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   Table of Contents - Current issue
January-June 2020
Volume 11 | Issue 1
Page Nos. 1-82

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Potential biomarkers to detect inflammation leading to coronary artery disease Highly accessed article p. 1
Arun H.S Kumar
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Comparative anthropometry analysis of the digital X-rays of the right and left hip joints in an Indian population p. 3
Vetrivel Chezian Sengodan, Navaneethan Appusamy
Background: Population-specific anthropometric analysis of hip joints has vital clinical and surgical implications including adoption of optimal preventive measures and selection of effective prosthesis. Hence, in this study, we determined the anatomical variance between the right and left hip of the patients referred to our orthopedic unit. Materials and Methods: Five hundred patients with a normal hip joint attending the Institute of Orthopedics and Traumatology Unit of Coimbatore Medical College Hospital, Coimbatore, India, were included in this study. Plain radiographs were taken to measure the neck-shaft angle (NSA), head diameter (HD), neck width (NW) of the right and left femur, and the values were compared with data reported in the literature for various other population. Results: The mean value of NSA (134.2°), HD (42.9 mm), and NW (28.2 mm) in the study population differed when compared with data reported in the literature for the Western and other Indian population. Significant changes were also observed between the right and left sides of the hip joint in the study population. Conclusion: This study concludes that significant differences exist between the right and left side of hip joint in the study population. Further the values observed in our study population were considerably different from the values reported in the literature for the Western population.
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Comparative evaluation of the effect of therapeutic ultrasound and transcutaneous electric nerve stimulation in temporalis and masseter myofascial pain p. 7
D. N. S. V Ramesh, Divya Nair, Pragati Kempwade, R Thriveni, Amit R Byatnal, Iram Rukhsar
Background: Myofascial pain is the one which originates from myofascial trigger points in skeletal muscle. The specific treatment should be aimed at finding the etiology and removing the root of cause, and when specific etiology is difficult to be determined, an oral physician should rely on treatment, which is less invasive and reversible, such as transcutaneous electrical nerve stimulation (TENS) and therapeutic US for pain and muscle dysfunction. Aim: The aim of this study was to determine and compare the therapeutic efficacy of ultrasound and TENS in the management of myofascial pain. Settings and Design: This study was a prospective and comparative study with randomized collection and division of samples with myofascial pain. Materials and Methods: Thirty patients with myofascial pain in the masseter and temporalis muscle were assigned into two different groups with 15 patients in each. Group 1 received TENS therapy and Group 2 received Th US. Both the groups were evaluated using the visual analog scale scale for pain. Statistical Analysis: The analysis was done using the Student's t-test (paired t-test and unpaired t-test) for intragroup and intergroup comparison. Results: The results showed a significant reduction in the mean pain score after treatment in Th US (2.07) as compared to TENS (3.20). There was no statistically significant difference between the two groups before treatment (P = 0.692); however, immediately after treatment, the difference was found to be significant (P = 0.003), and also significant in the 1 week follow up visit after treatment (P = 0.000). Intragroup comparison of pain index before and after treatment showed statistically significant differences (P = 0.000) within TENS and Th US group with the exception of comparison between posttreatment and the follow-up scores in Th US group (P = 0.301). Conclusion: It was concluded that the use of Th US when compared to TENS appeared to be better procedure for myofascial pain management.
