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Clinics and Practice
Volume 7
Issue 3
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Clinics and Practice is published by MDPI from Volume 11 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with PAGEPress.

Clin. Pract., Volume 7, Issue 3 (June 2017) – 12 articles

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809 KiB  
Brief Report
Reducing Radiation Exposure in an Electrophysiology Lab with Introduction of Newer Fluoroscopic Technology
by Munish Sharma and Koroush Khalighi
Clin. Pract. 2017, 7(3), 976; https://doi.org/10.4081/cp.2017.976 - 11 Sep 2017
Cited by 2 | Viewed by 665
Abstract
The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP) lab. We sought to know if the newer fluoroscopic technology (Allura Clarity) installed in a hybrid EP helps to reduce prescribed radiation dose. We [...] Read more.
The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP) lab. We sought to know if the newer fluoroscopic technology (Allura Clarity) installed in a hybrid EP helps to reduce prescribed radiation dose. We performed radiation dose analysis of 90 patients who underwent various procedures in the EP lab at a community teaching hospital after the introduction of newer fluoroscopic technology in June of 2016.Watchman device insertion, radiofrequency ablation procedures, permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) placement and battery changes were included in the study to compare radiation exposure during different procedures performed commonly in an EP lab. In all cases of watchman device placement, radiofrequency ablation procedures, PPM/ICD placement and battery changes, there was a statistically significant difference (<0.05) in radiation dose exposure. Significant reduction in radiation exposure during various procedures performed in an EP lab was achieved with aid of newer fluoroscopic technology and better image detection technology. Full article
660 KiB  
Case Report
A Case of Shunting Postoperative Patent Foramen Ovale under Mechanical Ventilation Controlled by Different Ventilator Settings
by Claudio Pragliola, Sara Di Michele and Domenico Galzerano
Clin. Pract. 2017, 7(3), 969; https://doi.org/10.4081/cp.2017.969 - 4 Aug 2017
Cited by 3 | Viewed by 667
Abstract
A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2 [...] Read more.
A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE. Full article
238 KiB  
Case Report
Hemochromatosis as Junctional Tachycardia, a Rare Presentation
by Ali Ghani, Irfan Ahsan and Charles Gottleib
Clin. Pract. 2017, 7(3), 979; https://doi.org/10.4081/cp.2017.979 - 3 Aug 2017
Cited by 2 | Viewed by 639
Abstract
We present here a 45-year-old male with no past medical problem who presented with palpitations. He was found to have supraventricular tachycardia intractable to medical therapy. Later his rhythm converted to junctional tachycardia. Further workup revealed hemochromatosis to be primary etiology causing the [...] Read more.
We present here a 45-year-old male with no past medical problem who presented with palpitations. He was found to have supraventricular tachycardia intractable to medical therapy. Later his rhythm converted to junctional tachycardia. Further workup revealed hemochromatosis to be primary etiology causing the arrhythmia. The low index of suspicion for additional workup is key to diagnosis and successful outcome. Full article
1499 KiB  
Brief Report
A New Imaging Tool for Realtime Measurement of Flow Velocity in Intracranial Aneurysms
by Athanasios K. Petridis, Marius Kaschner, Jan F. Cornelius, Marcel A. Kamp, Angelo Tortora, Hans-Jakob Steiger and Bernd Turowski
Clin. Pract. 2017, 7(3), 975; https://doi.org/10.4081/cp.2017.975 - 3 Aug 2017
Cited by 1 | Viewed by 515
Abstract
With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, [...] Read more.
With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.). It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way. Full article
935 KiB  
Case Report
Primary Breast Lymphoma: A Case Report and Review of the Literature
by Kamal E. H. Mohamed and Rusha A. E. Ali
Clin. Pract. 2017, 7(3), 939; https://doi.org/10.4081/cp.2017.939 - 3 Aug 2017
Cited by 5 | Viewed by 608
Abstract
Primary breast lymphoma (PBL) represents 0.04-0.5% of all malignant breast tumors, <1% of all patients with non-Hodgkin’s lymphomas and 1.7-2.2% of all patients with extra nodal lymphomas. Despite the high prevalence of breast cancer, primary breast lymphoma is very rare. We report a [...] Read more.
Primary breast lymphoma (PBL) represents 0.04-0.5% of all malignant breast tumors, <1% of all patients with non-Hodgkin’s lymphomas and 1.7-2.2% of all patients with extra nodal lymphomas. Despite the high prevalence of breast cancer, primary breast lymphoma is very rare. We report a rare case of PBL, successfully treated with surgery, chemotherapy and radiotherapy. This is the first case of PBL to be reported from Sudan to our knowledge. Full article
872 KiB  
Case Report
Gallstone Ileus: Dilemma in the Management
by Girish D. Bakhshi, Rajesh G. Chincholkar, Jasmine R. Agarwal, Madhukar R. Gupta, Prachiti S. Gokhe and Amogh R. Nadkarni
Clin. Pract. 2017, 7(3), 977; https://doi.org/10.4081/cp.2017.977 - 1 Aug 2017
Cited by 8 | Viewed by 658
Abstract
Gallstone ileus is a mechanical intestinal obstruction caused due to impaction of a large gallstone within the bowel. The ideal treatment of gallstone ileus remains controversial, with the main dilemma being between a one-stage and a two-stage surgical procedure. A 69-year old male [...] Read more.
