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Saravanabavanandan R, Jaimalani A, Khan MAN, Riaz S, Mangas GDM, Ahsan SM, Posani S, Patel T, Fawad M, Al-Tawil M. Gender-Based Outcome Discrepancies in Patients Who Underwent Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 208:134-142. [PMID: 37839170 DOI: 10.1016/j.amjcard.2023.09.033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023]
Abstract
Clinical evidence and emerging studies suggest that the clinical heterogeneity observed in hypertrophic cardiomyopathy could be because of gender-based differences. We aimed to explore the gender-related differences pertaining to the treatment outcomes after alcohol septal ablation (ASA) and septal myectomy (SM). We searched PUBMED/MEDLINE, EMBASE, and SCOPUS to identify studies that report gender-stratified comparison of outcomes. The primary outcome of interest was short-term (within 30 days) mortality. A total of 15 studies totaling 31,907 patients (47% men and 53% women) were included. Women were found to be significantly older at the time of intervention (ASA: mean difference [MD] 7.55 years; SM: MD 4.41). In the ASA and SM treatment arms, women had a significantly higher risk of short-term all-cause mortality (ASA: risk ratio 0.48, 95% confidence interval 0.32 to 0.71, p = 0.0003; SM: risk ratio 0.63, 95% confidence interval 0.44 to 0.90, p = 0.01), more frequent permanent pacemaker implantation (ASA; p = 0.002, SM: p = 0.05), and longer in-hospital stay (ASA: MD 1.00 days, SM: MD 0.69). Among those who underwent ASA, women had a significantly higher rate of atrioventricular block. In conclusion, regardless of ASA or SM, women consistently presented at an older age and exhibited a higher risk-increased mortality rate, a greater incidence of atrioventricular block, and a higher likelihood of permanent pacemaker requirement-and longer hospital stay among women than men. This strongly emphasizes the need for a gender-specific approach to optimize care and improve treatment outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
| | - Aniket Jaimalani
- Department of Medicine, Surat Municipal Institute of Medical Education and Research, Surat, India
| | | | - Sania Riaz
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Syed Muhammad Ahsan
- Dow Institute of Biological, Biochemical & Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarojini Posani
- Department of Medicine, Sri Devaraj URS Medical College, Kolar, India
| | - Tirath Patel
- American University of Antigua College of Medicine, Saint John, Antigua and Barbuda
| | - Moiz Fawad
- Department of Neurosurgery, King Saud Hospital, Unayzah, Kingdom of Saudi Arabia
| | - Mohammed Al-Tawil
- Faculty, Department of Medicine, Al-Quds University, Jerusalem, Palestine
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Vempati R, Ravulapalli P, Posani S, Mahalingam A, Tango T, Sayed Mushir Ali A. Hyperhomocysteinemia as a Cause of Acute Ischemic Stroke in a Four-Year-Old Child: A Report of a Rare Case. Cureus 2023; 15:e46981. [PMID: 38021803 PMCID: PMC10640911 DOI: 10.7759/cureus.46981] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Homocysteine is a type of amino acid that isn't genetically encoded by the human body. This amino acid is capable of causing oxidative damage to the endothelial cells, leading to the onset of thrombosis. Moreover, it can also inflict harm to neurons by activating pro-apoptotic factors, causing DNA damage, and inducing oxidative stress, as observed in various animal models and cell cultures. This case report highlights a four-year-old girl who exhibited signs of an ischemic stroke. The neurological examination revealed several symptoms, including anisocoria, decreased tone, decreased power, absent reflexes on the right upper and lower extremity, and hyper extensor plantar response, accompanied by upper motor neuron seventh cranial nerve palsy. An MRI scan further confirmed the presence of an ischemic stroke in the left middle cerebral artery territory. After a thorough evaluation, the probable cause of this condition was identified as severe homocysteine elevation.
