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Aortic Aneurysm in Hemodialysis Patients: A Report of Two Cases
Befa Noto Kadou Kaza,
Kossi Akomola Sabi,
Ali Hissein Mahamat,
Yasminatou Aminata Wendkuuni Bikinga,
Mays Hadi Al Torayhi,
Eyram Yoan Makafui Amekoudi,
Comlan Mawuko Blitti,
Keyit Leonard Yegha,
Ghislaine Medkouri,
Mohamed Gharbi Benghanem,
Benyounes Ramdani
Issue:
Volume 3, Issue 4, July 2015
Pages:
153-155
Received:
23 May 2015
Accepted:
1 June 2015
Published:
16 June 2015
Abstract: Introduction: Aortic aneurysm (AA) is a frequent pathology in the general population. Patients at risk are those who have factors that can lead to arterial degeneration mainly high blood pressure (HBP), smoking and inflammation. In patients with chronic kidney failure (CKF) especially those who undergo hemodialysis who have almost all these risk factors, very little attention on the study of AA is accorded them. We reported two cases of AA in hemodialysis patients. Observation: Case 1. Fifty two (52) years old male, with past history of HBP since 21years of age, declared to have a terminal CKF from an undetermined nephropathy that has been on hemodialysis since 15 years. After 6 years of hemodialysis he presented an acute coronary syndrome associated with a painful abdominal syndrome which led to the diagnosis of aneurysm of the ascending aorta that measured 5cm in diameter. Therapeutic abstinence was adopted with annual follow up using chest angio-CT scan and thrombosis prevention using platelet aggregation inhibitors. The lesion is stable since 9 years. Case 2. Forty two (42) years old male, with no particular past history. Terminal CKF from an undetermined nephropathy that has been on hemodialysis since 6 years. On the 5th year of hemodialysis he presented a painful abdominal syndrome with no gas no food passage that lead to the diagnosis of abdominal aorta aneurysm of 4.7cm diameter and a height of 12cm. Atherapeutic abstinence was adopted with follow up and anti thrombolytic therapy put. After one year of evolution, the patient developed a mesenteric artery ischemia that on exploration showed a fissuration of the aneurysm that lead to the death of the patient. Conclusion: Aortic aneurysm in CKF has been a concerned in patients who had in most cases polycystic kidney disease who were not yet on hemodialysis. AA is a reality in patients on hemodialysis. Its evolution is uncertain and at times it is fatal. Screening for it is obligatory.
Abstract: Introduction: Aortic aneurysm (AA) is a frequent pathology in the general population. Patients at risk are those who have factors that can lead to arterial degeneration mainly high blood pressure (HBP), smoking and inflammation. In patients with chronic kidney failure (CKF) especially those who undergo hemodialysis who have almost all these risk fa...
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Successful Rituximab Treatment of Autoimmune Hemolytic Anemia Caused by Both Warm Autoantibodies and Cold Agglutinin: A Case Report
Motoharu Shibusawa,
Yoshirou Murai,
Hisashi Tsutsumi
Issue:
Volume 3, Issue 4, July 2015
Pages:
156-159
Received:
28 February 2015
Accepted:
4 March 2015
Published:
23 June 2015
Abstract: This report describes a case which successfully treated with rituximab against autoimmune hemolytic anemia caused by both warm autoantibodies and cold agglutinin (mixed AIHA). A 52-year-old man with malaise was referred to our hospital in December 2002. A diagnosis of mixed AIHA was made. His clinical course showed that the hemolysis was mainly caused by cold agglutinin, with a possible contribution from the warm autoantibody. He was treated with prednisolone (PSL), Cyclosporine (CyA), and cyclophosphamide (CPA). The treatment with PSL, CyA, and CPA failed to stabilize the hemolysis caused by cold exposure in the winter season. In November 2013 (winter season), rituximab therapy (375 mg/m2 weekly for four weeks) was started, and the hemolysis improved. The present case suggests that rituximab is useful against mixed AIHA. Further studies are warranted to establish the effectiveness of rituximab against mixed AIHA.
Abstract: This report describes a case which successfully treated with rituximab against autoimmune hemolytic anemia caused by both warm autoantibodies and cold agglutinin (mixed AIHA). A 52-year-old man with malaise was referred to our hospital in December 2002. A diagnosis of mixed AIHA was made. His clinical course showed that the hemolysis was mainly cau...