Gallstone ileus is a mechanical intestinal obstruction caused due to impaction of a large gallstone within the bowel. The ideal treatment of gallstone ileus remains controversial, with the main dilemma being between a one-stage and a two-stage surgical procedure. A 69-year old male patient presented with gallstone ileus. A one-stage procedure with enterolithotomy and primary closure of duodenal fistula was done. His immediate postoperative recovery was uneventful, but after 3 weeks of surgery, he developed respiratory complications and expired of multi-organ failure. In gallstone ileus, patient presents with symptoms of intestinal obstruction. Enterolithotomy alone remains the most common operative method, but the definitive surgical management is still under research. An intraoperative dilemma between a one-stage or twostage surgery is difficult to resolve in absence of clear guidelines. Hence, more studies are required to come to a consensus in deciding its definitive management. Full article
978 KiB  
Case Report
Rectus Sheath Hematoma Associated with Apixaban
by Kulothungan Gunasekaran, Amanda R. McFee Winans, Swetha Murthi, Mudassar Raees Ahmad and Scott Kaatz
Clin. Pract. 2017, 7(3), 957; https://doi.org/10.4081/cp.2017.957 - 1 Aug 2017
Cited by 7 | Viewed by 647
Abstract
Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a [...] Read more.
Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma. Apixaban was discontinued and the patient was monitored for extension of the hematoma. After 2 days she was discharged home. Outpatient computed tomography 1 month later showed complete resolution of the rectus sheath hematoma. We recommend that clinicians become aware of the potential for rare and serious bleeding complications of anticoagulants and identify the need for early recognition and prompt management. Full article
586 KiB  
Case Report
Do All Patients with Atrial Fibrillation Need Long-Term Anticoagulation?
by Munish Sharma, Rohit Masih and Daniel A. N. Mascarenhas
Clin. Pract. 2017, 7(3), 955; https://doi.org/10.4081/cp.2017.955 - 31 Jul 2017
Cited by 1 | Viewed by 711
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The [...] Read more.
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this. Many times, a patient may not be in AF chronically, nor is the AF burden (the amount of time patient is in AF out of the total monitored time) calculated. We present three cases of new onset transient AF triggered by temporary stressors. We were able to restore normal sinus rhythm (NSR) with chemical cardioversion. As per 2014 American College of Cardiology (ACC)/American Heart Association (AHA) recommendations, we started all three patients on OACs based on CHA2DS2VASc score >2. However, the patients refused long term OACs after restoration of NSR and correction of the temporary enticing stressors. In any case, the decision to start OACs would have had its own risks. Here we describe how antiarrhythmic drugs were used to maintain NSR, all while they were continuously monitored to determine the need to continue OACs. Full article
719 KiB  
Brief Report
Epidemiology of First Epileptic Seizures in the Northern Aegean Island of Lesvos, Greece
by Anastasia Verentzioti, George Stranjalis, Theodosis Kalamatianos, Anna Siatouni, Damianos E. Sakas and Stylianos Gatzonis
Clin. Pract. 2017, 7(3), 942; https://doi.org/10.4081/cp.2017.942 - 18 Jul 2017
Cited by 2 | Viewed by 620
Abstract
We aimed at establishing the epidemiologic profile of first epileptic seizures (FES) in the Greek island of Lesvos. During a 1- year period (01/06/2010 to 31/05/2011), cases of FES admitted to the Lesvos General Hospital/addressed by general practitioners/private neurologists were prospectively identified. A [...] Read more.
We aimed at establishing the epidemiologic profile of first epileptic seizures (FES) in the Greek island of Lesvos. During a 1- year period (01/06/2010 to 31/05/2011), cases of FES admitted to the Lesvos General Hospital/addressed by general practitioners/private neurologists were prospectively identified. A total of 45 cases (30 males and 15 females; mean age ± SD of 59.4 ± 28.4 and 58.9 ± 26.8 years, respectively), were collected. The FES incidence rate was 52.1 (95% CI 37-67) per 105 persons. Provoked and unprovoked FES had an incidence of, 16.2 and 35.9 cases per 105 persons, respectively. Following ageadjustment to the 2000 US census population, incidence rates of FES (all types combined) were, 40.5 (95% CI 28-56) per 105 persons. Cerebrovascular disease (CVD) was the most prevalent etiologic factor. The present findings indicate a low-ranking incidence of FES in the studied population and highlight CVD as a leading causative factor. Full article
1006 KiB  
Case Report
A Case of Hypoglycemiainduced QT Prolongation Leading to Torsade de Pointes and a Review of Pathophysiological Mechanisms
by Faris Hannoodi, Hashim Alwash, Kushal Shah, Israa Ali, Sarwan Kumar and Khalid Zakaria
Clin. Pract. 2017, 7(3), 960; https://doi.org/10.4081/cp.2017.960 - 15 Jun 2017
Cited by 2 | Viewed by 638
Abstract
Torsades de pointes is a life-threatening cardiac arrhythmia. Occurrence of this arrhythmia as a result of hypoglycemia has not been reported in the literature. We describe an interesting case of an insulindependent diabetic patient presenting with torsades de pointes resulting from hypoglycemia. A [...] Read more.
