North American Journal of Medical Sciences最新文献

{"title":"Fusobacterium Nucleatum: Atypical Organism of Pyogenic Liver Abscess Might be Related to Sigmoid Diverticulitis.","authors":"Karn Wijarnpreecha,&nbsp;Nataliya Yuklyaeva,&nbsp;Suthanya Sornprom,&nbsp;Charles Hyman","doi":"10.4103/1947-2714.179961","DOIUrl":"https://doi.org/10.4103/1947-2714.179961","url":null,"abstract":"<p><strong>Context: </strong>Pyogenic liver abscesses (PLAs) are the most common form of liver abscesses in the United States. Most cases are caused by enteric bacteria and anaerobes. We report a case of PLA caused by a rare pathogen, Fusobacterium nucleatum, from an unusual primary site of infection.</p><p><strong>Case report: </strong>A 60-year-old male presented with subacute fever. Initial work-up revealed leukocytosis and elevated alkaline phosphatase (ALP). Dental examination and Panorex x-ray were normal. Imaging of the liver with abdominal computed tomography demonstrated a 5.5 cm abscess in the right lobe of the liver. Culture of the aspirate grew Fusobacterium nucleatum. He improved with abscess drainage and antibiotic therapy with moxifloxacin and metronidazole. Colonoscopy performed a few weeks later, demonstrated sigmoid ulceration most likely from the previous diverticulitis.</p><p><strong>Conclusion: </strong>PLAs can be a complication of sigmoid diverticulitis and as a result of occult dental disease as well. The clinical presentation of Fusobacterium infection is diverse and can be fatal if diagnosis is delayed. Therefore, early diagnosis and treatment are the keys to preventing serious complications.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34572828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Yoga in Relieving Medical Student Anxiety and Stress.","authors":"Jawad Fares,&nbsp;Youssef Fares","doi":"10.4103/1947-2714.179963","DOIUrl":"https://doi.org/10.4103/1947-2714.179963","url":null,"abstract":"Dear Editor, \u0000 \u0000Yoga is gaining prominence in improving mental health and quality of life and in the treatment of a number of psychiatric and psychosomatic disorders. Previous studies on medical education have shown that perceived stress is higher in medical students than in other age-controlled students.[1] As medical students are the underpinning of the medical profession, they must be aware of the adjunct therapy of yoga for the betterment of their own health as well as that of their patients. \u0000 \u0000As defined by the World Health Organization, health is “a state of complete physical, mental, and social well-being and not merely absence of disease or infirmity.”[2] This definition has been expanded to embrace the ability to “lead a socially and economically productive life.”[3] Apart from causing mental turbulences, anxiety and stress have unfavorable effects on the body that may evolve into chronic conditions, if left untreated.[4] Stress has been linked to harmful effects on the immune system,[5,6] while anxiety has been associated with coronary heart disease,[7] decreased quality of life,[8] and suicidal behavior.[9] \u0000 \u0000Although yoga has been practiced for over 5000 years, it has only newly gained popularity worldwide.[10] The drill originated in India and has been applied to relieve both mental and physical infirmities,[11,12,13] for it incorporates postures, breathing techniques, and meditation. From the yogic perspective, the body and the mind are so interconnected that they are essentially inseparable.[14] Whatever affects the body must impact the mind and vice-versa. Since the mind exists throughout the body and pervades its every particle, the yogic techniques which are implemented to stretch, strengthen, and otherwise improve, and develop the body must have a correspondingly deep effect on the mind and the emotions as well.[14] \u0000 \u0000Psychological stress and yoga are believed to be reciprocally related. Stress induces imbalance of the autonomic nervous system with decreased activity of the parasympathetic nervous system and increased activity of the sympathetic nervous system.[15] Autonomic imbalance is closely associated with anxiety. Scientific evidence supports the belief that yoga benefits physical and mental health via down-regulation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.[16] Deep relaxation and calming down of the mind lead to effective reduction in blood pressure, pulse rate, and respiratory rate by decreasing the amount of cortisol which typically increases during the body's response to stress.