Matrix metalloproteinases and their gene polymorphism in young ST-segment elevation myocardial infarction

Background: Genetic polymorphism in MMPs are associated with multiple adverse CV events. There is little evidence regarding role of MMPs and their genetic polymorphisms in young (<50 years) STsegment elevation myocardial infarction (STEMI) patients. Methods: This study included 100 young (18e50 years) STEMI patients and 100 healthy controls. Serum levels of MMP-3, MMP-9 and TIMP were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the MMP-9 gene (_x0001_1562 C/T and R279Q) & MMP-3 gene (5A/6A-1612) was evaluated. All these patients were followed up for one year and major adverse cardiac events (MACE) were determined. Results: Serum levels of MMP-3 (128.16 ± 115.81 vs 102.3 ± 57.28 ng/mL; P ¼ 0.04), MMP-9 (469.63 ± 238.4 vs 188.88 ± 94.08 pg/mL; P < 0.0001) and TIMP (5.84 ± 1.93 vs 2.28 ± 1.42 ng/mL; P < 0.0001) were significantly higher in patients as compared to controls. Additionally, patients with genetic polymorphisms in the MMP genes (5A/5A, 6A/6A and the AG genotypes) had an increased risk of STEMI. Patients with MACE had significantly higher levels of MMP-9 (581.73 ± 260.93 vs 438.01 ± 223.38 pg/mL; P ¼ 0.012). A cutoff value of 375.5 pg/mL of MMP-9 was best able to discriminate patients with STEMI and MACE with sensitivity of 77.3% and specificity of 57%. Conclusion: Novel biomarkers such as MMP-3, MMP-9 and TIMP and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals. Higher MMP-9 levels in STEMI patients with MACE suggests its potential role in predicting cardiac remodeling and left ventricular dysfunction

Knowledge, Attitude and Practices of teacher trainees about health-related topics during Teacher’s training course- A cross-sectional study

Introduction: A teacher is a person who educates others and is considered a role model to transmit the value of life. School is considered an important setting for comprehensive health promotion. Teachers can act as a bridge to pass health information and behaviour that they learn to students, families, and Communities. The major pivot in the present study is to assess the teacher’s trainees about health knowledge, attitude, and practices during their training course. Objectives: To assess the knowledge, attitude, and practice of health-related topics in teacher’s training course Materials and methods: A cross-sectional study was carried out in the B Ed and D Ed colleges of field practice area with a sample size was 150. It was a questionnaire-based study. Information was collected based on the interview method. Results: Knowledge and practice were better in B Ed trainees. The attitude of the trainees is nearly equal. Conclusions: The disparity is majorly based on their previous educational status. Those who have opted for B Ed have passed degrees like B.SC or B.A and trainees doing D Ed have joined immediately after the completion of their 12th standard. Hence, their knowledge of health-related topics is limited compared to B Ed trainees

Left ventricular function assessment after aortic and renal intervention in Takayasu arteritis by speckle tracking echocardiography: A pilot study

Background: Overt left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown. Methods: This study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention. Results: Six patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p ¼ 0.001), E/ e’ ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p ¼ 0.005) and median NT pro BNP decreased from 1673 pg/ml (970e2401 pg/ml) to 80 pg/ml (40e354 pg/ml) (p ¼ 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80 e898.5 pg/ml) to 34 pg/ml (29e70.8 pg/ml) (p < 0.01), mean GLS improved from 8.80 ± 0.77% to 16.3 ± 0.78% (p < 0.001) and mean E/e’ decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p ¼ 0.005) at 6 months follow up. Conclusion: LV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes

Study of targeted four node sampling of axilla in management of carcinoma of breast

Background: Axillary lymph node sampling is considered as one of the most pivotal investigations in determining the lymph node status in management of carcinoma breast. The present study attempts to assess sensitivity, specificity and positive predictive value of axillary four node sampling (FNS) in management of carcinoma of breast, and its efficacy in downstaged patients.Methods: A total of 35 patients, node negative operable cases of carcinoma breast and locally advanced breast cancer (LABC) patients downstaged after 3 cycles of neoadjuvant chemotherapy, were enrolled. Lymph node mapping was done by injecting 3 - 5 ml of methylene blue dye, just before surgery. Level 1 lymph nodes stained by methylene blue were sampled and axillary dissection was carried out, level 3 lymph nodes were identified and sampled, rest of the axillary dissection specimen was sent as a separate sample for histopathological examination , node positivity was compared in level 1 and level 3 , and conclusions were drawn.Results: The sensitivity, specificity for FNS in node negative operable cases were found to be 83.33% and 91.3% respectively.  The negative and positive predictive value were found to be 95.40% and 71.42% respectively. Specificity of FNS in LABC downstaged patients was found to be 40%.Conclusions: Targeted four node sampling using methylene blue dye can be considered as an alternative method for sentinel lymph node. Further study should be conducted to establish it as a reliable method for axillary lymph node staging.

