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   2014| July-September  | Volume 15 | Issue 3  
    Online since November 15, 2014

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The medieval origins of the concept of hypertension
Mojtaba Heydari, Behnam Dalfardi, Samad EJ Golzari, Hamzeh Habibi, Mohammad Mehdi Zarshenas
July-September 2014, 15(3):96-98
DOI:10.4103/1995-705X.144807  PMID:25538828
Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of "Fi al-Imtela0" (About the Fullness) from the Hidβyat al-Muta'allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of "Imtela," despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension.
  3,783 150 -
Cardioprotective effects of ghrelin in heart failure: From gut to heart
Mahalaqua Nazli Khatib, Padam Simkhada, Dilip Gode
July-September 2014, 15(3):74-76
DOI:10.4103/1995-705X.144792  PMID:25538820
Chronic heart failure (CHF) is a major cause of morbidity and mortality. Cardioprotective effects of ghrelin, especially in its acylated form have been demonstrated in heart failure (HF) models and exploratory human clinical studies. Hence, it has been proposed for the treatment of HF. However, the underlying mechanism of its protective effects against HF remains unclear. Future researches are needed to evaluate the efficacy of Ghrelin as a new biomarker and prognostic tool and for exploring its therapeutic potential in patients suffering from CHF.
  3,198 137 14
Spontaneous coronary artery dissection and acute myocardial infarction after cesarean section in a postpartum woman with untreated dyslipidemia
Swaroopa Pulivarthi, Taiwo Lawal, Dayuan Li, Murali Krishna Gurram
July-September 2014, 15(3):80-82
DOI:10.4103/1995-705X.144795  PMID:25538822
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We are presenting a case of a young woman with a history of untreated dyslipidemia presented with AMI secondary to left anterior descending coronary artery dissection during postpartum period. Physicians should be aware of this rare etiology of AMI which occurs during pregnancy and postpartum, since early diagnosis and treatment play a key role in saving both the mother and the baby. It is important to screen for other possible causes such as collagen vascular diseases, blunt injury to the chest, or cocaine abuse.
  2,653 75 2
Assessment of carotid body tumor and its association with tetralogy of fallot: Effect of the chronic hypoxia
Banu Sahin Yildiz, Ahmet Sasmazel, Ayse Baysal, Hulya I Gozu, Emre Erturk, Ozge Altas, Rahmi Zeybek, Alparslan Sahin, Mustafa Yildiz
July-September 2014, 15(3):86-88
DOI:10.4103/1995-705X.144800  PMID:25538824
This is a rare combined presentation of Tetralogy of Fallot and carotid body tumor (CBT). Hypotheses and further discussion provides data for the development of CBT as a response to chronic hypoxemia. This present study demonstrates and discusses such an occurrence.
  2,060 85 1
Assessment of heart rate turbulence in hypertensive patients: Rationale, perspectives, and insight into autonomic nervous system dysfunction
Antoine Kossaify, Annie Garcia, Fouad Ziade
July-September 2014, 15(3):68-73
DOI:10.4103/1995-705X.144790  PMID:25538819
Background: Heart rhythm turbulence is classically impaired in patients with previous myocardial infarction and congestive heart failure and is poorly investigated in patients with essential hypertension. Objective: To evaluate heart rhythm turbulence parameters (turbulence onset, (TO); turbulence slope, (TS) in a series of hypertensive patients while gaining insight into autonomic nervous system dysfunction. Setting and Design: University hospital, cross-sectional monocentric study. Materials and Methods: Heart rhythm turbulence was assessed in 50 hypertensive (case group) and 40 normotensive patients (control group). Results: TO and TS were found independently correlated with hypertension. The mean TO was found at -1.64% ± 2.85% in the normotensive patients compared to 1.21% ± 1.95% in the hypertensive patients; the mean TS was found at 4.29 ± 3.18 ms/RR in the normotensive patients compared to 2.27 ± 0.93 ms/RR in the hypertensive patients. Hypertension has a predictive value on heart rhythm turbulence impairment (OR 4.99, 95% CI 1.28-19.41, P = 0.02). Insights into the role of autonomic nervous system dysfunction for the management of hypertensive patients and prevention of malignant ventricular arrhythmia are presented and discussed with regard to heart rhythm turbulence. Conclusion: Essential hypertension is correlated with blunted heart rhythm turbulence parameters.