[14] Yoga, also, reduces the level of acetylcholine, which leads to the reduction in the sympathetic nervous system activity and increase in vagal activity.[14] As a result, it reduces psychological conflicts, suppressions, and hypersensitivities, which are recognized as the triggering factors for psychosomatic problems. \u0000 \u0000Moreover, stress is strongly concomitant with muscle tension. When mentally stre","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34572830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tocilizumab Efficacy in a Patient with Positive Anti-CCP Chronic Lyme Arthritis.","authors":"Julianna Hirsch, Itzhak Rosner, Doron Rimar, Lisa Kaly, Michael Rozenbaum, Nina Boulman, Gleb Slobodin","doi":"10.4103/1947-2714.179960","DOIUrl":"10.4103/1947-2714.179960","url":null,"abstract":"<p><strong>Context: </strong>Lyme arthritis, a manifestation of tick-borne Lyme disease, can prove to be refractory to classic treatment.</p><p><strong>Case report: </strong>We present a case of a 48-year-old male, diagnosed with chronic Lyme arthritis, refractory to recurrent and prolonged courses of doxycycline, ceftriaxone, as well as hydroxychloroquine and methotrexate. The patient responded partially to tumor necrosis factor (TNF)-alpha blockade by etanercept and, finally, entered long-term remission after his treatment was switched to tocilizumab.</p><p><strong>Conclusion: </strong>Off label treatment by biologic disease modifying antirheumatic drugs can be considered in selected patients with severe antibiotic-resistant Lyme arthritis.C.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34572827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yoga: A Strategy to Cope up Stress and Enhance Wellbeing Among Medical Students.","authors":"Apar Avinash Saoji","doi":"10.4103/1947-2714.179962","DOIUrl":"https://doi.org/10.4103/1947-2714.179962","url":null,"abstract":"Dear Editor, \u0000 \u0000Stress, burnout, and coping strategies in preclinical medical students by Fares et al.[1] made for an interesting read. I would like to compliment the authors for the commanding effort to put together a burning issue of psychological and physical stress and burnout among the medical students. The issue is often neglected both by the vulnerable population of students as well as the health-care community itself. The article definitely brings attention on the need for coping strategies and also puts together various methods for the physical and psychological wellbeing of the doctors-in-making. \u0000 \u0000Yoga, a mind-body practice of ancient Indian origin has gained significance in recent times due to its health benefits. Various practices of yoga have been found beneficial to attenuate stress and enhance functionality among medical students. Despite an array of coping strategies, yoga practices are found to reduce perceived stress,[2,3,4,5] anxiety,[4,6,7,8] markers of stress such as cortisol,[9] improved general health and well-being,[5,10,11] physical and physiological health,[6,12,13] improve cognition[14] as well as cultivation of positive emotions[2,3,7] such as empathy, compassion, and self-regulation. There is evidence of a reduction in work-related stress and better autonomic balance with the practice of yoga in health professionals.[15] The studies indicate not just the psychological benefits of yoga, but the physical benefits such as better autonomic balance, enhanced respiratory endurance, auditory and visual reaction times as well as muscle strength.[13] Few research studies showing the beneficial effects of yoga among medical students are listed in Table 1. \u0000 \u0000 \u0000 \u0000Table 1 \u0000 \u0000Findings of research studies on yoga for medical students \u0000 \u0000 \u0000 \u0000One of the most important stressors among medical students is the examination. Malathi and Damodaran and Malathi et al.[8,12] have found yoga to be beneficial in modulating the response to stress during the examination. In addition, studies indicate that yoga could enhance the examination performance and reduce anxiety.[16] Another important area of concern brought out by Fares et al. is the lack of self-care behavior among medical students.[1] Yoga and mindfulness-based practices have demonstrated beneficial impact on the self-care behavior in counselors, who encounter similar health issues of that of medical students.