Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India

The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients

Angiographic profile and outcomes in persistent non-valvular atrial fibrillation: A study from tertiary care center in North India

Background: The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established, yet it is often missed. There is evidence of myocardial ischemia on stress imaging in AF patients in the absence of obstructive CAD. In this prospective cohort, we studied the angiographic profiles of non-valvular AF patients. Methods: The study was a nonrandomized, prospective, single-center observational study of consecutive patients of persistent non-valvular AF. Patients symptomatic for AF despite optimal medical therapy for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with prior history of CAD were excluded. Results: A total of 70 patients were followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49) years. Hypertension was the commonest comorbidity seen in 74% patients. Obstructive CAD was present in 32 (46%) patients, non-obstructive (<50% stenosis) CAD in 17 (24%) patients and normal coronaries in 21 (30%) patients. Overall 49 (70%) patients had evidence of CAD. Amongst patients without obstructive CAD, slow flow was seen in 16 (42%) patients. Lower baseline ejection fraction, lower haemoglobin & albumin levels and higher creatinine levels was associated with increased mortality. In patients without obstructive CAD, hospitalizations for fast ventricular rate were significantly increased in those having slow flow on CAG (p ¼ 0.005). Conclusions: Majority (70%) of our patients had evidence of atherosclerotic CAD on CAG. A large proportion of patients without obstructive CAD had slow flow on CAG.

Neutrophil to Lymphocyte Ratio: Prognostic Marker for OSCC

Introduction: Tumor microenvironment is infiltrated by innateand adaptive immune system cells particularly T lymphocytesthat assist tumors to mimic inflammatory conditions seen innormal tissues. Tumor microenvironment plays an importantrole in determining the biological behavior of cancers likeproliferation, invasion, metastasis and therapeutic resistance.Study aimed to estimate and compare the neutrophil tolymphocyte ratio (NLR) in patients with oral squamous cellcarcinoma (OSCC) and in normal healthy individuals.Material and method: A case control study was conductedon 15 cases of oral squamous cell carcinoma (OSCC) and 15cases of normal healthy individuals. Neutrophil to lymphocyteratio (NLR) was determined by the examination of peripheralblood smear in each case.Results: In the present study, significant increased in theabsolute neutrophil count and decreased in the absolutelymphocyte count were observed along with high neutrophilto lymphocyte ratio in OSCC patients than that of healthycontrols.Conclusion: Neutrophil to lymphocyte ratio can be used asa feasible, cost‑effective, and potential marker for determingthe aggressive behavior of OSCC and may also benefit inprognostic prediction.

Prosthetic Rehabilitation of Ectodermal Dysplasia in a 14 Year Old Child: A Case Report

Ectodermal dysplasia is a diverse group of genetic disorders that involve defects of the ectodermally derived structures and their accessory appendages including hair, nails, teeth, skin and glands. Other parts of the body, such as the eyes or throat, may be affected as well. Oral signs and symptoms are present in most of patients. The aim of this article is to report a case of child affected by ectodermal dysplasia with partial anodontia and to summarize some of the literature on current knowledge of oral manifestations and orofacial function as dental manifestations can be crucial for differential diagnosis of this disorder.

A Case Of Brain Abscess Caused By Actinomyces Mimicking Glioma: A Rare Presentation

Actinomycosis is a rare, chronic and slowly progressive granulomatous disease, caused by filamentous Gram-positive anaerobic bacteria from Actinomycetaceae family (genus Actinomyces) belonging to endogenous flora of mucous membranes. Actinomycosis infection to the Central Nervous System is generally secondary to hematogenous dissemination from the primary infection in the lung, abdomen, pelvis or by continuity in a cervical, oral or facial infection, since it is closely related to mycobacteria in the mouth and gastrointestinal tract. Actinomyces abscess of the brain can at times be confused with space-occupying lesions (SOL), tuberculosis as was seen in this case. A biopsy is essential for the diagnosis as if treated early these patients have a good prognosis. We present a case of 28 years male presented with frontal SOL which came out as actinomycosis on biopsy.

