Infarct of the Middle Cerebellar Peduncle Mimicking Bell's Palsy: A Case Report.

The anterior inferior cerebellar artery (AICA) supplies the middle cerebellar peduncle, lower pons, upper medulla, and anterior inferior cerebellum. Ischemia in the AICA can cause the lateral inferior pontine syndrome. AICA syndrome is characterized by facial sensory loss and weakness, Horner syndrome, prolonged vertigo, audio-vestibular loss, and cerebellar signs. Many studies on AICA territory infarcts have demonstrated the rarity of complete AICA syndrome. In all cases of AICA territory infarcts, involvement of the middle cerebellar peduncle was observed, with the seventh cranial nerve (facial nerve) being the most frequently involved cranial nerve, vertigo was the most common presenting symptom, and atherosclerosis was the most common etiology. This case report aims to investigate the occurrence of middle cerebellar peduncle infarcts that mimic Bell's palsy, highlighting the importance of accurate diagnosis and appropriate management in such cases. Recognizing the unique characteristics and clinical presentation of middle cerebellar peduncle (MCP) infarcts is essential for distinguishing them from more common conditions like Bell's palsy, thereby ensuring timely and effective treatment.

Dynamic diffusion lung capacity of carbon monoxide (DLCO) as a predictor of pulmonary microangiopathy and its association with extra pulmonary microangiopathy in patients with type II diabetes mellitus.

BACKGROUND AND AIM: Lung as a target end organ for microvascular disease often remains underdiagnosed. This study aims to assess occurrence of pulmonary microangiopathy among Type 2 diabetes mellitus (T2DM) using dynamic diffusion lung capacity of carbon monoxide (DLCO). METHODS: A total of 120 participants aged >18 years were enrolled in this study. Group 1 comprised T2DM with microangiopathy (n = 40), group 2 include T2DM without microangiopathy (n = 40), group 3 were healthy controls (n = 40). Individuals with underlying lung disease, smoking history, heart failure, urinary tract infection, macrovascular complications of diabetes, microalbuminuria due to other causes were excluded from the study. Using electronic spirometry, Forced Expiratory Volume in first second (FEV1), Forced Vital Capacity (FVC) was measured and FEV1/FVC ratio calculated. DLCO (%predicted) using single breath method was measured in sitting position followed by supine position and delta DLCO was calculated. DLCO measured was compared between the three groups. RESULTS: DLCO (median [IQR]) in sitting (78 [70-82.75]) and supine position (70 [62-84]) among group one was significantly decreased when compared to other two groups (p value < 0.001, p value < 0.001 respectively). Delta DLCO (median, [IQR]) among patients with diabetic microangiopathy (-6 [-8 to -2]) was significant on comparison with group two (4[2,6]) and control group (5[4,6]) (p < 0.001). Negative delta DLCO reflecting pulmonary microangiopathy was significantly associated with extrapulmonary microangiopathy (p value = 0.027). CONCLUSION: Postural variation in DLCO is a useful non-invasive test for identifying pulmonary microangiopathy among T2DM patients. Presence of pulmonary microangiopathy has significant association with diabetic nephropathy and retinopathy.

Assessment of Peripheral Blood Mononuclear Cells Senescence and Endothelial Dysfunction among Adults with High Cardiovascular Risk. / Avaliação da Senescência de Células Sanguíneas Mononucleares Periféricas e na Disfunção Endotelial entre Adultos com Alto Risco Cardiovascular.

BACKGROUND: Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Biological aging has been associated with the occurrence of adverse cardiovascular outcomes; however, the underlying mechanism of this process remains unknown. OBJECTIVES: This study sought to evaluate if peripheral blood mononuclear cell (PBMC) senescence and endothelial biomarkers could influence cardiovascular (CV) risk and be suitable markers for the early detection of cardiovascular diseases in adults. METHODS: In this cross-sectional study patients free of CVD were classified as lower (n=32) and higher Interheart Risk (IHR) scores (n=28). PBMC senescence was assessed by estimating the telomerase activity (TA) and detecting the presence of senescent cells and endothelial dysfunction by estimating the concentration of nitrite and nitrate and of total antioxidant capacity (TAC). Statistical analysis was performed with SPSS version 16.0 (SPSS Inc., Chicago, IL). All p-values <0.05 were considered statistically significant. RESULTS: PBMC senescence 0.95 [p-value = 0.0001; 95% CI (0.874-1.026)] was a significant predictor of patients with higher IHR scores with a cut-off value of 21.65 with a sensitivity and specificity of 92% and 88% respectively. PBMC senescence, nitrite and nitrate and TA were found to be independently associated with high IHR scores. CONCLUSION: PBMC senescence, TA and nitrite, and nitrate status are suitable measures to predict high cardiovascular risk in adults with CV risk. Nevertheless, long-term follow-up studies are needed to confirm these findings. (Arq Bras Cardiol. 2021; 116(1):37-47).

