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Introduction: Aortic pseudoaneurysms are a type of contained rupture where most of the aortic wall is breached, leaving only a thin rim of the remaining wall or adventitia to hold the blood. This condition carries a high risk of rupture and potentially fatal complications. Typically, patients present with chest pain; haemoptysis can also occur, though rarely. Case description: A 64-year-old male who presented with two episodes of haemoptysis, with no history of cardiovascular surgery or trauma. A chest computerized tomography (CT) followed by an aortogram revealed a thoracic aortic pseudoaneurysm and the patient underwent surgical aortic repair without any complications. This case underscores the rare presentation of thoracic aortic pseudoaneurysm. Discussion: Haemoptysis is a rare manifestation of thoracic aorta pseudoaneurysm and can be a warning sign of impending rupture. Haemoptysis may occur due to formation of aortopulmonary fistula or direct erosion of pseudoaneurysm into lung parenchyma. Conclusion: It is imperative for clinicians to recognise such manifestations early for prompt diagnosis and prevention of complications. LEARNING POINTS: Recognise haemoptysis as the manifestation of thoracic aortic pseudoaneurysm.Early diagnosis and treatment are crucial due to high rate of complications and mortality.Trauma and cardiovascular surgery are the most common cause for thoracic aortic pseudoaneurysm; however, sometimes it can occur due to atherosclerosis.
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Extra-neural metastases of glioblastoma multiforme are uncommon with unidentified metastatic mechanism. There is no consensus over optimum treatment regimen. The current narrative review was planned to illuminate the presence criteria, sites of metastatic spread, incidence, mechanism, risk factors and management.
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Neoplasias Encefálicas , Glioblastoma , Humanos , Glioblastoma/patología , Neoplasias Encefálicas/patologíaRESUMEN
Granulomatosis with polyangiitis (GPA) is a rare systemic disorder of unknown aetiology. The histological findings comprise necrotising granulomatous inflammation of small arteries, arterioles, and the capillaries mainly of upper and lower respiratory tract and the kidneys. However, the disease rarely involves the cardiovascular system but may manifest as pericarditis, myocarditis, coronary arteritis, valvular lesions, and severe conduction disorders. We present an interesting, unusual, and complex case of a middle-aged man who initially presented with symptoms suggestive of Wagener's granulomatosis but two years later developed malignant ventricular arrhythmias. A diagnosis of exclusive involvement of the cardiac conduction system, without overt myocarditis, was made only after ruling it out by cardiac MRI, cardiac enzymes, echo, and normal serological markers. Evidence was paired with the cessation of monomorphic ventricular tachycardia due to induction therapy with Rituximab. In this case report, we highlight one of the rarest manifestations of GPA, i.e. Ventricular tachycardia without myocarditis.
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Granulomatosis con Poliangitis , Taquicardia Ventricular , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Rituximab/uso terapéutico , Taquicardia Ventricular/tratamiento farmacológico , Taquicardia Ventricular/etiologíaRESUMEN
BACKGROUND: FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) and FLAG-IDA (idarubicin added to standard FLAG) are salvage chemotherapy regimens used for relapsed and refractory acute leukemias. The toxicity of the FLAG-IDA courses is generally more severe than for the FLAG courses, with marked neutropenia and thrombocytopenia. This study aims to compare the outcomes of both regimens in terms of morbidity, mortality and remission/transplant. No comparison has been reported so far in Pakistan or the rest of third world countries. METHODOLOGY: This retrospective study was conducted in Hematology and Bone Marrow Transplant unit after approval from Institutional Review Board and Ethics Committee. 76 leukemic patients treated with salvage chemotherapy were included. Our endpoints for patient outcome analysis included disease remission/relapse, HSCT following remission, morbidity, mortality, progression free survival and overall survival. Kaplan Meier curves were made in SPSS for survival analysis. RESULTS: A total of 76 patients were included from 2015 to July 2018. 49 patients were given FLAG, and 27 were given FLAG-IDA. 31.6% in FLAG-IDA achieved complete remission (CR)/complete remission with incomplete counts (CRi). 21% in FLAG-IDA made it to Bone marrow transplant (BMT) (67% of those in CR/CRi). 41.7% in FLAG achieved CR/CRi, and 27.8% in FLAG made it to BMT (67% of those in CR/CRi). Common complications in both regimens were infection, bleeding and other complications e.g., rash, diarrhea, mucositis, etc. A statistically significant difference was found between overall survival of the two regimens, p value 0.033. CONCLUSIONS: FLAG regimen was found superior to FLAG-IDA with better survival and subsequent transplant rate.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Leucemia/tratamiento farmacológico , Terapia Recuperativa/métodos , Vidarabina/análogos & derivados , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Niño , Preescolar , Citarabina/administración & dosificación , Citarabina/efectos adversos , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Humanos , Idarrubicina/administración & dosificación , Idarrubicina/efectos adversos , Leucemia/patología , Persona de Mediana Edad , Pakistán , Supervivencia sin Progresión , Recurrencia , Inducción de Remisión , Estudios Retrospectivos , Análisis de Supervivencia , Tasa de Supervivencia , Vidarabina/administración & dosificación , Vidarabina/efectos adversos , Adulto JovenRESUMEN
Restless legs syndrome (RLS) is a common neurological disorder in hemodialysis (HD) patients. It is associated with poor sleep and decreased quality of life. The precipitants for the disorder are still poorly understood. The condition has not been studied extensively in Pakistan, which has a vast majority of end-stage renal disease patients on maintenance HD. We aimed to determine the prevalence of this condition in patients attending HD units of the largest renal dialysis center in Northern Pakistan. We also strived to determine any associations with dialysis inadequacy and the total duration of HD. This was an observational study comprising 279 patients. RLS was diagnosed using the International Restless Leg Syndrome Study Group criteria. Dialysis adequacy was determined using the Urea Reduction Ratio and the Kt/V technique. The prevalence of RLS in this large HD population was 24%. Our results show that a longer duration and greater number of HD sessions were significantly associated with the development of RLS (p<0.05). Dialysis inadequacy was not associated with the development of the disorder. These results may indicate that the pro-inflammatory nature of hemodialysis may have a role in the pathophysiology of RLS in HD patients and prolonged exposure to it may make them more prone to developing the disorder.
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OBJECTIVE: To determine the relation between food intake and diabetes control. METHODS: This cross-sectional study was carried out at Department of Medicine and Endocrinology, Shifa International Hospital, Islamabad, Pakistan, from July 2016 to February 2017, during which type-2 diabetes patients were interviewed using a structured questionnaire. Demographics, intake of high glycaemic index foods consumed in each food group, and general dietary practices were assessed by means of number of meals per day and adherence to the dietary plan. Glycated haemoglobin A1c values were recorded as well. SPSS 21 was used for data analysis. RESULTS: Of the 180 patients, 100(55.6%) were taking three meals a day. Besides, 108(60%) had an income >Rs50,000. Moreover, 127(70.6%) patients were not aware of the type of diabetes, while 117(65%) patients had high glycated haemoglobin levels. Furthermore, 148(82.2%) made a change in diet following diabetes diagnosis, while 168(93.3%) had recommended food available in their house, and 65(36.1%) followed a strictly-recommended dietary schedule. A statistically significant association was found between the consumption of different desserts/sweets and glycated haemoglobin levels (p=0.008) followed by fruit intake like mangoes (p=0.004) and grapes (p=0.02). CONCLUSIONS: There is a need to educate diabetics regarding diet management in terms of glycaemic index of foods.