Dr. Shobhana  Gaur  Md image

Dr. Shobhana Gaur Md

800 W 5Th Ave
Spokane WA 99204
509 382-2531
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 57.010481
NPI: 1457476269
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Late-onset erythromelalgia in a previously healthy young woman: a case report and review of the literature. - Journal of medical case reports
Erythromelalgia is a rare disorder characterized by episodic erythema and burning pain, which commonly involves the extremities. We present a case of late onset erythromelalgia in a previously healthy young woman and briefly review the literature. Our patient's case also has additional uncommon features not reported previously.A 33-year-old previously healthy Caucasian woman presented with complaints of episodic burning pain and flushing occurring in a central distribution involving her face, ears, upper chest and, occasionally, her upper extremities. Her symptoms were triggered by lying down or warm temperature exposure and were relieved by cooling measures. Extensive diagnostic work-up looking for secondary causes for the symptoms was negative and the diagnosis of erythromelalgia was made based on details provided in her clinical history supported by raised temperature in the affected area measured by thermography during a symptomatic episode. The patient did not respond to pharmacological therapy or surgical sympathectomy. She was advised on lifestyle modification to avoid activities which triggered her symptoms. She was hypothermic with a core temperature between 92 and 95 degrees F. She also had premature ovarian failure, which had not previously been reported.Erythromelalgia is a rare disorder of unknown cause. There is no confirmatory diagnostic test; diagnosis is based on details provided in the patient's medical history and physical examination during the episodes. For those affected, this disorder leads to significant long-term morbidity and unfortunately, to date, no definitive therapy is available except for lifestyle modification.
Is wider worse? QRS duration predicts cardiac mortality in patients with right bundle branch block. - Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Increasing QRS duration may be of prognostic significance in patients with right bundle branch block (RBBB) and may assist in predicting overall cardiovascular risk.To test this hypothesis, we examined the Computerized Patient Records of patients with complete and persistent RBBB. Primary and secondary end points were all-cause and cardiac mortality. The effects of QRS duration on death rates were analyzed using the Cox proportional hazards regression model (P < 0.05). We identified 52,852 patients with EKGs and selected all those with diagnosis of RBBB (QRS > or = 120 ms) between January 2000 and January 2004. Some patients had EKG records confirming RBBB since 1987. The QRS durations were categorized into four groups: 120-129, 130-139, 140-149, and > or = 150 ms.A total of 997 (1.9%) patients (mean age 68.9 +/- 10 years) with RBBB were followed for 1-226 (median 45) months. All-cause mortality occurred in 344 (34.5%), cardiac deaths in 59 (5.9%), noncardiac in 191 (19.2%), and unknown causes in 94 (9.4%) patients. Mean left ventricular EF for cardiac patients was 38 +/- 15%. In patients with cardiac deaths, QRS duration was associated with increased morality (P < 0.007). For every 10 ms increase in QRS duration, the risk of death rose by 26.6%. The effect of QRS duration on all cause mortality was not statistically significant (P < 0.43).Increasing QRS duration was an independent predictor of cardiac mortality in patients with RBBB, but had no influence on all-cause mortality. QRS duration has added prognostic information to the presence of right bundle branch block.

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