FUNDAMENTO: Doenças cardiovasculares (DCV) são uma das principais causas de mortalidade e morbidade em todo o mundo. O envelhecimento biológico tem sido associado à ocorrência de resultados cardiovasculares. Entretanto, o mecanismo subjacente desse processo ainda é desconhecido. OBJETIVOS: Buscamos avaliar se a senescência das células sanguíneas mononucleares periféricas (CSMP) e biomarcadores endoteliais poderiam influenciar o risco cardiovascular (CV) e ser marcadores adequados para a detecção precoce de doenças cardiovasculares em adultos. MÉTODOS: Neste estudo transversal, pacientes livres de DCV foram classificados como baixo (n=32) e alto (n=28) escore de risco intracardaco (IHR) A senescência das CSMP foi avaliada estimando-se a atividade de telomerase (AT) e detectando-se a presença de células senescentes e disfunção endotelial, estimando-se a concentração de nitrito e nitrato e a capacidade antioxidante total (CAT). A análise estatística foi realizada com o software SPSS, versão 16.0 (SPSS Inc., Chicago, IL). Todos os p-valores <0,05 foram considerados estatisticamente significativos. RESULTADOS: A senescência de CSMP de 0,95 [p-valor = 0,0001; 95% IC (0,874-1,026)] foi um indicador significativo de pacientes com escore de IHR mais alto, com um valor de corte de 21,65, com sensibilidade e especificidade de 92% e 88% respectivamente. Identificou-se que a senescência de CSMP, nitrito e nitrato, e AT eram independentemente associadas a um escore de IHR alto. CONCLUSÃO: Os status de nitrito e nitrato e AT, e a senescência de CSMP são medidas adequadas para prever o alto risco cardiovascular em adultos com risco CV. Entretanto devem ser realizados estudos de acompanhamento de longo prazo para confirmar esses achados. (Arq Bras Cardiol. 2021; 116(1):37-47).

Avaliação da Senescência de Células Sanguíneas Mononucleares Periféricas e na Disfunção Endotelial entre Adultos com Alto Risco Cardiovascular / Assessment of Peripheral Blood Mononuclear Cells Senescence and Endothelial Dysfunction among Adults with High Cardiovascular Risk

Resumo Fundamento Doenças cardiovasculares (DCV) são uma das principais causas de mortalidade e morbidade em todo o mundo. O envelhecimento biológico tem sido associado à ocorrência de resultados cardiovasculares. Entretanto, o mecanismo subjacente desse processo ainda é desconhecido. Objetivos Buscamos avaliar se a senescência das células sanguíneas mononucleares periféricas (CSMP) e biomarcadores endoteliais poderiam influenciar o risco cardiovascular (CV) e ser marcadores adequados para a detecção precoce de doenças cardiovasculares em adultos. Métodos Neste estudo transversal, pacientes livres de DCV foram classificados como baixo (n=32) e alto (n=28) escore de risco intracardaco (IHR) A senescência das CSMP foi avaliada estimando-se a atividade de telomerase (AT) e detectando-se a presença de células senescentes e disfunção endotelial, estimando-se a concentração de nitrito e nitrato e a capacidade antioxidante total (CAT). A análise estatística foi realizada com o software SPSS, versão 16.0 (SPSS Inc., Chicago, IL). Todos os p-valores <0,05 foram considerados estatisticamente significativos. Resultados A senescência de CSMP de 0,95 [p-valor = 0,0001; 95% IC (0,874-1,026)] foi um indicador significativo de pacientes com escore de IHR mais alto, com um valor de corte de 21,65, com sensibilidade e especificidade de 92% e 88% respectivamente. Identificou-se que a senescência de CSMP, nitrito e nitrato, e AT eram independentemente associadas a um escore de IHR alto. Conclusão Os status de nitrito e nitrato e AT, e a senescência de CSMP são medidas adequadas para prever o alto risco cardiovascular em adultos com risco CV. Entretanto devem ser realizados estudos de acompanhamento de longo prazo para confirmar esses achados. (Arq Bras Cardiol. 2021; 116(1):37-47)

Abstract Background Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Biological aging has been associated with the occurrence of adverse cardiovascular outcomes; however, the underlying mechanism of this process remains unknown. Objectives This study sought to evaluate if peripheral blood mononuclear cell (PBMC) senescence and endothelial biomarkers could influence cardiovascular (CV) risk and be suitable markers for the early detection of cardiovascular diseases in adults. Methods In this cross-sectional study patients free of CVD were classified as lower (n=32) and higher Interheart Risk (IHR) scores (n=28). PBMC senescence was assessed by estimating the telomerase activity (TA) and detecting the presence of senescent cells and endothelial dysfunction by estimating the concentration of nitrite and nitrate and of total antioxidant capacity (TAC). Statistical analysis was performed with SPSS version 16.0 (SPSS Inc., Chicago, IL). All p-values <0.05 were considered statistically significant. Results PBMC senescence 0.95 [p-value = 0.0001; 95% CI (0.874-1.026)] was a significant predictor of patients with higher IHR scores with a cut-off value of 21.65 with a sensitivity and specificity of 92% and 88% respectively. PBMC senescence, nitrite and nitrate and TA were found to be independently associated with high IHR scores. Conclusion PBMC senescence, TA and nitrite, and nitrate status are suitable measures to predict high cardiovascular risk in adults with CV risk. Nevertheless, long-term follow-up studies are needed to confirm these findings. (Arq Bras Cardiol. 2021; 116(1):37-47)

Acute coronary syndrome following snake bite: a report of three cases from a tertiary care hospital in rural southern India.

Snake bite is a common cause of preventable death in rural India which is often due to neurological complications and coagulopathy. We report on three patients who presented with bites and later developed acute coronary syndrome during the course of their stay in hospital. Such patients have to be managed conservatively because of their coexistent coagulopathy.