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Development and clinical evaluation of transmucosal mucoadhesive patch of lornoxicam for the odontogenic pain management: A preliminary study p. 12
R Thriveni, Iram Rukhsar, D.N.S. V Ramesh, Shrishailgouda S Patil, Amit R Byatnal, Divya Nair
Background: Pain is the most common complaint of the patient that brings him/her to the dentist, pain often occurring in conjunction with inflammation and which considerably reduces the quality of patient's life. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the dental pain management. The gastrointestinal complications associated with NSAIDs can be effectively overcome if they are delivered by transmucosal route in the form of buccal patch. Aim: The study aimed to evaluate the efficacy of mucoadhesive lornoxicam patches in odontogenic pain management. Materials and Methods: The present study was conducted in 60 adult patients of either sex, diagnosed with odontogenic pain, and were attending the outpatient department. Informed consent was obtained from all the patients. A 1 cm × 1 cm mucoadhesive patch containing 4 mg of lornoxicam was applied on the attached gingival region of the tooth with pain. Pain was recorded using a ten-point visual analog scale score before and every 5 min till 30 min after the application of the patch. Statistical analysis was performed using repeated measure ANOVA with P < 0.05. Results: The results of the study revealed a statistically significant drop in the pain scores from baseline to the score recorded after 30 min (P < 0.05). Conclusion: The results of the present study conclusively suggested the suitability, safety, and efficacy of the transmucosal delivery of lornoxicam in the form of mucoadhesive patch for the management of odontogenic pain.
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Analysis of hematological metal element levels in orthopedic patients with implants p. 17
Vetrivel Chezian Sengodan, Shreyas Doddihithlu
Background: The progressive increase in concentration of circulating metal by-products derived from the metal-based orthopedic implants may have deleterious effects in the patients over the long term. Therefore, it is necessary to profile the metal levels in the body of the patients receiving metal implants using appropriate highly sensitive techniques and strategies. Hence, in this study, we estimated the levels of metal in serum of patients with metal implants. Materials and Methods: Blood samples of 25 patients with metallic implants were collected at 6 months postsurgery. The blood samples were subjected to triple acid digestion and then analyzed through inductively coupled plasma–mass spectroscopy, and the blood levels of various metals were quantified. Results: An increase in serum levels of titanium was observed in the patients with metal implants at 6 months postsurgical implant. However, the levels of titanium were within the normal range (normal level <7.2 μg/l), and we did not observe any signs of detectable systemic toxicity. In contrast, the mean serum levels of cobalt (0.19–2.6 μg/l) and nickel (0.05–1.08 μg/l) were above the normal range. Conclusion: Orthopedic patients with metal implants had the serum levels of titanium within the normal range but had serum levels of cobalt and nickel above the normal range. Despite increase in the serum levels of cobalt and nickel, the patients did not show any clinical signs of toxicity.
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A comparative study of three scoring systems on palpable breast aspirates at a tertiary health-care center: A cross-sectional study p. 21
Kalyani Raju, Varsha Shree Rajanna
Background: The cytological grading system in fine-needle aspiration of breast lumps helps the surgeons to decide the method of management and assess the survival rate. However, till date, no single cytological grading system for breast aspirates has been adapted in routine practice. Hence, a comparative study of three different grading systems was done. Materials and Methods: This is a retrospective study conducted from January 2016 to June 2018. The stained aspirated smears of breast lump were assessed for cytomorphologic features and graded as per the Modified Masood's Scoring Index (MMSI), National Cancer Institute (NCI) Cytological Grading System, and Robinson's cytological grading and compared with histological diagnosis (four categories) and modified Scarff–Bloom–Richardson's scoring system (carcinoma cases). Results: The MMSI system had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 80%, 100%, 100%, 92.86%, and 94.44%, respectively. The NCI system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 60%, 97.44%, 90.0%, 86.36%, and 87.04%, respectively. The Robinson's cytological grading system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 84.62%, 71.43%, 100%, and 88.89%, respectively. Conclusion: Robinson's scoring system is the system with maximum sensitivity and is most effective in subcategorizing only malignant breast lesions. MMSI is the system with maximum specificity, PPV, and diagnostic accuracy, and can be considered as the standard grading system for both benign and malignant breast lesions on cytology.