  2,001 92 -
First degree heart block with multi-focal atrial ectopics in an adolescent girl due to hypomagnesemia
Anup John Thomas, Chandrasekaran Venkatesh, Palanisamy Soundararajan, Balasubramanian Amirthaganesh
July-September 2014, 15(3):77-79
DOI:10.4103/1995-705X.144794  PMID:25538821
Nutritional deficiencies are common in adolescent children and include deficiencies of both micro- and macronutrients. Magnesium is an important mineral that is essential for maintenance of numerous electrophysiological and biochemical processes in the body. We report an adolescent girl who developed an episode of syncope with first degree heart block on electrocardiography and run of multifocal atrial ectopics on 24 h holter monitoring. Serum magnesium was found to be low with decreased urinary magnesium excretion. There were no other electrolyte abnormalities. Structural heart disease was ruled out by a normal echocardiogram. The rhythm changes were attributable to nutritional hypomagnesemia and were promptly reversed on correcting the hypomagnesemia.
  1,936 82 -
Delay of fibrinolysis in St- elevation myocardial infarction: Results of an investigation conducted in a single center in Sousse Tunisia
Hatem Bouraoui, Besma Trimeche, Samia Ernez Hajri, Abdallah Mahdhaoui, Meriem Ben Romdhane, Gouider Jeridi
July-September 2014, 15(3):65-67
DOI:10.4103/1995-705X.144780  PMID:25538818
Background: The aim of our study was to assess the delay of fibrinolysis in ST elevation myocardial infarction (STEMI) in our region and to identify characteristics associated with prolonged delay. Patients and Methods: We analyzed clinical characteristics of a prospective cohort of unselected patients admitted for (STEMI). The study was conducted over three years 2007-2009 and 250 patients were included in a single center without capability of percutaneous coronary intervention. Results: The mean age of our patients was 58±13, 7 years. Ninety percent of our patients consult directly the emergency department and 61, (5%) of them were admitted within first 6 hours of onset of symptoms. Median time to reperfusion was 46 min. Predictor of this long delay to initiate fibrinolysis were inter-department decision OR 6; 95% CI 3,48-10,34, diabetes OR 2,25; 95% CI 1,28-3,96 age >58,4 years OR 1,97; 95% CI 1,19-3,25 and transfer from regional hospital to our center OR 1,78; 95% 1,03-3.07. Conclusion: These results suggest that improvement in organization health care system can shorten delay to fibrinolysis in a center without percutaneous coronary intervention capability.
  1,836 96 -
Giant pulmonary artery aneurysm in a patient with rheumatic mitral stenosis
Vikas Singh, Rashi Khare, Sharad Chandra, Sudhanshu Kumar Dwivedi
July-September 2014, 15(3):89-92
DOI:10.4103/1995-705X.144802  PMID:25538825
Pulmonary artery (PA) aneurysm is a rare condition, frequently associated with pulmonary hypertension. However, the evolution and treatment of this pathology is still not clear. We report a case of a 45-year-old female patient with giant PA aneurysm associated with rheumatic mitral stenosis and severe pulmonary arterial hypertension. The patient had undergone balloon mitral valvotomy around 7 years back; aneurysm was first identified 3 years back during routine follow-up. The PA aneurysm size, however, had remained almost unchanged with associated severe pulmonary regurgitation. Surgical correction was advised but denied by the patient. To our knowledge, this is the first case report of such a large PA aneurysm in association with rheumatic heart disease. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was advised in order to prevent the future complications.
  1,843 88 1
Diffuse pulmonary hemorrhage after fibrinolytic therapy for acute myocardial infarction in a cocaine abuser patient
Mohammad Parsa Mahjoob, Isa Khaheshi, Koosha Paydary
July-September 2014, 15(3):83-85
DOI:10.4103/1995-705X.144797  PMID:25538823
We report a 45-year-old man with antroseptal myocardial infarction who developed bilateral basal alveolar infiltrates after initiating the fibrinolytic therapy. Although thrombolytic therapy with streptokinase is generally used in the course of acute myocardial infarction and has diminished morbidity and mortality, pulmonary hemorrhage is an uncommon, but a potentially life-threatening complication that should be regarded as one of the differential diagnoses of pulmonary infiltrates or dropping hemoglobin with no apparent bleeding site.
  1,715 80 1
Xanthomas and hypercholoesterolemia
N Jayaprasad, LR Tomar, S Pruthi, G Muktesh, Amitesh Aggarwal
July-September 2014, 15(3):93-94
DOI:10.4103/1995-705X.144804  PMID:25538826
  1,369 104 -
Hajar A Hajar Albinali
July-September 2014, 15(3):64-64
  1,406 62 -
Rachel Hajar
July-September 2014, 15(3):63-63
  1,243 64 -
The visual aspect of medicine
Rachel Hajar
July-September 2014, 15(3):95-95
  1,206 57 -