Physiology and Anatomy

Pericardial effusions are frequent conditions, there etiologies are dominated by: acute infarction of the myocardium, myocarditis, metabolic disorders, certain neoplasias, inflammatory or infectious diseases, traumatisms and cardiac surgery. The dissection of the aorta is one of the rare conditions; it is primarily due to a rupture of the ascending aorta and presents diagnostic difficulties.We report the case of an 80 years old male, with a medical history of chronic smoking stopped since 2 years, a recently discovered of hypertension, a surgery for an inguinal hernia and appendicitis. Presented in our formation with an expansive pericardial effusion; clinical examination found an asymmetry of upper extremity blood pressures, thoracic radiography showed an unrolled aorta. Thoracic CT scan has allowed the diagnosis of aortic dissection type 1 of De Bakey classification and type A of Stanford. The patient was referred to a cardiovascular surgical center where he benefited of the replacement of the dissected aorta by a prosthetic tube while preserving his native valve, with positive outcomes.Our clinical observation aim to discuss diagnostic of dissection to any pericardial effusion or pericarditis, even in the absence of usual symptoms, in order to avoid any diagnostic delay. In our methodology we have overview a systemic review included PuBMed; all of our results in discussion are not based to basis recommendations because of the uncommun presentation having problem in extrapolating strong evidence but we have reporting somes basis of experts’ opinion.

Arrhythmogenic right ventricular dysplasia also known as arrhythmogenic Right Ventricular Cardiomyopathy is one of the leading causes of arrhythmic cardiac arrest in young people and athletes, but is probably under diagnosed in the older population. The clinical course of arrhythmogenic right ventricular dysplasia is characterized by the occurrence of arrhythmic events, which can cause sudden death, and the impairment of ventricular systolic function, which can lead to death from heart failure. Diagnosis has been facilitated by a set of clinically applicable criteria. The treatment is aimed at reducing the risk of sudden cardiac death properly risk-stratifying patients that would benefit from an implantable cardioverter defibrillator .Antiarrhythmic drugs and catheter ablation are also commonly used to improve quality of life by preventing ventricular arrhythmias, exercise restriction to prevent disease progression. This report presents case of elderly man with newly symptomatic arrhythmogenic right ventricular dysplasia.

Purpose: Halitosis is defined as an unpleasant odor that emanates from the oral cavity with intra–oral and/or extra–oral origins. The present study assessed factors influenced halitosis using different diagnostic modalities. Methods: 360 patients who attended shiraz dentistry school participate in this study. A total of 100patients aged 10-56years old included 58women& 42men complained of chronic halitosis. Organoleptic assessment was used to measure intensity of halitosis. The patients were divided into 6 groups according to their age & educational levels. Descriptive analysis was carried out regarding the degree of halitosis in each group. The chi-square test was used for the comparison between groups. Result: prevalence of halitosis was 27.8% of all subjects. Halitosis was multi factorial in this group & more than one factor could be seen in these patients. Dental caries was the most common cause of halitosis(62%) followed by periodontal disease (55%), highly protein diet (28%),smoking(13%) , inadequate root canal therapy & filling(12%) xerostomia(9%), Pseudo-halitosis(6% ) ,sinusitis & nasal polyp(4%),constipation & gastric reflux (4%) hormonal factors (%4) medication(4%) dentures(2%).there was no significant correlation between patients age , sex &educational level with halitosis(p=0.05). Conclusion: In this study, intra oral factors were the most common causes of halitosis. This problem can be prevented by appropriate dental care, suitable oral hygiene &increased public awareness.

Cholangiocarcinomas are rare tumors that develop in the bile duct. Their incidence worldwide is <1 out of 100,000 persons per year. Frequent metastatic sites of biliary cancer are the liver, peritoneum, intra-abdominal lymph nodes, and lungs , however , bladder metastasis was never described in the English literature. Here, we present an exceptional case of a 60 year-old male patient with a history of cholangiocarcionoma traited with surgeries and admitted after 2 years to the emergency with hematuria. The investigations with radiological tomography and cystoscopy with transurethral resection confirms a bladder metastasis of cholangiocarcinoma. Our patient was treated with a bladder hemostatic radiotherapy followed by chemotherapy with cisplatin and gemcitabine (cisplatin at a dose of 30 mg/m2 and gemcitabine at 1,000 mg/m2 on days 1 and 8, respectively, every 3 weeks). The prognosis for patients with cholangiocarcinoma is quite poor; the median survival for patients with unresectable cholangiocarcinoma is <1 year.

