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Makkar A, Siraj T, Zimmerman S, Evans D, Landa E, Ganim I, Sukpraprut-Braaten S, Wagner SD, Abhilash A. Food Bolus Masquerading as a Cardiac Mass on Echocardiogram. Cureus 2021; 13:e17872. [PMID: 34527503 PMCID: PMC8431984 DOI: 10.7759/cureus.17872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
An echocardiogram is the most utilized imaging modality in the evaluation of patients with intracardiac masses. Of these, left atrial myxomas are the most common intracardiac tumors in which diagnostic recognition is important for appropriate management. This paper demonstrates a case study on how a proper physical exam along with proper imaging modalities may result in avoiding misdiagnosing patients with large sliding hiatal hernias who present with the complaint of chest pain. This case reveals a food bolus within a sliding hiatal hernia masquerading as an intracardiac mass. Cardiac masses can potentially be misdiagnosed using transthoracic echocardiography (TTE). While transthoracic echocardiography is uniquely resourceful as a point-of-care modality, it can be challenging to confirm whether an identified mass is attached to the myocardium or other cardiac or intrathoracic structures. The patient exhibited symptoms compatible with a cardiac mass. Primarily, the physical examination is vital in determining whether the patient should be referred for additional diagnostic modalities to assess for a cardiac mass. Auscultation of bowel sounds on the cardiac examination is consistent with a suspected hiatal hernia.
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Affiliation(s)
- Abhilash Makkar
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | - Talhah Siraj
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | - Stacy Zimmerman
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | - David Evans
- Cardiology, Unity Health - White County Medical Center, Searcy, USA
| | - Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Ismail Ganim
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | | | - Stephen D Wagner
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
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Knefati M, Ganim I, Schmidt J, Makkar A, Igtiben S, Landa E, Tarawneh A, Hicks C, Zimmerman S, Sukpraprut-Braaten S. COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture. Cureus 2021; 13:e15310. [PMID: 34211811 PMCID: PMC8236337 DOI: 10.7759/cureus.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.
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Affiliation(s)
| | | | | | | | | | - Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Ahmad Tarawneh
- Pulmonary and Critical Care Medicine, Unity Health, Searcy, USA
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Kaur S, Gupta R, Khan ID, Jindal S, Prajapati S, Makkar A, Rajmohan KS. INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA. IJMMR 2019. [DOI: 10.11603/ijmmr.2413-6077.2018.2.9286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi.
Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics.
Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health.
Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.
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Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR). J Intellect Disabil Res 2019; 63:31-39. [PMID: 30338591 DOI: 10.1111/jir.12553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India). METHODS The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05. RESULTS Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively. CONCLUSIONS The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.
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Affiliation(s)
- A Makkar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - K R Indushekar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - B G Saraf
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - D Sardana
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, S.A.R
| | - N Sheoran
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
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Makkar A, Mishima T, Chang G, Scifres C, Sadovsky Y. Fatty acid binding protein-4 is expressed in the mouse placental labyrinth, yet is dispensable for placental triglyceride accumulation and fetal growth. Placenta 2014; 35:802-7. [PMID: 25096952 DOI: 10.1016/j.placenta.2014.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Fatty Acid Binding Protein-4 (FABP4) is a member of a family of FABP proteins that regulate intracellular lipid trafficking in diverse tissues. We recently showed that FABP4 regulates triglyceride accumulation in primary human trophoblasts. To assess the function of placental FABP4 in vivo, we tested the hypothesis that FABP4 is expressed in the murine placenta, and regulates placenta triglyceride accumulation. METHODS C57Bl/6 wild type or Fabp4-null mice were time-bred, and fetuses and placentas harvested at different time points during pregnancy. Placental FABP4 expression was assessed at different gestational ages, using quantitative PCR, immunohistochemistry, immunofluorescence and western immunoblotting. FABPs expression was examined by RT-qPCR. Placental lipids were extracted using the Folch method and triglyceride levels determined using a colorimetric quantification kit. RESULTS Using immunohistochemistry, we found that FABP4 was expressed in the placental labyrinthine layer, predominantly in endothelial cells in association with CD31 positive fetal capillaries. The level of placental FABP4 mRNA and protein increased from E12.5 to E16.5 and slightly decreased at E18.5. Breeding of Fabp4 heterozygous mice resulted in embryonic genotypes that followed a Mendelian distribution and exhibited normal weight and morphology, triglyceride content, and expression of other FABP family members. Exposure to hypoxia (O2 = 12%) between E12.5-E18.5 did not uncover a difference between wild type and Fabp4-null mice. CONCLUSIONS FABP4 is expressed in the mouse placental labyrinth, with highest expression at E16.5. FABP4 is dispensable for feto-placental growth and placental lipid accumulation.
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Affiliation(s)
- A Makkar
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, USA
| | - T Mishima
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - G Chang
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Tsinghua University School of Medicine Education Program, Beijing, China
| | - C Scifres
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Sadovsky
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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Prisciandaro J, Fox C, Horwood L, Hayman J, Makkar A, Moran J, Pelosi F. SU-E-T-183: Managing and Assessing Patients Receiving Radiotherapy with Implantable Cardiac Devices. Med Phys 2012; 39:3745. [DOI: 10.1118/1.4735242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bedi HS, Singh RP, Makkar A, Goel V, Yakhmi R, Jain S. Post cardiac surgery transfusion associated graft versus host disease—an uncommon but potentially lethal complication. Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bhargava JS, Kumar R, Singh RB, Makkar A. Civilian vascular trauma: an experience of 54 cases. J Indian Med Assoc 1996; 94:47-9. [PMID: 8810175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fifty-four patients with civilian vascular injuries of the extremities caused by blunt trauma in 41 patients and by penetrating trauma in 13 patients were evaluated. Twenty-nine patients (53.7%) had associated fractures/dislocations and 19 sustained concomitant venous injuries. Twenty-nine patients (53.7%) came with a lagging period of more than 12 hours. Vascular injuries were diagnosed both clinically and by Doppler examination. In patients with equivocal findings, arteriography was performed. Arterial repair was done in 19 patients and saphenous vein interposition grafting was done in 2 patients. Fifteen patients required fasciotomy. Amputation was done in 13 patients (24.07%). It is concluded that the time lag, incorrect and incomplete assessment, and the reluctance to perform fasciotomy early and completely are some of the factors responsible for poor results.
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Affiliation(s)
- J S Bhargava
- Department of Surgery, Pt BD Sharma Medical College, Rohtak
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