by Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Mohammed Al-Sadawi, Rodaina Ahmed, Jason Green, Iya Dubson and Samy I. McFarlane
Original Research
Cocaine is a commonly abused illicit drug in the United States. The complex effects of cocaine on the conduction system of the human heart has not been completely understood. Cocaine acts as a sympathomimetic by inhibition of reuptake of neuronal catecholamines, leading mostly to tachyarrhythmias on presentation. However, cocaine also exerts other effects on the conduction system including sympathomimetic, sino-bradycardic as well as local anesthetic properties. While Multiple cases of atrioventricular (AV) conduction blocks including first degree AV block, Mobitz type I and third degree AV blocks have been previously reported, we hereby present the first case report of cocaine- induced Mobitz type II second degree AV block. This case occurred in a 55 year old woman who presented with retrosternal chest pressure and tested positive for cocaine abuse as documented by urine toxicology test. Patient spontaneously converted to normal sinus rhythm the following day post admission to the hospital. Cocaine is known to inhibit sodium channels and thus has been known to decrease SA node automaticity and conduction via AV node. Electrophysiology studies have previously confirmed cocaine mediated delay in impulse conduction and repolarization. Though rare, physicians should be aware of the possibility of bradyarrhythmias associated with cocaine abuse in order to apply standard therapy such as pacemaker in the event of non-resolution of this serious arrhythmia.
American Journal of Medical Case Reports. 2018, 6(7), 146-148. DOI: 10.12691/ajmcr-6-7-7
Pub. Date: August 21, 2018
8533 Views2539 Downloads
by Sharad Samson Rajmani, Neeraj Salhotra, Dr Samit Biniwale, Levingston Chelladurai, Bashar Al Tunbi and Fahad Abaas Al Kheder
A Clinical Study
Micro vascular decompression is performed as a common procedure in neurosurgical field for trigeminal neuralgia, hemi facial spasm, tinnitus etc. Regular craniotomy or craniectomy amounts to significant concerns in length of incision, size of craniotomy, postoperative stay in hospital, complications encountered and outcome. Keyhole craniotomy is an answer to all these concerns [1]. We present here our short series of key hole craniotomies done for micro vascular decompression for various indications and confirming the favorable outcome.
American Journal of Medical Case Reports. 2018, 6(7), 143-145. DOI: 10.12691/ajmcr-6-7-6
Pub. Date: August 19, 2018
12702 Views1965 Downloads
by Bhavana Venkata Nagabhushana Rao and Bhavana Venkata Satyaraman
Case Report
Tuberculosis is a common etiological factor for fever of unknown origin in developing countries even today. Tuberculous mediastinal lymphadenitis is a disease of children as a part of primary tuberculosis. Mediastinal lymphadenitis without a parenchymal disease is unusual in an adult. Mediastinal tuberculous lymphadenitis presenting as fever of unknown origin could be mysterious when chest x ray was normal. Modern techniques like Computerised Tomography of chest and Endobronchial Ultrasound and Transbronchial Needle Aspiration (EBUS & TBNA) made it possible to make an early diagnosis in such clinical situations. We present a case of an adult with mediastinal tuberculous lymphadenitis with esophageal compression symptoms who presented with fever difficult to diagnose. And also we depict how modern techniques helped us to make an early and accurate diagnosis.
American Journal of Medical Case Reports. 2018, 6(7), 137-142. DOI: 10.12691/ajmcr-6-7-5
Pub. Date: August 14, 2018
12219 Views2796 Downloads
by Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Sudhanva Hegde, Jonathan D.Marmur, Perry Wengrofsky, Mena Yacoub, Michael Post and Samy I. McFarlane
Original Research
Marijuana is the most common drug of abuse in the United States. Marijuana acts on cannabinoid receptors CB1, CB2 and another distinct endothelial receptor. Marijuana is known to cause tachycardia, hypotension and hypertension. Various arrhythmias including atrial fibrillation, atrial flutter, II degree AV block, ventricular fibrillation, ventricular tachycardia, asystole and brugada pattern associated with marijuana use have been reported. We here present an interesting case of Type I Brugada pattern in electrocardiography (ECG) in a 36 year old healthy African American male who presented after smoking four joints. Urine toxicology test proved marijuana use. Acute coronary syndrome was ruled out, coronary angiogram revealed normal coronaries, 2D echocardiogram showed no evidence of structural heart disease. Upon resolution of Brugada pattern in ECG, procainamide challenge performed in electrophysiology laboratory did not induce Brugada pattern. Patient was asked to return to hospital if he developed fever that did not resolve with antipyretics. Further studies are required to to understand the effect of marijuana on cardiac ion channels.
