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Introduction and importance: Cysticercosis is a condition in which humans are infected by the larval form of the pork tapeworm Tenia solium. Cysticercosis in humans is common in the cerebral tissue but rare in the tongue. Case presentation: Here, the authors report a rare case of a 38-year-old male with neurocysticercosis and cysticercosis of the tongue. The patient presented with a complaint of loss of consciousness for 4-5 min. Local examination of his oral cavity revealed a swelling of ~2×2 cm on the tongue. An MRI of the brain showed various stages of neurocysticercosis involving the neuroparenchyma and tongue. For this, he was started on low-dose prednisolone of 50 mg tapered over 6 weeks and levetiracetam of 500 mg BD continued for his seizure episodes. He is responding well with the medications and is planned to start antiparasitic agent only after the perilesional edema decreases. Clinical discussion: Cysticercosis may involve the central nervous system, muscle, heart, lungs, peritoneum, eye, and subcutaneous tissue. Oral cavity and perioral involvement by cysticercous larva is rare in humans. Radiologic imaging, serology, and tissue biopsy can be used to confirm a diagnosis of cysticercosis. The most common locations for oral cysticercosis are the tongue, buccal mucosa, lower lip, and upper lip.Only 102 cases of oral cysticercosis have been reported based on a PubMed English-language literature search. Conclusion: Oral cysticercosis is a rare event, and it represents a difficulty in clinical diagnosis. But a patient with a mass in the tongue should be considered as a possible case of cysticercosis especially in endemic regions like Nepal.
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BACKGROUND: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. METHODS: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. RESULTS: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629. The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). CONCLUSIONS: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal.
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Intervención Coronaria Percutánea , Arteria Radial , Arteria Femoral , Humanos , Nepal/epidemiología , Intervención Coronaria Percutánea/efectos adversos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox. METHODS: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. RESULTS: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure. CONCLUSIONS: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention.
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Intervención Coronaria Percutánea , Arteria Radial , Anciano , Angiografía Coronaria , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal , Intervención Coronaria Percutánea/efectos adversos , Arteria Radial/diagnóstico por imagenRESUMEN
AIMS: We aim to modulate the renin-angiotensin system (RAS) by active immunization against angiotensin I/II, potentially by a novel type of peptide--'AngI-R' for the treatment of hypertension. METHOD: 27 spontaneous hypertensive rats (SHRs) were randomly divided into 3 groups (n=9). Effect of AngI-R on systolic blood pressure of SHRs was determined by its subcutaneous injection into SHRs with anti-angiotensin peptide AngI-R, captopril, physiological salt solution in the same schedule. Systolic blood pressure was monitored by tail-cuff arterial blood pressure measurement method and then calculated from the average of three measurements in each animal at a desired time (0, 4, 8, 16W). AngI, AngII and anti-AngI antibody were detected by ELISA and western blotting method. At the end, the pathologic changes in different organs of SHRs were observed. RESULT: The results exhibited a marked effect to lower the systolic blood pressure (-15 mmHg) of SHRs after subcutaneous injection with peptide AngI-R. The anti-hypertensive effect lasted for over 1 month. The level of AngI and AngII in the vaccinated group, after administration of AngI-R was lower than the one in the control group and the pre-administered group. The anti-AngI/II antibody titre in the experiment group significantly increased. CONCLUSION: The peptide AngI-R was able to decrease the blood pressure of SHRs. The peptide AngI-R induced an immune response to inhibit AngI and AngII, resulting in the decrease in blood pressure in SHRs.
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Angiotensina I/uso terapéutico , Hipertensión/prevención & control , Vacunas de Subunidad/uso terapéutico , Angiotensina I/administración & dosificación , Angiotensina I/antagonistas & inhibidores , Angiotensina II/administración & dosificación , Angiotensina II/antagonistas & inhibidores , Angiotensina II/uso terapéutico , Animales , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Hipertensión/patología , Isoanticuerpos/biosíntesis , Masculino , Proyectos Piloto , Conejos , Distribución Aleatoria , Ratas , Ratas Endogámicas SHR , Vacunas de Subunidad/administración & dosificaciónRESUMEN
Hypertension, which is one of the most common diseases afflicting mankind, is associated to increased morbidity, mortality and cost to society. Cardiovascular disease is the leading cause of death all around the world and hypertension is the most common reversible risk factor for cardiovascular diseases. The renin-angiotensin system (RAS) commands an important role in the regulation of blood pressure, and so, at present, has been a target for clinical control by drugs acting on the system. Despite the fact that effective drugs are available, only about one out of three people has their blood pressure successfully controlled, and the blame goes to the undesirable side effects and the poor oral drug compliance. Keeping in mind the increasing incidence of hypertension and the patients' inconsistency for the polypharmacy, immunization against renin and the angiotensins, although with less success, had been attempted in the past. More recently, immunization against angiotensin-I with PMD-3117 vaccine, angiotensin-II with CYT006-AngQb vaccine and targeting angiotensin-II type 1A receptor with ATR12181 vaccine have provided optimism in the development of a hypertension vaccine. AngQb vaccine has proved to become the first vaccine ever to lower (-9/-4 mm Hg) blood pressure in human beings. Vaccine could induce long lasting effects with a dosing interval of months, increasing patient acceptability and compliance and thus a better control of high blood pressure. Our objective will be to focus on the importance of the RAS and to explore the extent of safety, efficacy and the future implications of vaccine against the RAS.