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Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: A randomized control trial p. 27
Kanchan Kumar Sarker, Jasobanta Sethi, Umasankar Mohanty
Background: The purpose of this study was to investigate the comparative efficacy of spinal manipulative therapy-high-velocity low-amplitude (SMT-HVLA) thrust, core stability exercise (CSE), and supervised exercise on pain intensity (PI), segmental instability, and quality of life among patients with chronic nonspecific low back pain (CNSLBP). Materials and Methods: This was a randomized controlled trial conducted on 105 patients with CNSLBP (with duration of pain >3 months) distributed in three groups with 35 participants in each group, and an average age of the participants was 25.66 (standard deviation = 6.74) years. Participants received SMT-HVLA thrust (Group 1), CSE (Group 2), and supervised exercise (control group [CG]) with a common ergonomic advice (EA) for 2 weeks. The primary outcomes were PI measured by the Numeric Pain Rating Scale and segmental instability (postural sway) through the center of foot pressure measured by Win-Track platform. The secondary outcome was the quality of life measured by the EuroQoL questionnaire. All outcomes were assessed at baseline and 2 and 4 weeks. Two-way ANOVA followed by with post hoc Tukey's multiple comparison tests was carried out to examine treatment effects, and the relationship between the groups changes across outcome measures. Results: All participants completed the 2 weeks of intervention and the 4 weeks of follow-up. Group 1 had better outcomes than CG at 2 weeks (between-group difference in PI, P = 0.001; segmental instability, P = 0.001, and quality of life, P = 0.001) as compared to Group 2 and CG (between-group difference in PI, P = 0.03; segmental instability, P = 0.04; and quality of life, P = 0.05) as well as at 4 weeks (between-group difference in PI, P = 0.05; segmental instability, P = 0.03; and quality of life, P = 0.04). Conclusions: The SMT-HVLA thrust with EA providing pain reduction in patients with CNSLBP of high severity was associated with clinically better improvement in segmental instability (postural sway) and health-related quality of life. Thus, SMT may be an attractive option in such patients before proceeding for more invasive and costly treatments.
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Assessment of cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease: A cross-sectional study p. 35
Manisha Das, Somnath Maity, Supriyo Choudhury, Umme Habiba Faisal
Introduction: Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide and associated with multiple systemic involvements. Long-term hypoxia leads to impaired cognitive function and hand dexterity. With the background of few previous researches, we have aimed to assess cognitive function and hand dexterity in the patients with COPD as well as correlation between them and with oxygen saturation (SpO2). Materials and Methods: Data were collected and compared between 52 stable mild-to-moderate hypoxemic COPD patients defined by the Global Initiative for Obstructive Lung Disease Guidelines and 48 age- and sex-matched healthy volunteers attending the outpatient department of a government hospital Kolkata, using a validated questionnaire Mini-Mental State Examination (MMSE) tool for the assessment of cognitive function and the Nine-Hole Peg Test for assessment of hand dexterity. Results: The median (interquartile range [IQR]) value of Hand Dexterity Test for the dominant hand for the test group was 22 (20–24) s, and for the control group, 19 (18–20) s (P < 0.001). The median MMSE scores (IQR) for test and control groups were 19.5 (18–22) and 28 (26–29), respectively (P < 0.001). There is a negative correlation between these two parameters (correlation coefficient Spearman's rho −0.747 with 95% confidence interval −0.824 to −0.649, P < 0.001). SpO2has negative correlation with hand dexterity (correlation coefficient Spearman's rho −0.772 with 95% confidence interval −0.840 to −0.676, P < 0.001) and a positive correlation with MMSE score (correlation coefficient Spearman's rho 0.899 with 95% confidence interval +0.846 to +0.934, P < 0.001). Conclusion: Patients with COPD have reduced cognitive ability and hand dexterity. Hypoxia shows a negative correlation with hand dexterity and a positive correlation with cognitive impairment.