Physical Activity as a Clinical Tool in the Assessment of Malnutrition.

Objective: To measure physical activity in children with wasting and to look for association between poor physical activity and wasting. Methods: Physical activity was measured in 56 children with wasting, using Children’s Activity Rating Scale, and compared with age- and sex-matched controls. Results: A significant association was found between poor physical activity and malnutrition as determined by weight-for-height Z Score <-2 (P=0.001) and midupper- arm circumference (P=0.002). Conclusion: Physical activity can be used as clinical parameter to assess malnutrition.

Clinical Efficacy of Topical Terbinafine Versus Topical Luliconazole in Treatment of Tinea Corporis/Tinea Cruris Patients.

Aims: Tinea corporis & cruris of skin respond well to topical antifungal therapy, but there is a need to apply cream 2- 3 times daily for up to four weeks will impair compliance & lead to treatment failure. Luliconazole is one of those drugs offering good efficacy & tolerability with a short duration of treatment. Terbinafine, an allylamine antifungal agent, acts by selective inhibition of fungal squalene epoxidase. Luliconazole, an imidazole antifungal agent is considered to be more effective in inhibition of ergosterol biosynthesis and its reservoir property in stratum corneum is greater than that of terbinafine. As there are lack of studies between terbinafine & luliconazole, the present study was undertaken to compare the clinical efficacy in tinea corporis/tinea cruris patients. Study Design: Prospective parallel study. Place and Duration of Study: Study was conducted on 60 patients presenting to the Dermatology out-patient department of RL Jalapa Hospital, Kolar, from 1st December 30th April 2012. Methodology: Patients alternatively assigned to either terbinafine or luliconazole & advised to apply test drugs topically for 14 days. Clinical symptoms & signs were assessed using 4-point (pruritus, erythema, scaling) scale & 10% KOH mount at base line, end of treatment visit (15th day) & later 30th day. The data was analysed based on age, gender distribution, duration of lesion, clinical score & KOH mount. Results: Of the 60 patients recruited, all came for 1st follow up (14th day) & 51 patients for 2nd follow-up (30th day). Mean age of the patients was 33.80± 9.58 years in terbinafine & 33.90 ± 9.58 years luliconazole group. Majority of patients were in 12- 40 years aged in both group. Sixty patients and 51 patients were negative for KOH mount preparation on 15th & 30th day respectively. At the end of first follow-up, the clinical score was reduced from 3 to zero (P=0.0001) in both the treatment groups. Mycological cure was 100% in both the drug groups. There was no relapse in 51 patients who came for 2nd follow-up. Four in terbinafine and 5 in luliconazole group were lost to follow up. Conclusion: Only mild forms of tinea infections were included as compared to other studies where moderate to severe (pustules, incrustations, vesiculation). Hence the onset of illness, treatment duration and severity of illness were favorable in this study for two weeks. In both the treatment arms, clinical & mycological cure was comparable, hence once a day application for two weeks of terbinafine & luliconazole were equally effective for treatment of tinea corporis/cruris infection.

Exclusive Breast-feeding: Is Motivation the Only Issue.

Objectives: The aim of the study was: (1) To know the frequency of suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation (DOL) and excess neonatal weight loss (EWL) in mother-infant pairs with a high motivation to breastfeed; (2) to see if SIBB influenced lactational problems represented by: a] DOL, b] EWL; (3) in addition, we have tried to assess the risk factors for SIBB and other risk factors for DOL and EWL. Material and methods: A longitudinal hospital-based observational study. Infant breastfeeding behavior was assessed by IBFAT score, DOL was measured by maternal perception of breast fullness and maternal motivation by an initial interview based on breastfeeding self-efficacy scale. Results: Frequency of SIBB was 13.3% on Day 0, 6.6% on Day 3 and 2.9% on Day 7. DOL occurred in 11.8% of mothers and excess weight loss in 17.7% of infants. Prolonged labor, medications given during labor, inadequacy of sleep during peripartum and use of supplementary feeds were found to be significantly associated with SIBB. Infants with SIBB on Day 0 were 17 times more likely to have SIBB on Day 3 and they were also four times more likely to have excess weight loss. Failure of exclusive breastfeeding (EBF) occurred in 8.1% and showed a significant association with SIBB, but at two weeks all were breastfeeding exclusively. Conclusion: Infant behavior plays an important role in the success of early breastfeeding and if suboptimal, contributes to failure of EBF. Both infant behavior and onset of lactation constitute significant predictors of excessive weight loss and short-term failure of exclusive breastfeeding and help in determining the need for intensive lactation counseling in high-risk cases.

