Hamman Syndrome with a Rare Feature of Pneumorrhachis - An Unusual Complication of Polysubstance abuse and e-vaping.

Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status. Given the concerning physical examination, a computed tomography of the chest was undertaken, which showed pneumothorax, pneumomediastinum and pneumorrhachis. The patient was closely monitored in the intensive care unit and improved after symptomatic management. The symptoms of pneumorrhachis depend on the volume and location of air in intracranial and intraspinal space. Although asymptomatic in our case, it is crucial for clinicians to be aware that pneumorrhachis with Hamman syndrome can potentially cause neurological deficits and cardiopulmonary arrest in severe cases due to increased intraspinal and intracranial hypertension, emphasising the need for close monitoring. LEARNING POINTS: Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.

Silent Damage by Micro-aspirations: Untangling the Connection of Gastroesophageal Reflux Disease (GERD) and Achalasia With Interstitial Lung Disease.

Gastroesophageal reflux disease (GERD) frequently triggers respiratory conditions such as asthma and pneumonia. Inflammation occurs as a result of aspirated material, leading to symptoms such as cough, sputum production, chest discomfort from the involvement of the lower respiratory tract, and voice hoarseness owing to the involvement of the larynx. Repeated exposure to irritants can lead to fibrosis in the lungs. However, little is known about the association of achalasia with interstitial lung disease (ILD). We present a case of a patient with GERD who presented with cough and reflux for three months. Extensive testing confirmed the diagnosis of achalasia, and pneumatic dilation provided relief. The patient returned after two years with additional symptoms of shortness of breath. A CT scan of the chest showed worsening reticular changes and ground-glass opacity, indicative of ILD. An unremarkable toxin exposure history and a negative autoimmune panel led clinicians to explore the possible relationship between achalasia and ILD, highlighting the need for further exploration and research in this area.

Tissue characterization of benign cardiac tumors by cardiac magnetic resonance imaging, a review of core imaging protocol and benign cardiac tumors.

Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.

Glucagon-like peptide-1: a multi-faceted anti-inflammatory agent.

Inflammation contributes to many chronic conditions. It is often associated with circulating pro-inflammatory cytokines and immune cells. GLP-1 levels correlate with disease severity. They are often elevated and can serve as markers of inflammation. Previous studies have shown that oxytocin, hCG, ghrelin, alpha-MSH and ACTH have receptor-mediated anti-inflammatory properties that can rescue cells from damage and death. These peptides have been studied well in the past century. In contrast, GLP-1 and its anti-inflammatory properties have been recognized only recently. GLP-1 has been proven to be a useful adjuvant therapy in type-2 diabetes mellitus, metabolic syndrome, and hyperglycemia. It also lowers HbA1C and protects cells of the cardiovascular and nervous systems by reducing inflammation and apoptosis. In this review we have explored the link between GLP-1, inflammation, and sepsis.

Incidence of Microalbuminuria and Factors Affecting It in Patients With Type 2 Diabetes Mellitus.

Background and objectives Microalbuminuria prevalence is high in patients with type 2 diabetes mellitus (T2DM) all over the world and its prevalence is affected by several factors. In Pakistan, microalbuminuria and factors that play a role in its development in patients with T2DM are under-researched. This study aimed to determine the incidence of microalbuminuria and the factors affecting it in patients with T2DM. Material and methods This descriptive cross-sectional study was performed on 129 diagnosed patients with T2DM in the outpatient department of Benazir Bhutto Hospital, Rawalpindi, for approximately six months from August 2021 to January 2022. Patients were recruited in the study through a non-probability consecutive sampling technique and established inclusion and exclusion criteria. Ethical approval was obtained from the relevant hospital ethical review board (ERB). After explaining the study's aims, informed consent was also taken from all patients before the start of data collection. A self-structured and interview-based questionnaire was used for the collection of data. Descriptive statistics and a chi-square test were applied for the data analysis using Statistical Package for the Social Sciences (SPSS) version 25 (Armonk, NY: IBM Corp.). Results The incidence of microalbuminuria in the study population was 31.78%. The association between microalbuminuria and age (p = 0.002), gender (p = 0.003), duration of diabetes mellitus (p = 0.001), therapy type (p = 0.03), control of diabetes mellitus, (p = 0.001), and hypertension (p = 0.002) was statistically significant. Higher age group, male gender, longer duration of diabetes mellitus, oral hypoglycemic agents, poorly controlled diabetes mellitus, and history of hypertension, all were found to raise the incidence of microalbuminuria. Even though being overweight was also found to raise the incidence of microalbuminuria, the association between microalbuminuria and nutritional status was statistically insignificant (p = 0.05). Conclusion Microalbuminuria incidence is significantly high in the study population. The factors such as increasing age, male gender, longer duration of the diabetes mellitus, oral hypoglycemic agents, poorly controlled diabetes mellitus, and history of hypertension, all raise the incidence of microalbuminuria in patients with T2DM to a statistically significant extent. Screening of microalbuminuria patients with T2DM should be added to the routine investigations for diabetes mellitus for the early detection of renal and cardiovascular complications.

Risk Factors of Nephrolithiasis in a Tertiary Care Hospital in Rawalpindi: A Descriptive Cross-Sectional Study.

Background Nephrolithiasis (renal stones) is the most common urological disease. Its prevalence is high in every part of the world. Several factors lead to renal stone formation. In Pakistan, nephrolithiasis prevalence is also high as Pakistan is located in a region which is known as the salt belt. However, nephrolithiasis and its possible risk factors are under-researched in Pakistan. Objective This study aims to identify the risk factors for nephrolithiasis among admitted patients with renal stones. This may lead to a reduction in renal stone incidence and its allied complications by the prevention of risk factors that would have a major role in renal stone formation. Material and methods This descriptive cross-sectional study was performed among the 143 admitted patients with renal stones in the urology ward of Benazir Bhutto Hospital, Rawalpindi, for approximately six months from November 2021 to April 2022. Non-probability convenient sampling and developed inclusion and exclusion criteria were used for the recruitment of patients. After elaborating on the objectives, the study data were collected by interviewers through a self-structured questionnaire. Descriptive analysis was carried out using SPSS version 25.0 (IBM Corp., Armonk, NY). Results Nephrolithiasis was more prevalent among patients who had an age group range of 15-30 years (47.55%), male gender (56.65%), illiterate educational status (53.14%), lower socioeconomic status (66.43%), inadequate intake of water (61.53%), used tap water (56.64%), a habit of daily vegetable intake (65.04%), sedentary lifestyle (51.74%), family history of renal stones (57.34%), no diabetes mellitus (62.94%), no hypertension (52.45%), and overweight (48.23%). Conclusion In brief, the age group of 15-30 years, male gender, illiteracy, lower socioeconomic status, insufficient water intake, tap water, high vegetables, inactive lifestyle, family history of nephrolithiasis, and a high BMI all increase the risk of nephrolithiasis.