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High-sensitive C-reactive protein in patients with coronary artery disease p. 39
Virendra C Patil, Aniket B Avhad, Akshay R Kulkarni, Kaustubh A Pandere
Background: Inflammation plays a key role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Aim and Objectives: The aim of this study was to assess the relation of serum high-sensitivity C-reactive protein (hs-CRP) with the presence and severity of CAD. Study Design: This was a cross-sectional, observational study done on patients with diagnosis of acute coronary syndrome (ACS) undergoing coronary angiogram (CAG). Materials and Methods: A total of 100 patients were included in this study satisfying the inclusion criteria. The inclusion criteria were patients with the diagnosis of ACS undergoing CAG. All enrolled patients underwent hs-CRP, hemoglobin, serum creatinine, fasting lipid profile, blood sugar level, resting 12-lead electrocardiogram, creatine kinase–myocardial band, troponin -I, and CAG. Statistical Analysis: Data were analyzed for mean, percentage, standard deviation and Chi-square test for quantitative data using SPSS software version 21 (trial version), and P < 0.05 was considered statistically significant. Results: A total of 63% of male and 37% of female patients underwent CAG. The mean level of hs-CRP was 2.73 (±0.73) mg/L. The level of hs-CRP, severity of coronary artery involvement, and CAD risk factors was significantly more with an hs-CRP level of 1–3 mg/L followed by >3 mg/L. The significant number of patients with double-vessel disease (DVD) and triple-vessel disease (TVD) had an hs-CRP level between 1 and 3 mg/L compared to single-vessel disease (SVD) with P < 0.03. About 67.57% of females and 44.44% of males had an hs-CRP level of 1–3 mg/L, respectively (P < 0.02). A total of 53% of population had an hs-CRP level between 1 and 3 mg/L, 23% had <1 mg/L, and 24% had >3 mg/L (P < 0.02). The hs-CRP was positively correlated with severity of CAD by angiogram (+0.21). Conclusions: A significant number of patients had an hs-CRP level of 1–3 mg/L. The severity of CAD was positively correlated with a level of hs-CRP in incremental fashion. Patients with DVD and TVD had a high hs-CRP level compared to SVD. The hs-CRP can be considered as novel CAD risk factors to be screened in the patients with CAD where it cannot be forecasted by traditional risk factors.
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Anthocyanins isolated from Oryza Sativa L. protect dermal fibroblasts from hydrogen peroxide-induced cell death p. 45
Pakhawadee Palungwachira, Salunya Tancharoen, Pornpen Dararat, Thamthiwat Nararatwanchai
Background: Oxidative stress, cellular toxicity, and inflammation lead to skin damage, which results in premature skin aging. Recently, anthocyanins (ANT) have received much attention as dietary anti-oxidants involved in the prevention of oxidative damage. Materials and Methods: This study investigated the effects of ANT extracted from black rice (Oryza sativa L.) on the survival of rat dermal fibroblasts (RDFs) after oxidative stress-induced cellular damage by hydrogen peroxide (H2O2) using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. We further investigated the apoptosis-inducing effects of ANT using 4′,6-diamidino-2-phenylindole and Annexin V staining. The effect of ANT extract on autophagy was confirmed by reverse transcription polymerase chain reaction of the autophagy-related microtubule-associated protein 1B light chain 3 (LC3-II) and ffluorescence microscopy of the LC3-II protein. Results: The high-performance liquid chromatography results indicated the presence of cyanidin-3-O-glucoside in both extracts. The study demonstrated that the addition of crude or purified ANT extract before H2O2 treatment increased RDF cell viability. Pretreatment with ANT decreased the number of cells exhibiting dense chromatin fragments and DNA condensation, which are characteristics of apoptotic cell death. ANT decreased the number of late apoptotic/necrotic (Annexin + and propidium iodide (PI) +) cells and early apoptotic (Annexin V + and PI-) cells. Furthermore, ANT inhibited the H2O2-mediated induction of LC3-II gene expression in RDFs. Conclusion: The contribution of autophagy induction to the protective effects of ANT was verified by the observed decrease in the mRNA and protein expression of LC3-II. These results suggest the therapeutic potential of polyphenolic compounds extracted from O. sativa L. in oxidative damage-induced skin aging.
