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   2016| October-December  | Volume 6 | Issue 4  
    Online since September 30, 2016

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Chronic ankle instability: Current perspectives
Omar A Al-Mohrej, Nader S Al-Kenani
October-December 2016, 6(4):103-108
DOI:10.4103/2231-0770.191446  PMID:27843798
Ankle sprain is reported to be among the most common recurrent injuries. About 20% of acute ankle sprain patients develop chronic ankle instability. The failure of functional rehabilitation after acute ankle sprain leads to the development of chronic ankle instability. Differentiation between functional and anatomical ankle instability is very essential to guide the proper treatment. Stability testing by varus stress test and anterior drawer test should be carried out. Subtalar instability is an important pathology that is commonly by passed during the assessment of chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability might require surgical intervention. The surgical and conservative management options can be very much developed by in-depth knowledge of the ankle anatomy, biomechanics, and pathology. Anatomical repair, augmentation by tendon, or both are the basic methods of surgical intervention. Arthroscopy is becoming more popular in the management of chronic ankle instability.
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Etiological causes of pancytopenia: A report of 137 cases
Osman Yokus, Habip Gedik
October-December 2016, 6(4):109-112
DOI:10.4103/2231-0770.191447  PMID:27843799
Objective: The aim of this study is to evaluate the etiological causes of pancytopenia in patients who were admitted to the hematology ward due to pancytopenia. Materials and Methods: All patients who were admitted to the hematology ward of Ministry of Health Istanbul Training and Research Hospital due to pancytopenia between 2013 and 2015 were retrospectively evaluated regarding etiological causes. Results: A total of 137 patients was evaluated. The etiological causes of pancytopenia were recorded as Vitamin B12 deficiency (n: 24; 17%), chronic liver disease (n: 21; 15%), malignancy (n: 19; 13%), myelodysplastic syndrome (n: 18; 13%), aplastic anemia (n: 11; 8%), rheumatic diseases (n: 7; 5%), and endocrine causes (n: 3; 2%). Conclusion: The etiological causes of pancytopenia vary depends on patients' age, gender, country, and other conditions. Vitamin B12 deficiency is the most common treatable cause of pancytopenia. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imagings, without the need of a bone marrow examination.
  5,853 760 2
Does endothelial dysfunction correlate with endocrinal abnormalities in patients with polycystic ovary syndrome?
Rajani Dube
October-December 2016, 6(4):91-102
DOI:10.4103/2231-0770.191445  PMID:27843797
To study and critically analyze the published evidence on correlation of hormonal abnormalities and endothelial dysfunction (ED) in polycystic ovary syndrome (PCOS) through a systematic review. The databases including MEDLINE, PubMed, Up-To-Date, and Science Direct were searched using Medical subject handling terms and free text term keywords such as endocrine abnormalities in PCOS, ED assessment in PCOS, ED in combination with insulin resistance (IR), hyperandrogenism (HA), increased free testosterone, free androgen index (FAI), gonadotrophin levels, luteinizing hormone (LH), prolactin, estrogen, adipocytokines to search trials, and observational studies published from January 1987 to September 2015. Authors of original studies were contacted for additional data when necessary. PCOS increases the risk of cardiovascular disease in women. ED, which is a reliable indicator of cardiovascular risk in general population, is seen in most (but not all) women with PCOS. IR, seen in 70% patients with PCOS, is associated with ED in these women, but patients can have normal endothelial function even in the presence of IR. Free testosterone and FAI are consistently associated with ED, but endothelial function can be normal despite HA. Estradiol (not estrone) appears to be protective against ED though estrone is the predominant estrogen produced in PCOS. Increased levels of adipocytokines (visfatin) are promising in predicting ED and cardiovascular risk. However, more studies are required focusing on direct correlation of levels of prolactin, LH, estrone, and visfatin with ED in PCOS.
  2,925 3,593 2
Interrupted aortic arch with isolated persistent left superior vena cava in patient with Turners syndrome
M Obadah Kattea, Osama A Smettei, Abdulrahman Kattea, Rami M Abazid
October-December 2016, 6(4):117-119
DOI:10.4103/2231-0770.191449  PMID:27843801
We present a case of 13-year-old female with Turner syndrome (TS), who presented with unexplained lower limbs swelling and ejection systolic murmur at the left second intercostal space. Suspicion of mild aortic coarctation was made by echocardiography. Computed tomography angiography (CTA) showed a complete interruption of the aortic arch (IAA) below the left subclavian artery with persistent left superior vena cava (PLSVC) and absent right SVC, defined as an isolated PLSVC. The patient underwent successful surgical correction after unsuccessful trial of transcatheter stent placement. We present this case of asymptomatic IAA to draw attention to the importance of CTA in diagnosing such rare anomalies and ruling out asymptomatic major cardiovascular abnormalities in patient with TS.
  2,904 244 1
Left ventricular noncompaction diagnosed following Graves' disease
Habib Habib, Amer Hawatmeh, Upamanyu Rampal, Fayez Shamoon
October-December 2016, 6(4):113-116
DOI:10.4103/2231-0770.191448  PMID:27843800
Isolated left ventricular noncompaction (LVNC) is a rare genetic cardiomyopathy. Clinical manifestations are variable; patients may present with heart failure symptoms, arrhythmias, and systemic thromboembolism. However, it can also be asymptomatic. When asymptomatic, LVNC can manifest later in life after the onset of another unrelated condition. We report a case of LVNC which was diagnosed following a hyperthyroid state secondary to Graves' disease. The association of LVNC with other noncardiac abnormalities including neurological, hematological, and endocrine abnormalities including hypothyroidism has been described in isolated case reports before. To the best of our knowledge, this is the first reported case of LVNC diagnosed following exacerbation in contractile dysfunction triggered by Graves' disease.
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Coronary ectasia in a man on breast cancer therapy presenting with acute coronary syndrome
Dana C Johnson, Luay Rifai, Parag V Patel
October-December 2016, 6(4):120-123
DOI:10.4103/2231-0770.191450  PMID:27843802
Limited data exist on the association between breast cancer treatments and coronary artery disease anatomy, particularly in males. We describe an unusual case of diffuse coronary ectasia in a man with breast cancer presenting with acute coronary syndrome (ACS). A 66-year-old man with breast cancer on paclitaxel, tamoxifen, and carboplatin chemotherapy regimen, presents with new onset chest pain. Electrocardiogram reveals anterolateral ST-segment depressions and elevated troponin I level. Emergent angiography revealed grossly ectatic coronary arteries with a total thrombotic occlusion of the mid right coronary artery. Serial intracoronary aspiration thrombectomy revealed fragments of red thrombus. Intracoronary tenectaplase was ultimately administered to restore perfusion. The patient clinically improved and warfarin was added to his cardiac regimen. Laboratory work up for connective tissue disease was negative. Although paclitaxel has been implicated in coronary artery neointima and media proliferation in the setting of drug-eluting stents, we believe our case is the first to describe massive coronary ectasia with significant thrombus burden requiring complex coronary intervention and thrombolysis in the setting of breast cancer therapy in a man.
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