Assessment of Serum Uric Acid in Patients of Acute MI: Clinical Importance

Introduction: MI (Myocardial Infarction) remains an importanthealth problems. Various studies have recently found that uricacid may be a risk factor for cardiovascular diseases and anegative prognostic marker for mortality in subjects with preexisting congestive heart failure. Elevated serum uric acid ishighly predictive of mortality in patients with heart failure orcoronary artery disease and of cardiovascular events inpatients. Many studies including the National Health andNutrition Examination Survey (NHANES) study concluded thaturic acid is an independent risk factor for development ofcardiovascular and cerebrovascular diseases.Objective: To observe uric acid levels in patients with acutemyocardial infarction.Methodology: It was a hospital based observational studyperformed from January 2017 to July 2017 at Department ofCardiology, S. P. Medical College, Bikaner (Rajasthan) inwhich 75 patients was enrolled. Patients more than 18 years ofage diagnosed to have acute MI who presented to hospitalwithin 24 hours of onset of symptoms were included in thestudy, while patients with condition known to elevate UA (UricAcid) levels or patients receiving drugs affecting serum UAlevels & chronic alcoholics’ patients were excluded. Statisticalanalysis was done by software.Results: Patients of higher age with AMI had higher uric acidlevel as well as those who had previous history of MI hadhigher uric acid levels. Patients with AMI who died duringhospitalization had higher uric acid levels compare to alivepatients.Conclusion: SUA (Serum Uric Acid) can be used as a markerfor increased risk of acute MI. Furthermore, SUA can also beused for risk stratification after acute MI.

Angle closure glaucoma: a cause for bilateral visual threat.

Glaucoma is one of the leading causes of blindness worldwide. Primary angle closure glaucoma (PACG) is a leading cause ofblindness in East Asian people and known to cause bilateral blindness more frequently than other glaucoma. A retrospective study was thus undertaken to see the visual profile among these cases attending glaucoma unit. Total of 387 cases of angle closure glaucoma were seen in 3 years period. Out of these, 278 (71.8%) were females and 109 were males (28.2%). Among total cases, 61.5% had chronic angle closure glaucoma (CACG) and 38.5% had acute angle closure glaucoma (AACG) in one or both eyes. Bilateral angle closure attack was encountered simultaneously in 16 of the total acute angle closure cases accounting for 10.7%. Vision evaluation at the time of diagnosis among chronic angle closure glaucoma revealed blindness in 97 patients accounting for 20.4%. In acute glaucoma cases, after breaking the acute attack, the prevalence of blindness was found to be 8.9% out of total cases. Bilateral blindness was seen in 17.6% of total cases presented with either acute attack or chronic glaucoma. Mean intraocular pressure (IOP) was 32 mmHg (SD = 9.456) and 44 mmHg (8.67) in CACG and AACG respectively. Cataract was associated in 15.1% of CACG and 12.8% of AACG. Cataract related blindness was presumed to be present in only 4.1% cases of CACG and 14.3% of AACG cases who were blind. (p = < 0.001) Angle closure glaucoma is the frequent cause of bilateral blindness.

Leprosy blindness in Nepal.

Leprosy is a systemic disease with highest incidence of ocular complications and one of the important causes of blindness in the world. A comparative cross-sectional study was carried out to see the ocular involvement in leprosy leading to blindness in two groups of patients, one with the active disease and second already cured and thus released from treatment (RFT). Active cases attending Anandaban leprosy clinic, Patan hospital and RFT cases from Khokana leprosarium were included in the study consecutively. Total of 70 active cases and 101 RFT cases were evaluated during the study period. Active group of patients showed more of multibacillary type of disease than in RFT group. The prevalence of ocular manifestations was seen much higher among RFT cases accounting for 66.3% in contrast to active group where only 14.3% had ocular problems. Blindness was frequently seen in multibacillary (MB) leprosy patients in compare to paucibacillary (PB) disease in both the groups. However blindness frequency was seen more often among RFT cases accounting for 24% in compare to only 2.9% among active group. Causes of blindness were mainly corneal and cataract related disorders. Risk of blindness also increased with the increase in duration of illness. RFT group of leprosy patients are at higher risk of developing blindness than the active group thus eye care services should be more focused for this group. Having multibacillary type of disease could also be a risk for development of blindness.

Up-regulation of micro-opioid receptors in the spinal cord of morphine-tolerant rats.

Though morphine remains the most powerful drug for treating pain, its effectiveness is limited by the development of tolerance and dependence. The mechanism underlying development of tolerance to morphine is still poorly understood. One of the factors could be an alteration in the number of micro-receptors within specific parts of the nervous system. However, reports on changes in the micro-opioid receptor density in the spinal cord after chronic morphine administration are conflicting. Most of the studies have used subcutaneously implanted morphine pellets to produce tolerance. However, it does not simulate clinical conditions, where it is more common to administer morphine at intervals, either by injections or orally. In the present study, rats were made tolerant to morphine by injecting increasing doses of morphine (10-50 mg/kg, subcutaneously) for five days. In vitro tissue autoradiography for localization of micro-receptor in the spinal cord was done using [3H]-DAMGO. As compared to the spinal cord of control rats, the spinal cord of tolerant rats showed an 18.8% increase or up-regulation in the density of micro-receptors in the superficial layers of the dorsal horn. This up-regulation of micro-receptors after morphine tolerance suggests that a fraction of the receptors have been rendered desensitized, which in turn could lead to tolerance