[17] \u0000 \u0000From the review of existing scientific literature on the application of yoga in medical students, it is evident that yoga is a self-practiced, low cost, safe, efficacious as well as acceptable tool benefitting the target population. There are positive outcomes for the medical students in their physical, psychosocial, and emotional health. The practices that are safely used in the wellbeing of student community include asana (physical postures), pranayama (breathing practices), dhyana (meditation), mindfulness-based stress relaxation, and mind sound resonance technique (M","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34572829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden Among Caregivers of Children Living with Human Immunodeficiency Virus in North India.","authors":"Ramesh Chand Chauhan,&nbsp;Sanjay Kumar Rai,&nbsp;Shashi Kant,&nbsp;Rakesh Lodha,&nbsp;Nand Kumar,&nbsp;Neelima Singh","doi":"10.4103/1947-2714.179117","DOIUrl":"https://doi.org/10.4103/1947-2714.179117","url":null,"abstract":"<p><strong>Background: </strong>Due to wider access to and free antiretroviral therapy (ART) program, the number of children dying due to acquired immune deficiency syndrome (AIDS)-related causes has declined and the nature and duration of human immunodeficiency virus (HIV)/AIDS caregiving has also dramatically altered. The care of children living with HIV/AIDS (CLHA) places a significant additional burden on the caregivers.</p><p><strong>Aims: </strong>This study was conducted to assess the perceived burden among caregivers of children living with HIV in North India.</p><p><strong>Materials and methods: </strong>A hospital-based cross-sectional study among 156 CLHA-caregiver dyads in North India was conducted from June 2010 to May 2011. Data were collected by using a pretested structured interview schedule. The caregiver burden was measured with a 36-item scale adapted from Burden Assessment Schedule of Schizophrenia Research Foundation (BASS). Child characteristics, caregiver characteristics, caregiving burden, the knowledge of caregivers, and issues related to health care, nutrition, education, and psychological aspects were studied.</p><p><strong>Results: </strong>Caregivers had a mean age of 35.9 ± 10.2 years. Women accounted for over three-fourth (76.9%) of the caregivers. Nearly two-third of them (65.4%) reported as living with HIV. The mean caregiver burden score was 68.7 ± 2.9. A majority of the caregivers reported either low or moderate burden. Standardized percentage score was high in the domains of physical and mental health, external support, patients' behavior, and caregivers' strategy and seemed to be comparatively less in the other domains such as support of the patient and taking responsibility.</p><p><strong>Conclusions: </strong>Caring of children is a universal practice but there is a need of special care for children living with HIV. The majority of caregivers who were usually the mothers perceived the burden and need to be assisted in caring for the child. Stigma and discrimination with HIV infection further increased the burden as caregivers did not disclose the HIV status to any near and dear one.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/bf/NAJMS-8-129.PMC4821091.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34432705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Severe Aortic Regurgitation: Imaging with Pathological Correlation.","authors":"Rajesh Janardhanan,&nbsp;Ahmed Khurshid Pasha","doi":"10.4103/1947-2714.179137","DOIUrl":"https://doi.org/10.4103/1947-2714.179137","url":null,"abstract":"<p><strong>Context: </strong>Acute aortic regurgitation (AR) is an important finding associated with a wide variety of disease processes. Its timely diagnosis is of utmost importance. Delay in diagnosis could prove fatal.</p><p><strong>Case report: </strong>We describe a case of acute severe AR that was timely diagnosed using real time three-dimensional (3D) transesophageal echocardiogram (3D TEE). Not only did it diagnose but also the images obtained by 3D TEE clearly matched with the pathologic specimen. Using this sophisticated imaging modality that is mostly available at the tertiary centers helped in the timely diagnosis, which lead to the optimal management saving his life.</p><p><strong>Conclusion: </strong>Echocardiography and especially 3D TEE can diagnose AR very accurately. Surgical intervention is the definitive treatment but medical therapy is utilized to stabilize the patient initially.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/69/NAJMS-8-167.PMC4821097.