Relation between non-alcoholic fatty liver disease and ischemic heart disease studied at rural tertiary care centre in Uttar Pradesh, India

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States and other industrialized countries, many study has identified NAFLD as a risk factor not only for premature coronary artery disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Aim of this study was to the presence of NAFLD in patients with Ischemic Heart Disease (IHD) and Relation of NAFLD with other risk factors of IHD.Methods: The study group consisted of 150 patients that comply with inclusion criteria and selected of 100 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Statistical evaluations were performed using T test, Chi- square test.Results: The present study was done in 100 patients of coronary artery disease divided into two groups i.e. Non NAFLD group n= 62 (62%) and NAFLD group n= 38 (38%). The present study shows that the prevalence of NAFLD was highest (86.8%) in more than 40 years of age group. The present study shows that the prevalence of NAFLD was more in males (84.2%) as compare to females (15.8%). The present study also shows significantly high incidence of metabolic syndrome in patients with NAFLD (23.7%) as compared to Non-NAFLD (3.2%) patients with Coronary Artery (CAD).Conclusions: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. The study results suggest the synergistic effect in between fatty liver and deranged lipid profile for developing IHD. Abdominal ultrasonography may provide valuable information about IHD risk assessment.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19 / 中华创伤杂志(英文版)

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Neuropathic pain

It is generally accepted that neuropathic pain is caused by nerve injury. It has been discovered that nerve damage can change the biochemistry, and even the anatomic organization of not only primary sensory afferents but also spinal and even brain neurons. The reorganization suggests that efforts to explain neuropathic pain on the basis of normal pain processing are at least partly misguided. Each form of pain sensation will have to be studied on its own terms. On the other hand, the reorganization explains that drugs effective against normal pain can be ineffective against neuropathic pain, whereas drugs effective against neuropathic pain tend not to be analgesic in the ordinary sense. Because the neuropathic pain circuits are in many ways a new system, certain drugs will affect the neuropathic pain circuit but not the old system. The past decade has seen the discovery of several classes of such drugs, including NMDA receptor antagonists, N-type calcium channel blockers and a group identified initially as anticonvulsants that may act by multiple mechanisms. Animal models are now in wide use as a tool enabling researchers to screen such drugs and others. An alternative treatment for neuropathic pain has emerged with the development of gabapentin, a structural analogue of GABA, which has recently been shown to decrease the allodynia and hyperalgesia associated with animal model of neuropathic pain. Moreover, gabapentin has been shown to be effective in clinical conditions of neuropathic pain, which are resistant to standard analgesics. Similarly, an anti-arrythmic drug, mexiletine has been found effective in the treatment of painful diabetic neuropathy. The work can be expected to speed the arrival of effective therapies for patients who have had none

Myocardial infarction in patients aged 35 and below

To define the risk factors, clinical presentation and outcome of patients of AMI, aged 35 and below. Design: A retrospective analytical study conducted over a period of 5 years [From 01-08-1991 to 31-07-1996]. Setting: Punjab Institute of Cardiology, Lahore. Subjects. One hundred and eleven patients, aged 35 and below, presenting with AMI. Main Outcome Measures: Risk factors, clinical presentation, outcome and mortality in AMI below the age of 35. Of the total 111 patients 103 [92.7%] were males and 8 [7.2%] were females. One [0.9%] was below 21 years of age, 9[8.1%] between 21 to 25 years, 21 [18.9%] between 26 to 30 and 80 [72.07%] of the patients were between 31 to 35 years of age. Major risk factor turned out to be smoking [79.2%] followed by family history [39.6%]. 5[4.5%] patients had DM and 9[8.1%] had hyperlipidemia. The commonest anatomical location for Ml was Inferior wall [43.24%]. In 5[4.5%] of the patients Ml re-occurred within one year. In hospital mortality after first episode of Ml was 4.5%. Major risk factor for AMI at young age is smoking followed by family history and other factors