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Affiliation(s)
- Roopeessh Vempati
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
- Cardiology, Heart and Vascular Institute, Detroit, USA
| | - Pratyusha Ravulapalli
- Internal Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kolar, IND
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Akhshaya Mahalingam
- Pediatrics, Government Stanley Medical College, Chennai, IND
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Tamara Tango
- Neurosurgery, Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
- Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
- Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Anam Sayed Mushir Ali
- Internal Medicine, Indian Institute of Medical Science and Research, Aurangabad, IND
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
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Lainingwala AC, Gajula S, Fatima U, Afroze S, Posani S, Moondra M, Mangukiya NP, Parmar MP, Venugopal V. A Unique Case of Harlequin Ichthyosis in the Tertiary Health Care System in a Rural Area. Cureus 2023; 15:e43342. [PMID: 37700957 PMCID: PMC10495033 DOI: 10.7759/cureus.43342] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Harlequin ichthyosis (HI) is a severe and rare genetic anomaly that affects skin development and leads to the formation of thick, diamond-shaped plates of keratinized skin. The adenosine triphosphate binding cassette A 12 (ABCA12) gene, which is essential for the transportation of lipids required for the skin's barrier function, has mutations that result in this condition. The affected individuals exhibit distinct clinical features, including thickened skin, deep cracks, and fissures, which can result in significant physical and functional impairments. HI is usually apparent at birth, with affected infants presenting with tight and rigid skin that restricts movement and normal growth. The condition is associated with various complications, including difficulty breathing, feeding difficulties, and increased susceptibility to infections. Due to the impaired skin barrier, affected individuals are also prone to dehydration and temperature dysregulation. In this case report, we present a unique case of ichthyosis in a nine-month-old child. Despite advances in medical care, HI remains a challenging condition with a high mortality rate, particularly in the neonatal period. However, with early detection, appropriate interventions, and an improved understanding of the underlying molecular mechanisms, there is hope for enhanced management and improved quality of life for individuals living with HI.
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Affiliation(s)
- Aashka C Lainingwala
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sahini Gajula
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Umaima Fatima
- Internal Medicine, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Hyderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sabah Afroze
- Internal Medicine, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Hyderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kolar, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Mudit Moondra
- Internal Medicine, Rabindranath Tagore Medical College, Udaipur, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Nisarg P Mangukiya
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Vishal Venugopal
- Internal Medicine, Bhaarath Medical College & Hospital, Chennai, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
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Kalluru PKR, Mamilla M, Valisekka SS, Mandyam S, Calderon Martinez E, Posani S, Sharma S, Gopavaram RR, Gargi B, Gaddam A, Reddy S. Aminotransferases in Relation to the Severity of Dengue: A Systematic Review. Cureus 2023; 15:e39436. [PMID: 37234451 PMCID: PMC10208548 DOI: 10.7759/cureus.39436] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
A systematic review was conducted to investigate the relationship between aminotransferases and the severity of dengue infection, which is a prevalent and significant infection in tropical and subtropical regions. Aminotransferases are enzymes that are often elevated in dengue due to the liver's physiological and immunological response to the infection. This review focused on analyzing various studies that examined the correlation between aminotransferase levels and the severity of dengue. Extensive literature searches were performed using ("dengue*" OR "dengue fever*" OR "dengue haemorrhagic fever*" OR "dengue shock syndrome*") AND ("alanine aminotransferase*" OR "aspartate aminotransferase*") on PubMed. The selected articles were thoroughly reviewed, encompassing epidemiology, pathogenesis, and clinical manifestations of dengue. The consistent findings across the studies indicated that aminotransferases can serve as predictive markers for dengue severity. Therefore, early assessment of liver enzyme levels is crucial in dengue cases, and elevated levels should be closely monitored to prevent adverse outcomes.
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Affiliation(s)
| | - Mahesh Mamilla
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | - Sai Sudha Valisekka
- Internal Medicine, University of Minnesota School of Medicine, Minneapolis, USA
| | | | | | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kothagudem, IND
| | - Shriya Sharma
- Internal Medicine, Dnipropetrovsk State Medical Academy, Dnipro, UKR
| | | | - Borgharkar Gargi
- Public Health, University of Alabama at Birmingham School of Medicine, Brimingham, USA
| | - Anvitha Gaddam
- Internal Medicine, Siddhartha Medical College, Vijayawada, IND
| | - Sushritha Reddy
- Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, IND
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