Aim. The aim of this review is to determine the relationship between sleeping body posture and severity of obstructive sleep apnea. This relationship has been investigated in the past. However, the conclusions derived from some of these studies are conflicting with each other. This paper intends to summarize the reported relationships between sleep posture and various sleep indices in patients diagnosed with sleep apnea. Methods and Materials. A systematic review of the published English literature during a 25-year period from 1983 to 2008 was performed. Results. Published data concerning the sleep apnea severity and posture in adults are limited. Supine sleep posture is consistently associated with more severe obstructive sleep apnea indices in adults. However, relationship between sleep apnea severity indices and prone posture is inconsistent.
Background:Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature.Materials and Methods:We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH) and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH) D levels as normal (>20 ng/ml) or vitamin D deficient (<20 ng/ml).Results:We identified 71 such patients. Fifty-two patients (73%) had low serum 25(OH) D (<20 ng/dl). Eighty-three percent patients reported musculoskeletal pain. Fifty-two percent patients fulfilled the American College of Rheumatology criteria for chronic widespread pain. About 50% patients fulfilled the criteria for biochemical osteomalacia. Low serum 25(OH) D level (<20 ng/dl) was significantly associated with headache, musculoskeletal pain, and osteomalacia.Discussion:These suggest that both chronic musculoskeletal pain and chronic headache may be related to vitamin D deficiency. Musculoskeletal pain associated with vitamin D deficiency is usually explained by osteomalacia of bones. Therefore, we speculate a possibility of osteomalacia of the skull for the generation of headache (osteomalacic cephalalgia?). It further suggests that both musculoskeletal pain and headaches may be the part of the same disease spectrum in a subset of patients with vitamin D deficiency (or osteomalacia), and vitamin D deficiency may be an important cause of secondary CTTH.
Hemorrhage from downhill varices is a rare manifestation. The etiology of downhill varices is due to superior vena cava obstruction while uphill varices are secondary to portal hypertension. We report a rare case of 55-year-old female with bleeding downhill varices not associated with obstruction or compression of superior vena cava, but was due to severe pulmonary artery hypertension secondary to chronic rheumatic heart disease. ( J CLIN EXP HEPA-TOL 2014;4:63-65) E sophageal varices are classified as downhill or uphill varices. Uphill varices are common, found at the lower end of the esophagus, extend upwards and develop as a consequence of portal hypertension. Downhill varices are rare, found at upper esophagus, extend downwards and usually develop due to superior vena cava obstruction. Very rarely they can develop due to pulmonary artery hypertension. We report a case presenting with upper gastrointestinal bleed from the downhill varices, which was also found to have uphill varices due to portal hypertension. The downhill varices in this patient were due to moderate pulmonary artery hypertension as a consequence of chronic rheumatic heart disease with severe mitral regurgitation, mild mitral stenosis and severe tricuspid regurgitation. CASE REPORTA 55-year-old female was admitted with repeated episodes of hematemesis and melena of 15 days duration. Patient was a diagnosed case of liver cirrhosis. General physical examination revealed pallor, raised jugular venous pressure, pedal edema and icterus. Her pulse was 82/min, regular and a blood pressure of 110/70 mmHg. Her abdomen was distended and shifting dullness was present. Cardiovascular examination revealed apical impulse in 6th intercostal space 2 cm outside mid-clavicular line, grade II parasternal heave, palpable pulmonary artery pulsations and palpable 2nd heart sound at parasternal 2nd left intercostals space, loud P2, opening snap and grade III/VI pansystolic murmur in mitral and tricuspid area. Respiratory and central nervous system examination were normal. On investigation her hemoglobin was 8 g/dL, platelet counts 0.76 lakh/mm 3 , TLC 7200/mm 3 with normal differentials, aspartate aminotransferase (AST) 40 U/L, alanine transferase (ALT) 41 U/L, alkaline phosphatase 150 mg/dL, total bilirubin 2.4 mg/dL with unconjugated fraction of 1.6 mg/dL, total serum proteins 6.2 g/dL, albumin 2.1 g/dL, prothrombin time 20 s, urea 19 mg/dL, creatinine 1 mg/dL, Na 143 meq/l and K was 3.7 meq/L. Her X-ray chest showed cardiomegaly, straightening of left heart border, findings suggestive of right atrium (RA) and left atrium (LA) enlargement, dilated pulmonary artery and superior vena cava (SVC) [ Figure 1]. Her ECG showed normal sinus rhythm with evidence of RA and LA enlargement with evidence of right ventricular hypertrophy (RVH) and left ventricular (LV) volume overload. Her serology was negative for ANA, HBsAg, anti HCV antibodies and HIV. On upper gastrointestinal endoscopy she had large varices 2 columns extending from post cricoid region downwards decreasing...
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