Brugada pattern masking anterior myocardial infarction

A middle-aged male smoker presented with atypical chest pain. Initial electrocardiogram (ECG) showed Brugada Type 1 pattern. Subsequent ECGs demonstrated evolving anterior ST elevation myocardial infarction (STEMI), consistent with the elevated cardiac enzymes. Coronary angiogram showed significant stenoses in the left anterior descending artery, which were stented emergently. In retrospect, subtle changes were noted in the initial ECG, which could have alerted one to the STEMI. However, the presence of a Brugada Type 1 pattern masked the ECG changes of anterior STEMI and made the diagnosis difficult. A discussion of the literature surrounding Brugada syndrome is undertaken, including its clinical features, risk stratification and management.     

Cell typing of the scabetic lesion and its clinical correlation

Scabies is a pruritic dermatosis due to infestation by a mite that stimulates both humoral and cellular immune responses causing cutaneous lesions as well as pruritus. Changes in immune response pattern with treatment are associated with improvement in symptoms and clinical cure. In this study, we analysed the cellular infiltrate types and patterns in lesions of Scabies. Treated patients were divided into 2 groups as those with and without pruritus. In the pre-treatment cases, there was a high incidence of T3, T4, T6 and T8 infiltration in the lesions, with T4 greater than T8. Following treatment, it was noted that T8 density was significantly increased in patients who had resolution of symptoms. It can therefore be concluded that T4 cell dominance is the cause of persistant itching and T8 increase leads to improvement in the pruritus.     

Stability of activated partial thromboplastin time (APTT) test under different storage conditions

We designed this study to assess the effect of storage time and temperature on the activated partial thromboplastin time (APTT) test and plasma activity of factor VIII (FVIII). A total of 71 subjects, comprising 34 healthy controls and 37 patients receiving unfractionated heparin were enrolled. After centrifugation of collected specimens aliquots of plasma were stored at room temperature (20-22 degrees C), refrigerated at 2-6 degrees C and frozen at - 40 degrees C. Determination of APTT and plasma activity of FVIII were performed immediately after sampling (zero time) and after 6, 12 and 24 h. We found no significant difference in APTT after 6 h at room temperature and 4 degrees C compared to zero time values (P>0.05) in control group, while APTT was significantly changed at other storage conditions. With regard APTT test in patients on heparin therapy and samples for FVIII activity in healthy subjects; there was a statistically significant change in their results after 6, 12 and 24 h at room temperature, 4 and - 40 degrees C compared to zero time value(P < 0.05). Our data demonstrate that the APTT test can be done within 6 h when stored at room temperature and 4 degrees C without change in the result in healthy subjects. APTT test in patients on heparin therapy and samples for FVIII test in healthy subjects must be done immediately and without delay to avoid reduction in their activities.     

Technetium 99m-diethylene triamine penta-acetic acid aerosol clearance in the evaluation of pulmonary involvement in sickle cell disease

BACKGROUND: Pulmonary clearance of inhaled technetium (Tc) 99m-labeled diethylene triamine penta-acetic acid (DTPA) aerosol is a sensitive non-invasive marker of alveolar permeability and patients with interstitial lung diseases show enhanced clearance. However, a previous study in adult patients with diabetes mellitus showed delayed clearance. OBJECTIVES: To investigate DTPA clearance in steady-state, otherwise healthy adult sickle cell disease (SCD) patients and correlate it with pulmonary function tests (PFTs), hematologic and clinical parameters. MATERIALS AND METHODS: The subjects were randomly selected from the Hematology Clinic of Mubarak Hospital, Kuwait. Hematologic and pulmonary function data were collected with standard methods. DTPA radio-aerosol clearance studies were performed using ultrafine nebulizer containing 35 mCi (1295 MBq) of Tc 99m-DTPA in its reservoir and t(1/2) clearance in minutes was determined. Average values for both lungs were calculated and compared with normal values for our population. RESULTS: Forty-three subjects (24 SS and 19 S-beta(0)thal) aged between 16 and 45 yr (mean of 27.1 +/- 9.7) were studied. Twenty-two subjects (51.2%) had delayed, while only 10 (23.3%) showed enhanced DTPA clearance. Patients with enhanced clearance showed better PFTs than those with normal or delayed clearance. There was significant negative correlation of DTPA clearance with forced expiratory volume in 1 s, forced vital capacity and total lung capacity and significant positive correlation with age. CONCLUSIONS: Majority of adult SCD patients have delayed DTPA clearance unlike in inflammatory lung diseases, but similar to diabetes mellitus. DTPA clearance may be a useful modality for monitoring pulmonary involvement in SCD.     