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Effect of fenugreek consumption with metformin treatment in improving plaque index in diabetic patients p. 55
Gopalakrishnan Sundaram, Ramakrishnan Theagarajan, Kanimozhi Gopalakrishnan, Gnanasagar Ramesh Babu, Gomathi Dhakshina Murthy
Aims and Objectives: The aim of this study is to compare the efficacy of metformin and fenugreek seed powder as an adjunct to scaling and root planing (SRP) with the effect achieved using SRP and metformin alone by assessing their respective effects on periodontal parameters, glycemic status, and inflammatory marker. Materials and Methods: Eighty patients were included in this study who were further divided into two groups. Each group consisted of 40 patients. Group 1 patients included chronic periodontitis with uncontrolled type 2 diabetes mellitus (DM), who received SRP and treatment with metformin. Group 2 patients included chronic periodontitis with uncontrolled type 2 DM, who received SRP, metformin plus fenugreek powder. Periodontal parameters such as plaque index (PI), gingival index, bleeding on probing, pocket depth, and clinical attachment levels were evaluated at baseline and 1 month after nonsurgical periodontal therapy. Blood samples were also collected to assess the levels of glycosylated hemoglobin (HbA1c) and inflammatory cytokine interleukin-6 (IL-6) at baseline and after 1 month of nonsurgical periodontal therapy. Results: On intragroup comparison of clinical parameters at baseline and after treatment, a statistically significant reduction was observed for both Group 1 and Group 2 patients. When intergroup comparison was done after treatment, significant reduction was observed only for PI (P < 0.0031). On intragroup comparison was done for fasting blood sugar (FBS) and HbA1c before and after nonsurgical periodontal treatment, there were statistically significant changes seen in both the groups for FBS (P < 0.001) and for HbA1c in Group 2 patients alone. The level of IL-6 also reduced after treatment compared to baseline values (P < 0.001). Conclusion: The direct effect of fenugreek on the FBS level could attribute to the changes in the PI and decrease in the inflammation. Thus, the study showed that fenugreek seeds could be used as an adjuvant in chronic periodontitis patients to control type 2 DM and inflammatory marker IL-6.
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The duration of mechanical ventilation in patients with chronic obstructive pulmonary disease and acute respiratory distress syndrome admitted to the intensive care unit: Epidemiological findings from a tertiary hospital p. 61
Fatmah M Othman, Yassin T Ismaiel, Saad A Alkhathran, Abdulaziz S Alshamrani, Meshal A Alghamdi, Taha Ismaeil
Context: Data for examining the duration and risk factors associated with the length of hospital stay with mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) are scarce. Aims: The aim of the study was to examine the hospital stay duration with MV in such patients in the intensive care unit (ICU). Settings and Design: This cross-sectional study was conducted at King Abdulaziz Medical City in Riyadh between 2016 and 2018. Subjects and Methods: Adult patients with ARDS or COPD admitted to the ICU and receiving MV were included in the study. Their medical records were reviewed for information regarding the length of hospital stay, demographic profile, and comorbidity. Results: In total, 136 and 95 patients with ARDS and COPD, respectively, were admitted and received MV. The mean (standard deviation) age of patients with ARDS and COPD was 53 (19) and 68 (12) years, respectively. The patients with COPD had a higher obesity rate (61% in the obese category), higher mean Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score (23.5 vs. 22.7), and preexisting chronic respiratory disease than those with ARDS. The median (interquartile range) MV duration in patients with ARDS was 7 (2–13) days, which was higher than that in patients with COPD (4 [1–9] days). Conclusions: Age, APACHE II score, and preexisting comorbidity contributed to the increase in the length of hospital stay with MV among patients with ARDS. Clinicians must consider such factors before using MV to improve patient outcomes.
