Pallavi Bellamkonda

Utility and limitations of objective measures of asthma.

INTRODUCTION Asthma is a chronic inflammatory disorder of the airways characterized by airway inflammation, airway hyperresponsiveness, and variable airways obstruction.1 National estimates show that approximately 22 million people currently have asthma in the United States.2 In 2007, the American Lung Association estimated that the annual economic cost of asthma in the United States was

I Do Not Even Remember What I Smoked! A Case of Marijuana-induced Transient Global Amnesia

19.7 billion.3 From 1980 to 1996, the number of work and school days missed increased by more than 50% to 14 million days each.4 These increases correspond to increased prevalence because the days missed per person have not changed significantly. The diagnosis of asthma is generally based on a combination of symptoms and demonstration of reversible airflow obstruction on pulmonary function testing or spirometry. Spirometry is used for diagnosis and monitoring of asthma control. Reversibility in adults is defined as an increase in forced expiratory volume in 1 second (FEV1) of 200 mL or more and 12% or more from the baseline measurement after bronchodilation. Bronchoprovocation testing is often used to help with the diagnosis when, despite symptoms suggestive of asthma, spirometry results are normal or inconclusive and reversibility is not demonstrated. However, bronchoprovocation can also help in monitoring response to therapy and overall asthma control. In addition, bronchoprovocation can also aid in the evaluation of occupational asthma. Agents used for bronchoprovocation can act directly on the airways, such as methacholine and histamine, or indirectly, such as adenosine monophosphate, hypertonic saline, and exercise. More recently, fractional exhaled nitric oxide (FeNO) has been used as a marker of airway inflammation. FeNO has been studied as a tool to not only help in the diagnosis but also follow disease control. Overall, evidence is conflicting on whether objective measures of asthma correlate well with one another. We review 4 commonly used objective measures of asthma: spirometry, methacholine challenge, hypertonic saline challenge, and FeNO (Table 1).

MITRAL ANNULAR CALCIFICATION AND RISK OF STROKE IN SEVERE AORTIC STENOSIS: A PROPENSITY SCORE ANALYSIS

I do not even remember what I smoked! A case of marijuana induced transient globalamnesia.George Mansour, MD Ahmad Abuzaid, MBChB Pallavi Bellamkonda, MDPII: S0002-9343(14)00580-4DOI: 10.1016/j.amjmed.2014.07.001Reference: AJM 12600To appear in: The American Journal of MedicineReceived Date:17 June 2014Revised Date: 1 July 2014Accepted Date:1 July 2014Please cite this article as: Mansour G, Abuzaid A, Bellamkonda P, I do not even remember what Ismoked! A case of marijuana induced transient global amnesia., The American Journal of Medicine(2014), doi: 10.1016/j.amjmed.2014.07.001.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.

Probable hydrochlorothiazide-induced myopericarditis: first case reported

Mitral annular calcification (MAC) & aortic valve sclerosis/stenosis (AS) are both known to be associated with increased risk of ischemic stroke. The independent association of MAC with stroke in the presence of severe AS is largely unknown, which we wanted to explore in this study. We

IMPACT OF MITRAL ANNULAR CALCIFICATION ON OUTCOMES OF AORTIC VALVE SURGERY

Hydrochlorothiazide has never been reported as a reason for myopericarditis. An African American female, with past history of hypertension, coronary artery disease, and sulfa allergy, presented with indolent onset and retrosternal chest pain which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications included hydrochlorothiazide (HCTZ) which was started three months ago for uncontrolled hypertension. Significant laboratory parameters included erythrocyte sedimentation rate (ESR) of 47 mm/hr and peak troponin of 0.26 ng/mL. Transthoracic echocardiogram (TTE) revealed preserved ejection fraction with no segmental wall motion abnormalities; however, it showed moderate pericardial effusion without tamponade physiology. We hypothesize that this myopericarditis could be due to HCTZ allergic reaction after all other common etiologies have been ruled out. There is a scarcity of the literature regarding HCTZ as an etiology for pericardial disease, with only one case reported as presumed hydrochlorothiazide-induced pericardial effusion. Management involves discontinuation of HCTZ and starting anti-inflammatory therapy.

Coronary arteriovenous fistula with coexisting atrial septal defect

Mitral annular calcification (MAC) is an independent predictor of cardiovascular events and vascular death. Studies have addressed the impact of MAC on mitral valve surgery but there is no data on the impact of MAC on outcomes of aortic valve (AV) surgery. Our study aimed to determine the impact of

Limitations of objective measures of asthma.

A 36-year-old Hispanic woman was referred for an asymptomatic cardiac murmur and auscultation revealed wide and fixed second heart sound. Transthoracic echocardiogram showed severely dilated right atrium and ventricle. Transesophageal echocardiogram (TEE) confirmed left-to-right shunt through secundum atrial septal defect (ASD) (1.5 cm×2.0 cm×2.5 cm), with Qp:Qs 2:1 on Doppler studies (figure 1). In view of large ASD size and inadequate superior rim of tissue, the patient was planned for surgical …