Sathe S.,Saint Josephs Regional Medical Center
Current Pain and Headache Reports | Year: 2013
In the current classification of headache disorders, headache attributable to genetic disorders is not classified separately, rather as headache attributed to cranial or cervical vascular disorder. The classification thus implies that a vascular pathology causes headache in these genetic disorders. Unquestionably, migraine is one of the prominent presenting features of several genetic cerebral small vessel diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy, retinal vasculopathy with cerebral leukodystrophy, and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty. Shared genetic features, increased susceptibility, and/or vascular endothelial dysfunction may play a role in pathogenesis of migraine. Common or overlapping pathways involving the responsible genes may provide insight regarding the pathophysiological mechanisms that can explain their comorbidity with migraine. This review focuses on clinical features of genetic vasculopathies. An independent category - migraine related to genetic disorders - should be considered to classify these disorders. © 2013 Springer Science+Business Media New York.
Pastakia S.D.,Purdue University |
Pastakia S.D.,Moi University |
Fohl A.L.,University of Michigan |
Schellhase E.M.,Purdue University |
And 2 more authors.
Journal of the American Pharmacists Association | Year: 2010
Objectives: To assess the frequency of indications for vitamin K antagonist (VKA) therapy in the inpatient and outpatient setting in Eldoret, Kenya, and to describe the strategies used for managing these conditions. Methods: All inpatient admissions during a 1.5-month period were prospectively assessed for any indications for VKA therapy by clinical pharmacy staff. For the outpatient assessment, the files of all patients receiving care in the outpatient adult cardiology clinic within the previous 6 months were identified and evaluated for indications for VKA therapy. For patients identified with an indication for VKA therapy, additional information was collected, including the VKA indication, pharmacologic management, and any other risk-modifying conditions. Results: In the primary analysis, 20 of the 554 patients admitted to the public adult wards (3.61% [95% CI 2.14-5.08]) were candidates for VKA therapy. Of the 168 outpatient cardiology clinic charts reviewed, 72 patients (42.8% [37.96-47.76]) had indications for VKA therapy. In the secondary analysis, 70% of the inpatient population and 93% of the outpatient population received suboptimal VKA therapy. Of these patients in need of VKA therapy, 53.3% were on aspirin therapy only and 33.7% were not receiving any pharmacologic therapy. Conclusion: As developing countries begin to address the growing burden of chronic diseases, a commensurate focus on providing infrastructure for comprehensive cardiovascular care, including an organized VKA monitoring service, needs to occur.
Shah N.,Saint Josephs Regional Medical Center |
Shah N.,Seton Hall University |
Cavanagh Y.,Saint Josephs Regional Medical Center |
Cavanagh Y.,New York Medical College |
And 3 more authors.
Journal of Natural Science, Biology and Medicine | Year: 2015
The etiology of gastric antral vascular ectasia (GAVE) syndrome or gastric hyperplastic polyps (HPs) is not fully understood. We report a case of gastric HP arising in a patient treated with argon plasma coagulation (APC) for GAVE syndrome. Despite unclear etiologic progression, this and previously reported cases suggest a temporal relationship between the treatment of GAVE and HP. A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. Diagnostic esophagogastroduodenoscopy (EGD) demonstrated diffuse GAVE. He was treated with 5 APC treatments, at 6-week intervals, over a 30 weeks period. 16 months after the initial APC treatment, an EGD performed secondary to persistent anemia demonstrated innumerable, large, bleeding polyps in the gastric antrum. Biopsy performed at that time confirmed hyperplastic gastric polyps. It has been proposed that HPs are regenerative lesions that arise at sites of severe mucosal injury. Our patient's treatment of GAVE with APC created significant mucosal injury, resulting in HP. Technique and genetic factors may have promoted hyperplastic changes during the regeneration of mucosa, at sites previously treated with APC. This case highlights the potential progression of GAVE to HP in a patient with persistent anemia after APC therapy.
Shah A.M.,Saint Josephs Regional Medical Center |
Eddi R.,Saint Josephs Regional Medical Center |
Eddi R.,Seton Hall University |
Kothari S.T.,Saint Josephs Regional Medical Center |
And 6 more authors.
Journal of the Pancreas | Year: 2010
Context Acute pancreatitis is diagnosed on the basis of clinical features, biochemical tests and imaging studies. Normal serum amylase level has been reported in the setting of acute pancreatitis but normal serum lipase level in acute pancreatitis is extremely rare. Case report Herein, we present a case series of acute pancreatitis with normal serum lipase levels along with a review of the topic. Conclusion In appropriate clinical setting, the diagnosis of acute pancreatitis should be entertained even with normal serum amylase and lipase levels.