Torsades de pointes is a life-threatening cardiac arrhythmia. Occurrence of this arrhythmia as a result of hypoglycemia has not been reported in the literature. We describe an interesting case of an insulindependent diabetic patient presenting with torsades de pointes resulting from hypoglycemia. A 62-year-old male was admitted to the hospital following an episode of severe insulin-induced hypoglycemia and a cardiac arrest. He was found to unresponsive at home after taking insulin. His serum glucose was found to be 18. He was given juice initially to normalize his glucose and was then transferred by EMS to ER where he was given 5% dextrose infusion. Analysis of the LifeVest rhythm recording showed torsades de pointes that was terminated by defibrillation of the LifeVest. Several mechanisms are responsible for torsade, including QT interval prolongation, adrenalin secretion and calcium overload leading to intracellular calcium oscillations. These mechanisms are a trigger to torsade de pointes. Predisposing factors were present leading torsade to occur. Full article
576 KiB  
Brief Report
O Blood Group as a Risk Factor for Helicobacter pylori IgG Seropositivity among Pregnant Sudanese Women
by Gasim I. Gasim, Abdelmageed Elmugabil, Hamdan Z. Hamdan, Duria A. Rayis and Ishag Adam
Clin. Pract. 2017, 7(3), 958; https://doi.org/10.4081/cp.2017.958 - 7 Jun 2017
Cited by 6 | Viewed by 769
Abstract
The objective was to investigate the prevalence and the association between blood groups and Helicobacter pylori IgG seropositivity among pregnant Sudanese women. A cross-sectional survey was carried- out at Saad Abul Ela Maternity Hospital, Khartoum, Sudan during the period of July 2014 through [...] Read more.
The objective was to investigate the prevalence and the association between blood groups and Helicobacter pylori IgG seropositivity among pregnant Sudanese women. A cross-sectional survey was carried- out at Saad Abul Ela Maternity Hospital, Khartoum, Sudan during the period of July 2014 through December 2015. Questionnaires covering socio-demographic and obstetrics information were administered. Specific H. pylori IgG antibody was analysed using ELISA. One hundred eighty six pregnant women were enrolled. The mean (SD) of the age, parity was 28.3 (2.6) years and 2.6 (3.5), respectively. Of the 186 women, 42 (22.6%), 24 (12.9%), 11(5.9%) and 109 (58.6%) had blood group A, B, AB and O, respectively. H. pylori IgG seropositivity rate was 132/186 (71.0%). There was no significant difference in age and parity between women with H. pylori IgG seropositive and seronegative. Compared with the women with H. pylori IgG seronegative, significantly higher numbers of women with H. pylori IgG seropositive had O blood group, [84/132(63.6) versus 25/54(46.3), P<0.001]. In binary logistic regression, women with O blood group (OR= 2.084, 95% CI=1.060 -4.097, P=0.033) were at a higher H. pylori IgG seropositivity. The current study showed that women with blood group O were at higher risk for H. pylori IgG seropositivity. Full article
650 KiB  
Case Report
Case of Acute ST Segment Elevation Myocardial Infarction in Infective Endocarditismanagement with Intra Coronary Stenting
by Ghulam Murtaza, Zia ur Rahman, Puja Sitwala, Vatsal Ladia, Bhavesh Barad, Kais Albalbissi, Timir K. Paul and Vijay Ramu
Clin. Pract. 2017, 7(3), 950; https://doi.org/10.4081/cp.2017.950 - 7 Jun 2017
Cited by 4 | Viewed by 747
Abstract
Embolic events from infective endocarditis can cause acute coronary syndrome. Mortality rate is high and optimal management might be different from those chosen in setting of classic atherosclerotic coronary artery disease. We present a case of 56-yearold male who had received 5 weeks [...] Read more.
Embolic events from infective endocarditis can cause acute coronary syndrome. Mortality rate is high and optimal management might be different from those chosen in setting of classic atherosclerotic coronary artery disease. We present a case of 56-yearold male who had received 5 weeks of antibiotics for aortic valve endocarditis and developed acute ST segment elevation myocardial infarction in hospital settings. Interestingly, patient had recent left heart catheterization that was normal. This was recognized as embolic event from sterile vegetation. Patient was managed with balloon angioplasty and placement of intracoronary stent. Following re-vascularization, patient chest pain and electrocardiogram normalized and he improved in short term. However due to multiple comorbidities he had to be intubated and placed on dialysis. Full article
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