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Detection of scrub typhus by real-time polymerase chain reaction and immunoglobulin M ELISA among patients with acute febrile illness p. 66
Nithiyanandan Saravanan, Prashanth Rajendiran, Sathish Sankar, Mageshbabu Ramamurthy, Archana Sasimohan, Vishnu Vineeta, George Varghese, Mercy John Idikula, Mary V Jesudason, Raja Rajeswari Mangalakumar, Aravindan Nair, Ranganathan Babujanarthanam, Balaji Nandagopal, Gopalan Sridharan
Background: Scrub typhus caused by Orientia tsutsugamushi is a vector-borne zoonotic infection endemic in several parts of the globe. The infection generally presents with fever and nonspecific clinical features but may lead to severe complications with a high mortality rate if untreated. Early diagnosis and timely management are therefore important. Serological diagnosis such as Weil–Felix test, indirect immunofluorescence assay, immunoglobulin (Ig) M/IgG ELISA, and rapid antibody detection assays are either less sensitive or laborious. Molecular detection by polymerase chain reaction (PCR) targeting specific gene targets of O. tsutsugamushi is warranted. Materials and Methods: We developed a real-time PCR assay targeting 47-KDa htrA gene for the specific diagnosis of the pathogen. The assay was evaluated in a buffy coat from whole blood or serum samples collected from patients presenting with acute febrile illness. Randomly selected samples were also tested for IgM by commercial IgM ELISA assay. Results: The real-time PCR assay was able to detect <1 genome copy per the PCR input and specific to O. tsutsugamushi on heterologous pathogens testing. The samples were negative by real-time PCR and 13 samples were positive by IgM ELISA. This study found a relatively low prevalence of scrub typhus in the population. Conclusion: The assay developed in this study could be a useful diagnostic tool for the detection of O. tsutsugamushi in clinical samples. The study also indicated the need for a wide epidemiological survey that could help determine appropriate health measures including treatment and prevention.
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Phytochemical analysis and evaluation of antibacterial activity of different extracts of soil-isolated fungus chaetomium cupreum p. 72
Nazir Ahmad Wani, Waseem Iqbal Khanday, Sharmila Tirumale
Background: Chaetomium cupreum is soil-isolated pigment-producing fungus used as biocontrol agent. Hypothesis: The aim of the present study was to evaluate the bioactive constituents and antibacterial potential of C. cupreum extracts on bacteria such as Staphylococcus aureus, Bacillus subtilis, Salmonella typhi, and Proteus vulgaris. Materials and Methods: The qualitative and quantitative screening of secondary metabolites was done by standard procedures. The antibacterial activity of different extracts of C. cupreum was determined by agar well diffusion method and broth microdilution methods. Results: Among the different extracts of C. cupreum, ethyl acetate and n-butanol extracts exhibited antibacterial activity. In the n-butanol extract, the most susceptible organism was found to be B. subtilis with zone of inhibition 18.5 ± 0.7 mm, followed by P. vulgaris 15.5 ± 0.7 mm, S. typhi 12.5 ± 3.5 mm, and S. aureus 12.0 ± 2.8 mm at 0.5 mg/ml, whereas in the ethyl acetate extract, the most susceptible organism was to found be P. vulgaris with zone of inhibition 17.5 ± 0.7 mm followed by B. subtilis 17.0 ± 1.4 mm, S. typhi 14.0 ± 0.7 mm, and S. aureus 13.5 ± 0.7 mm at 0.5 mg/ml. Conclusion: The obtained results suggest that C. cupreum extracts contain compounds that possess antibacterial activity.
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Dissecting aortic aneurysm associated with severe aortic regurgitation in an asymptomatic young female p. 81
HS Natraj Setty, C Rama, P Raghavendra Murthy, Santhosh Jadav, Krishna Murthy, Rahul Patil, Sathwik Raj, Babu Reddy, BC Srinivas, TR Raghu, CN Manjunath
An aortic aneurysm is a rare clinical entity since most patients will present with complications of dissection or rupture before the size of aneurysm reaches that magnitude. The classical presentation of a patient with acute aortic dissection (AAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature (mimics myocardial infarction). However, some patients present with painless AAD. We hereby present a case report of a 28-year aged female who presented with palpitation from the past 2 years, diagnosed to have aortic aneurysm with dissection and severe aortic regurgitation. She eventually underwent Bentall's procedure and had an uneventful recovery.
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