Students studying in Hungary were better informed about travel-related issues than native students from Indian medical colleges. The probable reasons for such variations were cultural differences, variation in their pre-medical curricula and teaching, frequent travel, a previous university degree, military training, maturity, and staying away from parents. The overall attitude and practice of medical students toward travel health issues were sub-optimal, since the subjects taught did not focus much on travel and health-related issues. Hence, there is an urgent need to initiate standardized teaching in the field of travel medicine for the students of health sciences for the benefit of the community.

Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS.

Cardiac involvement in children with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is known but less often considered. Our objectives were to determine cardiac manifestations in pediatric HIV/AIDS and estimate the cardiac isoform of alpha-2 macroglobulin [CA2M] among them. We recruited 67 pediatric HIV/AIDS patients, 37 with cardiac involvement (group A) and 30 without (group B); 30 cardiac patients without HIV infection (group C); and 30 healthy control subjects without any comorbid illness (group D). Their sociodemographic and clinical information were collected along with echocardiogram and blood for CA2M. Patterns of cardiac involvement in HIV/AIDS (group A) were pericardial effusion, left ventricular dysfunction, pulmonary hypertension, and cardiomyopathy and observed in 43, 30, 16, and 11% of subjects, respectively. CA2M levels among groups A, B, C, and D were 132.67 +/- 5.01, 41.25 +/- 3.33, 65.99 +/- 2.48 and 29.59 +/- 2.76 microgm/ml, respectively. It was elevated significantly in group A (P = 0.001; 95% confidence interval [CI] 87.27-95.55) compared with group B and was independent of sex and CD4 count among HIV/AIDS subjects. Although CA2M was elevated in HIV-negative patients with cardiac involvement, it was much less than in HIV/AIDS subjects with cardiac involvement (P = 0.001; 95% CI 62.54-70.82). Because CA2M is a cardiac biomarker, further research with larger population is needed to ascertain the role of CA2M as a diagnostic/therapeutic/prognostic marker in cardiac patients with and without HIV infection.

Hypothesis of snake and insect venoms against Human Immunodeficiency Virus: a review.

BACKGROUND: Snake and insect venoms have been demonstrated to have beneficial effects in the treatment of certain diseases including drug resistant human immunodeficiency virus (HIV) infection. We evaluated and hypothesized the probable mechanisms of venoms against HIV. METHODS: Previous literatures published over a period of 30 years (1979-2009) were searched using the key words snake venom, insect venom, mechanisms and HIV. Mechanisms were identified and discussed. RESULTS & CONCLUSION: With reference to mechanisms of action, properties and components of snake venom such as sequence homology and enzymes (protease or L-amino acid oxidase) may have an effect on membrane protein and/or act against HIV at multiple levels or cells carrying HIV virus resulting in enhanced effect of anti-retroviral therapy (ART). This may cause a decrease in viral load and improvement in clinical as well as immunological status. Insect venom and human Phospholipase A2 (PLA2) have potential anti-viral activity through inhibition of virion entry into the cells. However, all these require further evaluation in order to establish its role against HIV as an independent one or as a supplement.

Common ailments observed among students and their parents during travel.

BACKGROUND: Vast majority of Indians travel for religious, cultural and socio-economic purposes either alone or with families. OBJECTIVES: The present study attempts to elicit the travel related health issues experienced by college students (youth) and their parents (elderly) during travel, to identify the variations between youth and elderly, and to suggest remedial measures. MATERIAL AND METHODS: A total of 400 college students (age range 17-25; mean age 21) and 330 of their parents (age range 39-64; mean age 49) were included in the study. After a brief introduction to the study, a pretested structured anonymous questionnaire was distributed and completed. The data was analyzed statistically. RESULTS: Ailments were significantly (p<0.01) more prevalent among parents (elderly) than college students (youth) and were attributed to co-existing or exacerbation of pre-existing illnesses, stress of travel and waning immunity. None carried medical insurance or took pre-travel advice. Less than 21% of students and more than 70% of parents carried medicines for common ailments during travel. Also, parents carried personal protective materials significantly more than their wards. COMMENTS: A joint effort by health care professionals, travel agents, government and media towards community education may decrease the travel related ailments/illnesses.