Relationship between resistin and aPAI‐1 levels with insulin resistance in Saudi children

Background: Association of resistin with insulin resistance (IR) in humans is still controversial and few studies have investigated the association of plasminogen activator inhibitor‐1 (PAI‐1) with IR in children. The purpose of the present study was therefore to evaluate serum levels of resistin and active PAI‐1 (aPAI‐1) in Saudi children and their association with the various obesity‐related complications. Methods: In this cross‐sectional study, 73 boys and 77 girls with varying body mass index (BMI) were recruited. They were assessed for anthropometric measures and fasting serum levels of glucose, insulin, lipid profile, resistin, angiotensin II (ANG II) and aPAI‐1. Results: Resistin was positively correlated with hips (r = 0.33, P < 0.01), waist (r = 0.23, P < 0.05) and BMI (r = 0.33, P < 0.01). The association of resistin with the markers of obesity was also significant in girls but lost significance in boys. aPAI‐1 was positively correlated with total cholesterol (r = 0.24; P < 0.01), triglycerides (r = 0.2, P < 0.05), HOMA‐IR (r = 0.26, P < 0.01) and insulin (r = 0.26, P < 0.01). The significant association of aPAI‐1 with IR was also true in girls but lost significance in boys. Conclusion: Resistin is not correlated with IR and further studies are needed to explore the role of resistin especially in childhood obesity. In contrast, increased levels of PAI‐1 may contribute to the risk of cardiovascular diseases related to obesity and insulin resistance in children. The observed gender‐related differences in the association between resistin, aPAI‐1 with obesity markers and IR could be attributed to sexual dimorphism in body fat distribution.     

Histologic study of colonic mucosa in patients with chronic diarrhea and normal colonoscopic findings

BACKGROUND: There are controversies about the importance of biopsies of normal colon mucosa in the investigation of patients with chronic diarrhea. STUDY: Colonic and terminal ileum biopsies of 167 patients were reviewed. In 5 patients, used as controls, colonoscopy was done due to family history of colon cancer. RESULTS: The 5 patients without symptoms had no histologic abnormalities. The histologic findings in 162 patients with chronic diarrhea were as follows: 110 patients (67.9%) with normal histology, microscopic colitis not otherwise specified, and isolated small granulomas; 17 (10.5%) patients had findings of borderline diagnostic significance, including possible collagenous colitis, some features of lymphocytic colitis and melanosis coli; and 35 (21.6%) patients, with diagnostic significant histologic findings as collagenous colitis, lymphocytic colitis, minimal change microscopic colitis, eosinophilic colitis, pericrypt eosinophilic enterocolitis, intestinal spirochetosis, schistosomiasis, and Crohn's disease. Of the 52 patients with either borderline or significant diagnostic abnormalities, in 8 (15.4%) the diagnosis was done only with a proximal study (ascending, transverse, or descending colons). CONCLUSIONS: Histologic lesions of possible diagnostic value could exist in 32.1% of chronic diarrhea patients with normal colonoscopy, which can justify, in certain cases, mucosa biopsies, which might contribute for a more precise etiologic diagnosis; also, the distribution of these histologic changes has pointed out the importance of having all colon segments biopsied.