Hypertrophic Cardiomyopathy is an inherited disorder that affects the muscle of the heart or the Myocardium. This condition results from a mutation to several genes that affects the production of cardiomyocytes proteins and therefore lead to an abnormal thickening and enlargement of the heart walls. That myocardial thickening induces rigidity and stiffness that reduces the heart efficiency of contractility and narrows the capacity of its cavities. Nonetheless it can cause an irreversible damage to the myocardial tissue producing a scar tissue that interferes with the heart electric activity and rhythm which may end with a life-threatening arrhythmia and death.

Patients with (ARSA) are often asymptomatic and discovered accidentally during MRI scans and X-rays ordered by physicians. It is reported that (ARSA) has an incidence of 0.5 % to 2%. The aberrant artery in this anomaly follows a retro esophageal path and it rarely takes a pathway anterior to the the trachea or esophagus. Instead of this artery being the first branch with the right common carotid on brachiocephalic artery, it arises on its own as the fourth branch, after the left subclavian artery. It can be associated with chromosomal defects like trisomy 21 and 18.

The traumatic dissection of the renal pedicle is rarely reported after blunt trauma. Clinical symptoms often fickle and rare. Thus, the diagnosis is based angio- CT; arteriography remains useful when revascularization gesture is considered. Observation: We return a case of a 23-year-old patient referred for a renal’s pedicle traumatic dissection near the aortic ostium imposing a monitoring in intensive care. Management strategies for RAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The late diagnosis and localization delicate forced us not to use the endoscopic embolization: the risk was too high; and with respect to the endoscopic revascularization was not possible due to lack of means. We update through a review of the literature aspects of the diagnostic and therapeutic care of the renal artery's traumatic dissection.

Breast cancer is the second leading cancer among the women in the world. India is the one of the country having the highest breast cancer patients. In breast cancer patients the glycolysis rate is very high when compare to normal glycolysis rate in normal women. The enzymes like pyruvate kinase, hexokinase, phosphpfructkinase levels are different concentrations among the breast cancer patients. The high rate of glycolysis observed in cancer at anaerobic conditions is known as Warburg effect. The Warburg effect is the enhanced conversion of glucose to lactate observed in tumor cells, even in the presence of normal levels of oxygen. The pyruvate kinase level in tumors are high optimum density values when compared to normal tissues values. The mean values of pyruvate kinse enzyme is 0.278 in tumor tissue and 0.200 in normal tissues. There is a significant effect of haemoglobin on pyruvatekinase values. There may be some significant effect of pyruvate kinase on haemoglobin and vice versa.

Tuberculosis (TB) is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. We have studied 276 cases in Hyderabad to investigate the persistence of TB and potential threat aspects for condensing TB, within which the positive kinfolk’s history of TB proves to be substantial threat factor. Previously diagnosed patients were poorly obedient to anti-TB treatment. This study focuses the exposure of convicts to TB due to the presence of highly transmittable cases. This study sturdily specified the necessity of an effective treatment program in the broad-spectrum community. This study was conducted in medical units 1of Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro. Out of total, 274 patients studied, majority of the patients were from poor, deprived and lower social class. To control this infection early diagnosis of the disease and its treatment under the supervision is very important.

Osteoarthritis (OA) is a disorder which is characterised by pain and decreased Range of motion. OA is a disease process of axial and peripheral joints. It is characterized by progressive deterioration and loss of articular cartilage and by reactive bone changes at the margins of the joints and in the sub-chondral bone. It is a progressive disorder of the joints. Knee is the most commonly affected joints. Its management can be pharmacological, non pharmacological or surgical. Amongst the nonpharmacological and surgical management a very important goal of management is correction of the malalignment of the joint. This malalignment is because of improper loading of the knee joint and is responsible for a lot of symptoms and disease progression. This can be done conservatively by bracing, taping and shoe modifications. The purpose of this article is to review the existing conservative methods and techniques available to correct and manage biomechanical malalignments evident in knee osteoarthritis