American Journal of Medical Case Reports. 2018, 6(7), 134-136. DOI: 10.12691/ajmcr-6-7-4
Pub. Date: August 07, 2018
10146 Views3541 Downloads
by Ines Kechaou, Wejdene Ouechtati, Eya Cherif, Imene Boukhris, Slim Chenik and Lamia Ben Hassine
Case Report
Endocarditis of the right heart related to a pacemaker is a serious complication. In this regard, we report a case of a patient aged 59 which is characterized by the occurrence of this complication a very long time after implantation of the materiel. In this patient, the diagnosis was delayed due to untimely antibiotic therapy.
American Journal of Medical Case Reports. 2018, 6(7), 132-133. DOI: 10.12691/ajmcr-6-7-3
Pub. Date: August 03, 2018
7746 Views1690 Downloads
by G P Mishra, Tariq Al Saadi, Neeraj Salhotra, Samit Biniwale, Mohammad Hadad, Mohammad Hashim, Ali Al Mashani, Qassim Al Hinai and Sharad Samson Rajmani
Data Report
Brain and spinal tumors contribute to the main bulk of neurosurgery work in any Neurosurgical center. Effective audit of the work of a neurosurgical center amounts to earmarking the areas needing improvement and hence an enhanced patient care. Our department also performed an annual audit of the cranial and spinal tumors dealt in one year and analyzed the results. Benign to malignant all varieties of cranial tumours were seen in a small population of a country like Oman, however state of art diagnostic facilities were used to diagnose, treat and follow up the patients. Careful eye was kept on the pseudoprogression of the tumours as repted in the radiological reports. Results revealed a standard distribution of the tumours seen in other centers reported in the literature. Extent of tumour excision was done in standard guidelines keeping patient useful outcome in mind. Resurgery in maligant tumours were offered in young patients if comes back with recurrence.
American Journal of Medical Case Reports. 2018, 6(7), 128-131. DOI: 10.12691/ajmcr-6-7-2
Pub. Date: July 30, 2018
8340 Views1620 Downloads
by Satyajit -Mallick, Hasanat MA, Fariduddin M, Tahseen - Mahmood, Mohona -Zaman and Sharmin -Jahan
Case Report
Bartter syndrome is a rare autosomal recessive renal tubulopathy resulting in hypokalemic, hypochloremic metabolic alkalosis with hyperreninemia. It consists of a set of closely related overlapping syndromes having variable presentation. Advances in molecular diagnostics have revealed the underlying mutations in numerous genes that affect the function of ion channels and transporters which normally mediate salt reabsorption in the distal nephron segments. The classic manifestations are childhood onset of fatigue, polyuria, polydipsia, salt craving, vomiting, dehydration, short stature, and failure to thrive. It should be suspected in any young, normotensive individual presenting with persistent hypokalemic alkalosis in the absence of surreptitious diuretic abuse. It requires high index of clinical suspicion for appropriate diagnosis and timely treatment have been shown to reverse the clinical and biochemical abnormalities thereby improve the outcome. Here we report a 19-year-old boy with classical Bartter syndrome that was treated with Potassium supplementation, NSAID, spironolactone and he showed significant improvement on subsequent follow-up.
American Journal of Medical Case Reports. 2018, 6(7), 124-127. DOI: 10.12691/ajmcr-6-7-1
Pub. Date: July 28, 2018
8571 Views1756 Downloads2 Likes