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Low Levels of Vitamin D with Chronic Stable Angina: A Prospective Case-Control Study.","authors":"Ab Hameed Raina,&nbsp;Mohammad Sultan Allai,&nbsp;Zafar Amin Shah,&nbsp;Khalid Hamid Changal,&nbsp;Manzoor Ahmad Raina,&nbsp;Fayaz Ahmad Bhat","doi":"10.4103/1947-2714.179130","DOIUrl":"https://doi.org/10.4103/1947-2714.179130","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. A low level of vitamin D is associated with chronic stable angina.</p><p><strong>Aim: </strong>This study was aimed at supporting or refuting this hypothesis in our population.</p><p><strong>Materials and methods: </strong>The study was a prospective case-control study. We studied 100 cases of chronic stable angina and compared them with 100 matched controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL.</p><p><strong>Results: </strong>The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 75% of the cases were vitamin D-deficient (<20 ng/mL); 12% were vitamin D-insufficient (20-30 ng/mL), and 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 33% were vitamin D-insufficient, and 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, with the difference being statistically significant (P ≤ 0.0001). There was no statistically significant relation between the disease severities, i.e., on coronary angiography (CAG) with vitamin D level. Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027).</p><p><strong>Conclusion: </strong>Our study indicates a correlation between vitamin D deficiency and chronic stable angina. Low levels may be an independent, potentially modifiable cardiovascular risk factor.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/7a/NAJMS-8-143.PMC4821093.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periodic Acid-Schiff Staining Parallels the Immunoreactivity Seen By Direct Immunofluorescence in Autoimmune Skin Diseases.","authors":"Ana Maria Abreu Velez,&nbsp;Yulieth Alexandra Upegui Zapata,&nbsp;Michael S Howard","doi":"10.4103/1947-2714.179132","DOIUrl":"https://doi.org/10.4103/1947-2714.179132","url":null,"abstract":"<p><strong>Background: </strong>In many countries and laboratories, techniques such as direct immunofluorescence (DIF) are not available for the diagnosis of skin diseases. Thus, these laboratories are limited in the full diagnoses of autoimmune skin diseases, vasculitis, and rheumatologic diseases. In our experience with these diseases and the patient's skin biopsies, we have noted a positive correlation between periodic acid-Schiff (PAS) staining and immunofluorescence patterns; however, these were just empiric observations. In the current study, we aim to confirm these observations, given the concept that the majority of autoantibodies are glycoproteins and should thus be recognized by PAS staining.</p><p><strong>Aims: </strong>To compare direct immunofluorescent and PAS staining, in multiple autoimmune diseases that are known to exhibit specific direct immunofluorescent patterns.</p><p><strong>Materials and methods: </strong>We studied multiple autoimmune skin diseases: Five cases of bullous pemphigoid, five cases of pemphigus vulgaris, ten cases of cutaneous lupus, ten cases of autoimmune vasculitis, ten cases of lichen planus (LP), and five cases of cutaneous drug reactions (including one case of erythema multiforme). In addition, we utilized 45 normal skin control specimens from plastic surgery reductions.</p><p><strong>Results: </strong>We found a 98% positive correlation between DIF and PAS staining patterns over all the disease samples.</p><p><strong>Conclusion: </strong>We recommend that laboratories without access to DIF always perform PAS staining in addition to hematoxylin and eosin (H&E) staining, for a review of the reactivity pattern.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/fd/NAJMS-8-151.PMC4821094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreaticoureteral Fistula: A Rare Complication of Chronic Pancreatitis.","authors":"Hiren G Patel,&nbsp;Yana Cavanagh,&nbsp;Sohail N Shaikh","doi":"10.4103/1947-2714.179134","DOIUrl":"https://doi.org/10.4103/1947-2714.179134","url":null,"abstract":"<p><strong>Context: </strong>Chronic pancreatitis is an inflammatory condition that may result in progressive parenchymal damage and fibrosis which can ultimately lead to destruction of pancreatic tissue. Fistulas to the pleura, peritoneum, pericardium, and peripancreatic organs may form as a complications of pancreatitis. This case report describes an exceedingly rare complication, pancreaticoureteral fistula (PUF). Only two additional cases of PUF have been reported. However, they evolved following traumatic injury to the ureter or pancreatic duct. No published reports describe PUF as a complication of pancreatitis.