Torsades de pointes in a patient of dilated cardiomyopathy occurring early on oral amiodarone therapy.

Amiodarone induced proarrhythmic effects are rare. We report a case of amiodarone induced torsades de pointes in a young boy aged 16 years occurring early after initiation of oral amiodarone. This case underscores the need of careful electrocardiographic monitoring early during amiodarone therapy to avoid a potentially fatal arrhythmia.

Do Omega-3 fatty acids prevent atrial fibrillation after open heart surgery? A meta-analysis of randomized controlled trials

OBJECTIVES: N-3 polyunsaturated fatty acids have been proposed as a novel treatment for preventing postoperative atrial fibrillation due to their potential anti-inflammatory and anti-arrhythmic effects. However, randomized studies have yielded conflicting results. The objective of this study is to review randomized trials of N-3 polyunsaturated fatty acid use for postoperative atrial fibrillation. METHODS: Using the CENTRAL, PUBMED, EMBASE, and LILACS databases, a literature search was conducted to identify all of the studies in human subjects that reported the effects of N-3 polyunsaturated fatty acids on the prevention of postoperative atrial fibrillation in cardiac surgery patients. The final search was performed on January 30, 2011. There was no language restriction, and the search strategy only involved terms for N-3 polyunsaturated fatty acids (or fish oil), atrial fibrillation, and cardiac surgery. To be included, the studies had to be randomized (open or blinded), and the enrolled patients had to be >18 years of age. RESULTS: Four randomized studies (three double-blind, one open-label) that enrolled 538 patients were identified. The patients were predominantly male, the mean age was 62.3 years, and most of the patients exhibited a normal left atrial size and ejection fraction. N-3 polyunsaturated fatty acid use was not associated with a reduction in postoperative atrial fibrillation. Similar results were observed when the open-label study was excluded. CONCLUSIONS: There is insufficient evidence to suggest that treatment with N-3 polyunsaturated fatty acids reduces postoperative atrial fibrillation. Therefore, their routine use in patients undergoing cardiac surgery is not recommended.

Subperiodic, asymptomatic microfilaremia in an adult male from Mysore: a nonendemic area.

Wuchereria bancrofti is found throughout tropics and subtropics like Asia, Pacific islands, Africa, areas of South America and Caribbean basin. In all these areas, except Pacific islands, microfilaria occurs in the periodic form, in which case the microfilaria are found in large numbers in the peripheral blood during night. In the Pacific islands, they occur in the subperiodic form, i.e., microfilaria are present in the peripheral blood at all times and reach the maximum level of parasitemia in the afternoon. Microfilaria of Wuchereria bancrofti and Brugia malayi occurring in India displays a nocturnal periodicity, appearing in large numbers at night. This is the biological adaptation to the nocturnal biting habits of the vector mosquitoes. The maximum density in blood is reported between 10 PM and 2 AM. Here is a case report of asymptomatic microfilaremia showing subperiodicity, which is very unusual in India.

Villous adenoma: a rare tumor of vaginal vault.

Villous adenomas are extremely rare tumors in the vagina and are indistinguishable from their colonic counterparts. These are considered as enteric type neoplasms of lower female genital tract arising from cloacal remnants. The significance of this lesion lies in the fact that it has to be distinguished from metastatic adenocarcinoma from other sites. We present a case of villous adenoma of vaginal vault, a rare site of presentation in a 30-year-old female.

Gastrointestinal stromal tumour--a paradigm shift in management of solid tumours.

Gastrointestinal stromal tumour (GIST) till recently were non-responsive to all chemotherapy agents. With the advent of c-kit, diagnosis of GIST has become more specific. STI-571, a tyrosine kinase, has become one of the first targeted therapeutic agent tobe active in solid tumour. At present it is the only agent with substantial activity in GIST.

Thromboembolism: a rare complication of cardiac hydatidosis.

A cardiac hydatid cyst is rare. We report a case of cardiac hydatid cyst localized in the atria which was diagnosed by two-dimensional echocardiography following a thromboembolic stroke. Surgical resection of the cyst was performed and histopathologic examination confirmed the diagnosis.