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Relationship of Glycosylated Hemoglobin with Fasting Plasma Glucose and 2 Hours After Breakfast Plasma Glucose in Type 2 Diabetes
Sheikh Salahuddin Ahmed,
Tarafdar Runa Laila,
Fazle Nur,
Mamun Ul Islam Khan,
Umme Sadia Mili,
Md. Abdul Mahid Khan,
Mohammad Rafiqul Hoque
Issue:
Volume 3, Issue 4, July 2015
Pages:
160-164
Received:
31 May 2015
Accepted:
9 June 2015
Published:
25 June 2015
Abstract: Background: Glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG) and 2 hours (2-hr) after breakfast (ABF) plasma glucose, are often used to monitor and manage glycemia in stable diabetic patients. Data regarding the relationship and relative contribution of FPG and 2-hr ABF plasma glucose to HbA1c level in Type 2 diabetes mellitus (T2DM) are insufficient. Objective: To examine the correlation of FPG, and 2-hr ABF with HbA1c in known patients having T2DM; and to find out which one of FPG and ABF is the dominant contributor to overall glycemia in monitoring diabetes. Study Design and Methods: The study was carried on 664 known T2DM patients under treatment and routine follow-up at a tertiary care hospital in Bangladesh. FPG & 2-hr ABF plasma glucose concentrations were measured by hexokinase method. HbA1c was measured by high performance liquid chromatography based hemoglobin assay system. The Pearson correlation coefficient was used to investigate the relationship of FPG and ABF with HbA1c and their significance. Results: Both FPG and ABF levels were correlated with HbA1c but higher correlation was seen between FPG and HbA1c. The correlation coefficients between FPG and HbA1c and between ABF and HbA1c were 0.722 and 0.664 respectively. Both the correlations were found statistically significant (p<0.001). Conclusion: In patients with T2DM, FPG and ABF both were significantly correlated with HbA1c; and in our study we found that overall correlation of HbA1c with FPG was higher than ABF plasma glucose level.
Abstract: Background: Glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG) and 2 hours (2-hr) after breakfast (ABF) plasma glucose, are often used to monitor and manage glycemia in stable diabetic patients. Data regarding the relationship and relative contribution of FPG and 2-hr ABF plasma glucose to HbA1c level in Type 2 diabetes mellitus (T2DM) a...
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Ct Cardiac Imaging for Evaluation and Treatment of Ischemic Heart Disease
Faruk Erzengin,
Evren Bursuk
Issue:
Volume 3, Issue 4, July 2015
Pages:
165-179
Received:
30 May 2015
Accepted:
22 June 2015
Published:
4 July 2015
Abstract: The formation of atherosclerotic and calcified plaques begins and develops not only below the endothelium (intimae), but also in the adventitia. Multislice Computed Tomography (MSCT= Cardiac CT) is a very important tool for the diagnosis and treatment of the atherosclerotic calcification in the coronary arteries. Due to rapid improvement in technology, MSCT techniques have also progressed quickly, leading to the development of the 640 slice MSCT. Following the development of this advanced non-invasive technology (640 slice), came up from stage 4C than to the 1A level. Compared to older technologies (e.g. 64, 128 and 320 slice MSCT), the 640 slice MSCT provides various advantages such as higher lateral resolution, lower radiation, and the ability to obtain results more rapidly and accurately. We also introduce a special four cases diagnosed by MSCT, two of them silent ischemia, one of them acute asymptomatic myocardial infarction, and the last one angina pectoris with myocardial bridge(respectively, a 88 year old man, 62 year old man, 66 year old man and 53 year old woman). It was observed that a new innovative combined drug (polypill) is able to prevent the formation of atherosclerotic and calcified plaque of arteries, and to regress pre-existing ones.
Abstract: The formation of atherosclerotic and calcified plaques begins and develops not only below the endothelium (intimae), but also in the adventitia. Multislice Computed Tomography (MSCT= Cardiac CT) is a very important tool for the diagnosis and treatment of the atherosclerotic calcification in the coronary arteries. Due to rapid improvement in technol...
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Diabetes Mellittus and the Risk of Cancer Formation – Possible Link and Review of Literature
Ekpe,
Ekpe Lawson,
Omotoso Ayodele Joshua
Issue:
Volume 3, Issue 4, July 2015
Pages:
180-184
Received:
10 June 2015
Accepted:
10 July 2015
Published:
17 July 2015
Abstract: Background: The incidence of cancer is increased in patients with Type 2 diabetes mellitus. The aetiology is not exactly known. Various studies have been done to ascertain this fact. Aim: The aim of this study was to access the correlation between cancer and diabetes mellitus. Method: Using internet search, a comprehensive literature review was done and words such as diabetes mellitus, cancer, breast, pancreas, colorectal, prostate, liver, were searched from google scholar, yahoo, pubmed, medline, web MD to check for various articles published on this subject. The references of the relevant articles were also searched. Results: Analyses of results of various studies were considered and their RR were noted to access the correlation between cancer and diabetes mellitus. Conclusion: There is an increased fold rise of various cancers among type 2 diabetes mellitus patients.