</p><p><strong>Case report: </strong>A 69-year-old Hispanic female with a past medical history of cholecystectomy, pancreatic pseudocyst, and recurrent episodes of pancreatitis presented with severe, sharp, and constant abdominal pain. Upon imaging, a fistulous tract was visualized between the left renal pelvis (at the level of an upper pole calyx) and the pancreatic duct and a ureteral stent was placed to facilitate fistula closure. Following the procedure, the patient attained symptomatic relief and oral intake was resumed. A left retrograde pyelogram was repeated 2 months after the initial stent placement and demonstrating no evidence of a persistent fistulous tract.</p><p><strong>Conclusion: </strong>Due to PUF's unclear etiology and possible variance of presentation, it is important for physicians to keep this rare complication of pancreatitis in mind, especially, when evaluating a patient with recurrent pancreatitis, urinary symptoms and abnormal imaging within the urinary collecting system and pancreas.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/37/NAJMS-8-163.PMC4821096.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patent Foramen Ovale and Migraine: Casual or Causal.","authors":"Adrija Hajra,&nbsp;Dhrubajyoti Bandyopadhyay","doi":"10.4103/1947-2714.179139","DOIUrl":"https://doi.org/10.4103/1947-2714.179139","url":null,"abstract":"Dear Editor, \u0000 \u0000The atrial septum primum and septum secundum are usually closed by the first year of age. Incomplete closure of the septum primum and septum secundum results in patent foramen ovale (PFO). On the other hand, migraine is a common condition characterized by unilateral headache associated with nausea, photophobia, and phonophobia. These two conditions may be related to each other. \u0000 \u0000Various mechanisms have been described to explain this relation. Subclinical emboli, as well as metabolites from the venous circulation bypass the pulmonary circulation through the PFO. They enter the systemic circulation and result in irritation of the trigeminal nerve and brain vasculature. This may trigger a migraine. \u0000 \u0000A small double-blind crossover study has demonstrated that aspirin, an antiplatelet drug may reduce the formation of platelet-fibrin complexes and improve a migraine. It may be possible that increased platelet activation may be a risk factor for a migraine through the action of serotonin. Transient hypoxemia resulting from shunting of blood through the PFO causes microinfarcts in the brain. It may lead to a migraine. PFO may predispose to subclinical ischemia and paradoxical embolism that may result in triggering the migraine.[1] Another study has postulated the eustachian valve, Chiari's network, and migraine with aura can be adjunctive risk factors for paradoxical embolism in the evaluation of both symptomatic and asymptomatic PFO patients.[2] It has been demonstrated that PFO is not just an example of migraine comorbidity but exerts a causal effect in the triggering of the aura by applying the criteria proposed by Bradford Hill.[3] \u0000 \u0000Epidemiologic data have shown that PFO and migraine are related. Two Italian groups were the first to report, in case-control studies, a significantly higher prevalence of PFO in subjects with a migraine with aura. They have used transcranial Doppler ultrasonography (TCD) for evaluation of patients. A study of young cryptogenic stroke patients has shown increased prevalence of a migraine in patients with PFO. A retrospective study showed that migraine patients with PFO have higher right-to-left shunting compared to controls. In a meta-analysis of seven studies, it was concluded that there was only low-grade evidence supporting the association between PFO and migraine.[1] A study published on 2012 demonstrated that the intravenous injection of air bubbles results in bioelectrical disturbances in the brain of patients with a migraine with aura. They have large right-to-left cardiac shunts. On the contrary, this effect was absent in patients with equally large right-to-left cardiac shunts, but without a migraine. However, the majority of these patients did not experience a headache. It suggested that subclinical hypoxia-ischemia induced by paradoxical cerebral embolism was not a common cause of migraine attacks in a migraine with aura patients with large PFOs. But they may occasionally trigger aura and h","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/52/NAJMS-8-169.PMC4821098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34433093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}