Case report: severe symptomatic hyponatremia associated with lisinopril therapy.

A 63-year-old white female who was being treated for hypertension with lisinopril presented with seizures, altered mental status, and a serum sodium of 101 mEq/L. Serum sodium prior to initiation of lisinopril therapy was 137 mEq/L. The hyponatremia was corrected and did not recur after lisinopril was stopped. The hyponatremia may have been a result of polydipsia and inappropriate antidiuresis secondary to ACE-inhibitor therapy.     

Longitudinal correlations between MRE,MRI-PDFF,and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase II trial of selonsertib

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Valve injury and repair in balloon aortic valvuloplasty

Aortic valves 0.5, and 4.5 months after successful percutaneous balloon aortic valvuloplasty (BAV) were examined. BAV caused macroscopic and microscopic fractures in calcific deposits. An inflammatory response was identified that may lead to valvular scarring. This process may be an important factor in the development of restenosis after BAV.     

Vivax and falciparum malaria seen at an Indian service hospital

The cases of 740 adult males with vivax and/or falciparum malaria managed in a military hospital in north-eastern India during the period from June 1978 to March 1981 were analysed. Four hundred and nine (55.3%) were infected with Plasmodium falciparum, 237 (32.0%) with P. vivax and the remaining 94 (12.7%) with both P. vivax and P. falciparum. The majority of cases were chloroquine sensitive and did not pose diagnostic or therapeutic problems. Of 381 patients subjected to an extended field test, 82 (21.5%) exhibited a variable degree of chloroquine resistance. Cerebral and haemopoietic involvement were the commonest of the pernicious syndromes observed in 92 (12.4%) patients. Atypical presentations, variable chloroquine resistance and presentation with complications call for timely recognition and institution of a specific supportive therapeutic regime.     

Peer-Led and Professional-Led Group Interventions for People with Co-occurring Disorders: A Qualitative Study

This pilot study evaluated the experience of people with co-occurring disorders (mental illness and addiction) in relation to peer-led and professional-led group interventions. The study used a qualitative (phenomenological) approach to evaluate the experience of a convenience sample of 6 individuals with co-occurring disorders who participated in up to 8 sessions each of both peer-led and professional-led group interventions (with a similar rate of attendance in both groups). The semi-structured interview data were coded and thematically analyzed. We found 5 themes within and across the 2 interventions. In both groups, participants experienced a positive environment and personal growth, and learned, albeit different things. They were more comfortable in the peer-led group and acquired more knowledge and skills in the professional-led group. Offering both peer-led and professional-led group interventions to people with co-occurring disorders may be better than offering either alone     

Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram

BackgroundThe consequences of atherosclerosis can be detected by multislice computed tomography (MSCT), invasive coronary angiogram (CAG) and the resultant myocardial ischaemia by myocardial perfusion single photon emission computed tomography (MPS). In this study an attempt is made to compare MSCT with MPS and also to compare the MSCT findings with that of invasive CAG in patients suspected to have coronary artery disease (CAD).Materials and methodsA total of 99 patients suspected to have CAD underwent both MSCT and MPS with ^99mTc sestamibi. The MSCT studies were classified as having no CAD, significant CAD (>50% diameter stenosis), and insignificant CAD (<50% diameter stenosis). Myocardial perfusion single photon emission computed tomography was reported as normal and reversible ischaemia. In a subgroup of 33 patient invasive CAG was done.ResultsIn 99 patients, 396 coronaries were evaluated with MSCT and MPS. Coronary artery calcium scoring (CACS) in these patient ranged from 0 to 2200. No CAD was noted in 128 (32%) coronaries but MPS was found abnormal in 9 (7%) coronaries. Insignificant CAD was noted in 169 (43%) coronaries amongst which reversible ischaemia was noted in 23 (14%). Significant CAD was noted in 99 (25%) coronaries of which only 54 (55%) were MPS positive for reversible ischaemia. The MSCT has a negative predictive value (NPV) of 97%. When MSCT was normal, MPS was almost normal, but the reverse was not true. That is when MPS was normal MSCT was not always normal but showed lesion of insignificant obstruction.In the subset of 33 patients, who underwent invasive angiogram, 132 coronaries were evaluated. Coronary angiogram showed 48 coronaries (36%) to have significant CAD (>50% diameter stenosis). Multislice computed tomography correlated well in 46 (84%) with P value of <0.001 (χ²-test) but for 9 (16%) showing overestimation due to increased CACS (>800). Myocardial perfusion single photon emission computed tomography was normal in 15 (27%) coronaries.ConclusionMyocardial perfusion single photon emission computed tomography provides functional information of the anatomical lesions and MSCT provides anatomical information. Both are two different diagnostic modalities. The MSCT has high NPV in patients with less likelihood for CAD. When compared with CAG, the correlation with MSCT was good and is useful where the calcium score is low.     

Non-mechanical traumatic gas gangrene: forgotten but not gone

We report a case of gas gangrene (GG) in a non-diabetic HIV seronegative man who died within 60 hours following an intramuscular injection in rural India. The occurrence of GG after intramuscular injection is rare and only a few cases have been reported in the published literature.