Abstract: Background: The incidence of cancer is increased in patients with Type 2 diabetes mellitus. The aetiology is not exactly known. Various studies have been done to ascertain this fact. Aim: The aim of this study was to access the correlation between cancer and diabetes mellitus. Method: Using internet search, a comprehensive literature review was don...
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Thyroid Dysfunction and Morphological Abnormalities in Patients with Type 1 Diabetes Mellitus
Heba-Allah Moustafa Kamal Al-Din,
Rokaya Abd-Al Aziz Mohamed,
Shereen Sadik El-Sawy,
Noha Adly Sadik,
Rasha Mohamed Abd El Samie,
Mahmoud Ahmed Khatab,
Laila Ahmed Rashed
Issue:
Volume 3, Issue 4, July 2015
Pages:
185-193
Received:
28 June 2015
Accepted:
7 July 2015
Published:
17 July 2015
Abstract: Background: Type 1 diabetes mellitus is an autoimmune disease. Several studies have documented great variations in the prevalence of thyroid dysfunction and autoimmune thyroid disease (AITD) in type 1 diabetic patients. Undiagnosed thyroid dysfunction has negative impact on the metabolic control and will aggravate the cardiovascular disorders. Objectives: We aimed to investigate the presence of thyroid dysfunction and the associated morphological abnormalities in type 1 diabetes mellitus. Methods: 80 type 1 diabetic patients without overt thyroid disease attending the outpatient clinic of diabetes at Kasr Al Aini hospital, faculty of medicine, Cairo University were enrolled in the study. Thyroid functions (TSH, FT4, FT3), anti thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-TG) antibodies were measured in all patients. Thyroid ultrasound was performed in all patients and in 50 healthy control subjects. The data was analyzed and expressed in terms of mean ± SD. Pearson correlation was performed to establish the relationship between different variables. Results: 52 of 80 patients (65%) showed high TSH levels with mean (12.37±3.9 mIU/ml) and 25 patients (31.3%) showed positive anti-TG anti-TPO levels with mean (906 ± 184.3, 628 ±137.5 IU/ml) respectively. The high TSH levels were statistically significantly associated with high anti-TG levels and anti-TPO levels with (mean 570.23± 372.41, 366.52±281.34 IU/ml) respectively with P-value < 0.001. There was significant increase in the gland volume in diabetic patients with mean (3.4±1.5 ml) versus (2.9±0.9 ml) in the control group, P-value <0.046. Also 25% of patients showed heterogenous hypoechogenic gland texture versus 6 % in the control group which was statistically significantly different, P-value = 0.008 and 50% of the patients showed increase in gland vascularity versus 12% in the control group which was statistically significantly different with P-value <0.001. These morphological abnormalities were associated with high (TSH, anti-TPO and anti-TG) levels but weren’t significant. High TSH levels were strongly positively correlated with anti-TPO and anti-TG, r = (0.84, 0.83) respectively, P-value <0.001. Conclusions: Type 1 diabetic patients had high incidence of thyroid dysfunction and AITD associated with morphological abnormalities of the thyroid gland. So we recommend screening for thyroid dysfunction in all patients with type 1 DM to avoid additional cardiovascular risk factors.
Abstract: Background: Type 1 diabetes mellitus is an autoimmune disease. Several studies have documented great variations in the prevalence of thyroid dysfunction and autoimmune thyroid disease (AITD) in type 1 diabetic patients. Undiagnosed thyroid dysfunction has negative impact on the metabolic control and will aggravate the cardiovascular disorders. Obje...
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Prinzmetal Angina in Major Hemophilia a Patient: A Case Report
Romaric Mahutondji Massi,
Bienvenu Houssou,
Marième Camara,
Nisrine Khoubila,
Asma Quessar,
Bouchra Oukkache
Issue:
Volume 3, Issue 4, July 2015
Pages:
194-196
Received:
4 July 2015
Accepted:
14 July 2015
Published:
31 July 2015
Abstract: Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF : ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg / L (Normal : 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day ; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist.
Abstract: Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are fre...
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