Mahmoud M. Ramadan

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis.

Peritoneal tuberculosis (TB) is a considerable problem in certain developing nations. Current diagnostic tests for peritoneal TB are difficult and time-consuming. This study aimed to determine the effectiveness of an adenosine deaminase (ADA) assay and the QuantiFERON-Gold (QFT-G) assay in the rapid diagnosis of TB peritonitis. Forty-one patients with a presumptive diagnosis of TB peritonitis with ascites were admitted to Mansoura University Hospital and included in the study. Ascitic fluid and blood samples were collected from each patient. Fluid samples were examined biochemically (protein concentration), cytologically (white blood cell count) and microbiologically (Ziehl-Neelsen stain and TB culture in Löwenstein-Jensen media), and ADA levels were determined using colorimetry. Interferon-γ levels in whole-blood samples were measured using the QFT-G assay. Fourteen (34 %) patients received a final clinical diagnosis of TB peritonitis; these patients were subclassified as definite (positive culture for Mycobacterium tuberculosis; eight patients), highly probable (four patients) and probable (two patients) for TB peritonitis. Of the 14 patients with a final clinical diagnosis of TB peritonitis, 3 (21 %) tested positive using an acid-fast bacilli smear, which showed a sensitivity of 21 % and a specificity of 100 %. A receiver operating characteristic curve showed that a cut-off value of 35 IU l(-1) for the ADA level produced the best results as a diagnostic test for TB peritonitis, yielding the following parameter values: sensitivity 100 %, specificity 92.6 %, positive predictive value (PPV) 87.5 % and negative predictive value (NPV) 100 %. The QFT-G assay yielded the following values: sensitivity 92.9 %, specificity 100 %, PPV 100 % and NPV 96.4 %. The ADA and QFT-G assays might be used to rapidly diagnose TB peritonitis and initiate prompt treatment while waiting for a final diagnosis using the standard culture approach.

A Huge Thrombosed Pulmonary Artery Aneurysm without Pulmonary Hypertension in a Patient with Hepatosplenic Schistosomiasis

Patient: Male, 55 Final Diagnosis: Thrombosed pulmonary artery aneurysm Symptoms: Cough productive • fever • shortness of breath Medication: — Clinical Procedure: Pericardiocentesis Specialty: Cardiology Objective: Rare disease Background: We herein report a case of huge pulmonary artery aneurysm in a 55-year-old male farmer from the Nile delta (Lower-Egypt), mostly due to infestation with Schistosoma mansoni, which is the parasite causing hepatosplenic schistosomiasis. Case Report: This male patient was admitted with a month-long history of progressive shortness of breath, 2-month history of fever, and a cough with mucoid sputum for 10 days. On examination, he had normal temperature and blood pressure, but he had tachypnea, tachycardia, and congested neck veins. Electrocardiography showed multifocal atrial tachycardia and right bundle branch block. Conclusions: The present case is unique in that it shows the presence of a huge pulmonary artery aneurysm despite the absence of pulmonary hypertension.

Spontaneous hemarthrosis following fibrinolytic therapy for acute myocardial infarction: a case report and literature review.

Patient: Male, 48 Final Diagnosis: Spontaneous hemarthrosis of right knee Symptoms: A rapidly growing knee swelling was “witnessed” associated with severe tenderness, hotness and profound agony but without color change Medication: — Clinical Procedure: Suprapatellar arthrocentesis of the right knee joint Specialty: Cardiology Objective: Unusual clinical course Background: Despite the widespread use of fibrinolytic therapy and the numerous reports on its bleeding complications, spontaneous hemarthrosis following fibrinolytic therapy is quite rare. Case Report: We describe in this report a patient with no previous history of articular disease who developed a spontaneous right knee bloody effusion following fibrinolytic therapy using rt-PA for acute ST-elevation myocardial infarction. Furthermore, we provide a review of all cases of spontaneous hemarthrosis documented so far in the literature. Conclusions: Several pre-existing joint diseases may predispose to hemarthrosis following fibrinolytic therapy, even in patients who deny previous or current articular disorders. Therefore, hemorrhage should be considered in the differential diagnosis of mono-arthritis following fibrinolytic therapy for STEMI.

Noncomplicated Excision of a Mobile Pedunculated Septal Hemangioma of the Left Ventricle

Patient: Female, 27 Final Diagnosis: LV hemangioma Symptoms: Palpitation • dyspnea • fatigue Medication: — Clinical Procedure: Posterior atriotomy Specialty: Cardiology Objective: Rare disease Background: Cardiac tumors are quite rare, and differential diagnosis of them is challenging. Case Report: A young lady with a history of palpitations, dyspnea, and fatigue was proven by transthoracic echocardiography and cardiac magnetic resonance imaging to have a mobile left ventricular mass with rounded contour attached to the mid-part of the interventricular septum. The mass was approached via a posterior inter-atrial approach to avoid left ventriculotomy and provide adequate exposure to completely excise the tumor and control its pedicle with minimal cardiac trauma. Histological examination of the mass was diagnostic of capillary and sinusoidal hemangioma. Conclusions: Complete excision of cardiac hemangioma is recommended once it is diagnosed, for histopathologic diagnosis and because of the possibility of serious complications.

Hypertensive retinopathy and coronary angiographic findings: is there a relationship?

Background The retina provides a window to study human circulation, but no data exist on the association between hypertensive retinopathy and the risk of coronary artery disease (CAD) in middle-aged hypertensive patients. Participants and methods We studied 62 consecutive hypertensive nondiabetic patients referred to our catheterization laboratory for coronary angiography (CAG) because of suspected CAD. CAD burden was quantified using the Duke Myocardial Jeopardy scoring system. Direct ophthalmoscopy and photography was performed, and the retinal signs obtained were graded according to the modified Scheie classification. Eligible patients, 57±8.3 years of age, underwent CAG. About 52% of patients were diagnosed with significant CAD, 29% had multivessel disease, and 25% had coronary ectasia. Hypertensive retinopathy was present in 92% of CAD patients; 50% had low-grade retinopathy and 42% had high-grade retinopathy. Results The grades of retinopathy were not associated with copresentation of ectasia or various CAG findings in any of the three main coronary vessels. Similarly, no association was found in the extent of ectasia (focal vs. diffuse) or the number of coronary vessels affected. No statistically significant associations were found between the grades of retinopathy and median or log-transformed values of the Duke score. Conclusion No retinal changes of any grade were associated with the presence or severity of CAD and thus may not be used to screen for CAD in hypertensive patients.

Adiponectin/C-reactive protein interplay in healthy individuals and in patients with coronary artery disease

Abstract Herein we report our observations derived from a study of 113 subjects who underwent coronary angiography, of whom 32 were free of coronary lesions (controls). In this work, we aimed to evaluate adiponectin levels at the site of maximal concentration (hepatic veins); and examine a possible association with coronary artery disease (CAD) and the prototypic inflammatory marker C-reactive protein. We found higher mean coronary adiponectin levels in CAD patients than in non-CAD controls. Also, a significant positive correlation was found between hepatic vein adiponectin and coronary C-reactive protein in CAD patients, but this was negative in non-CAD controls. Thus, we may conclude that the beneficial anti-inflammatory activity of adiponectin may be qualitatively reduced in CAD patients.