Obesity, The Single Most Important Risk Factor for OSA: A Case Report

Obstructive sleep apnea (OSA) is characterized by repetitive airflow reduction caused by collapse of the upper airway during sleep in addition to daytime sleepiness, clinical symptoms include fatigue, insomnia, and snoring. The condition is associated with adverse clinical outcomes, including cardiovascular disease, hypertension, cognitive impairment, and metabolic abnormalities.1 Among the risk factors for OSA, obesity is probably the most important. Several studies have consistently found an association between increased body weight and risk of OSA. Tomographic scanned images have shown that obesity causes increased fatty deposits in the pharyngeal area.2 The deposits encroach on the airway and contribute to airway narrowing. Also, among obese patients as compared to normal controls, fat deposits appear to alter the shape of the upper airway without necessarily reducing the cross-sectional area. M. A. Ciscar et al used magnetic resonance imaging to investigate differences between obese and normal controls.2 Ultrafast magnetic resonance imaging was used to study the upper airway and surrounding soft tissue in 17 patients with OSA during wakefulness and sleep, and in eight healthy subjects whilst awake. Coronal sections of awake OSA patients showed elliptical-shaped airways with long axes that were oriented anteroposterior; normal controls had airways that were oriented transversely. Studies using computed tomography have produced similar results.14Pulse Vol.10 January-December 2017 p.38-41

Surgical Management of Large Mediastinal Masses–12 Years’ Experience in Apollo Hospitals Dhaka

Objective: The aim of this study was to evaluate the role of surgical treatment for large mediastinal tumors. A retrospective study was done from 6.8.2005 to 11.5.2017. Total 39 patients were included in this study. Age range was from 7 months to 70 years. Male was 24 and female was 15.Background: Most of the tumours were thymoma (12 cases). Others were thymoma with myasthenia gravis in 3 cases, Thymic carcinoma 2 cases, Nodular sclerosing Hodgkin’s lymphoma in 1 case, Schwannoma in 3 cases, Cystic mass in 5 cases, Schwannoma with cystic degeneration in 1 case, Fibromyxoma in 1 case, Dermoid in 4 cases, Teratoma in 3 cases, Fibrosing mediastinitis in thymic mass in 1 case, Lymphoid hyperplasia in 1 case, Malignant Mesenchymal tumour in 1 case, Myxoid Liposarcoma in 1 case.Method: Surgical exposure varies from sternotomy in 22 cases, to clamshell incision in 1 case, posterolateral thoracotomy in 14 cases and anterolateral thoracotomy in 2 cases. Superior Venacava was injured in 1 case, repaired successfully by 6/0 prolene controlled by partial clamp. Some of the mediastinal mass needed careful dissection from lung, pleura, encircling distal aortic arch and proximal part of left subclavian artery, encircling left brachiocephalic vein. 1 case needed reconstruction of sternum with prolene mesh, marsupialization was done in 2 cases, adjacent pleura, fatty tissue, part of pericardium was removed in 5 cases. Lobectomy was needed in 1 case. In 1 case, recurrence of fibrosing mediastinitis needed steroid therapy. Extensive growth of the tumour which involved surrounding vital structures was decided not to proceed for excision in 2 cases.Results: Overall five-years survival rate was 94.87% .2 patients of the series died due to disease process as they were cases of advanced malignant mediastinal mass.Conclusion: Surgical treatment for mediastinal mass specially involving surrounding structures though challenging, gives good outcome.Pulse Vol.10 January-December 2017 p.12-17

Chikungunya: should it be taken seriously?

not availablePulse Vol.10 January-December 2017 p.5

Simultaneous Detection and Differentiation of Chikungunya Virus and Dengue Virus in Blood at Clinical Presentation by Real Time RT-PCR

Background: Chikungunya viral infection in Bangladesh has marked 2017 summer with unprecedented magnitude for the first time. Chikungunya virus (CHIKV) and Dengue virus (DENV) are arboviruses that share the same Aedes mosquito vectors and thus overlap in their endemic areas.These two viruses cause similar clinical presentations, especially in the initial stages of infection. Because the outcomes and management strategies for these two viruses are different, early and accurate diagnosis is imperative. Early diagnosis is also important for surveillance and outbreak control.Objective: As virus isolation is not undergoing in the country and antigen based commercial detection assay is not available for CHIKV we used one step real time reverse transcriptase polymerase chain reaction (RT-PCR) method to detect and discriminate CHIKV and DENV in blood during suspicious clinical symptoms.Results: By this RT-PCR method we have detected 603 cases of CHIKV and 233 cases of DENV and thus facilitated rapid diagnosis and clinical management in the recent CHIKV outbreaks in the country.Conclusion: This is the first report about molecular detection and differentiation of CHIKV and DENV at time of clinical presentation and further show evidence of simultaneous outbreaks of both the viral infections in the country.Pulse Vol.10 January-December 2017 p.6-11

Left Atrial Myxoma with Mild Left Ventricular Dysfunction— A Case Report

Atrial Myxoma is the most common primary cardiac tumors accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium. This is a case of large left atrial (LA) myxoma presented with features of mitral stenosis associated with moderate left ventricular failure (LVF) and mild pulmonary artery hypertension (PAH) The patient improved markedly after tumor excision.Pulse Vol.10 January-December 2017 p.29-33

Anti-Phospholipid Antibody Syndrome with Subdural Hematoma: A Case Report

A 33-year-old man with anti-phospholipid antibody syndrome associated with Budd Chiari syndrome and subdural hematoma. He developed venous thrombosis in his hepatic vein (stenting done) when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT). Subdural hematoma demonstrated with Computed tomography (CT) of brain. Laboratory studies revealed thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely antiphospholipid antibodies. Based on these findings, we consider that the tendency of this bleeding may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Antiphospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction and on anticoagulant (warfarin).Pulse Vol.10 January-December 2017 p.25-28

CME in Apollo Vol.10(1)

not availablePulse Vol.10 January-December 2017 p.57-58

A Case of Neurofibromatosis type 1 with Moya Moya Disease

A 5 years old boy with multiple café au lait spots came with intermittent weakness of the right side of the body and seizures. The child had global developmental delay. His MRI and MRA showed thickening of the optic nerves, abnormal signal in multiple areas of the brain with non-visuation of the left middle cerebral artery. The child was diagnosed to have neurofibromatosis type 1 with seizures with bilateral optic glioma with Moya Moya disease.Pulse Vol.10 January-December 2017 p.34-37

Pulse Message Vol.10(1)

not availablePulse Vol.10 January-December 2017 p.62-63

Anterior Mediastinal Teratoma- A Rare Variety

Anterior mediastinal teratomas are rare germ cell tumors. We report a case of such rare tumor in a 16 years old boy who presented with sudden severe right sided abdominal pain which radiating to chest for one day. CT scan of the chest was suggestive of anterior mediastinal teratoma. Patient underwent Clamshell thoracotomy. Peroperatively a large mass was found in the anterior mediastinum containing huge amount of sebum like material. It was adherent to mediastinal surface of right & left lung, pericardium and great vessels (SVC, Aorta). The tumor and was resected out except part of its posterior surface which was adherent to pericardium and great vessels and was left in situ. He had a smooth & uneventful post-operative recovery. Histopathology reported as mature (benign) teratoma with no evidence of malignancy.Pulse Vol.10 January-December 2017 p.52-56