Influence of Stent Length on Peri–Procedural Myocardial Injury after Percutaneous Coronary Intervention.

Background: About one-third of all elective PCI procedures are associated with significant myocardial injury termed peri-procedural myocardial injury (PMI), which has been associated with increased subsequent mortality. The stent length is one of the factors that can predict procedure related Troponon I release. Methods: This interventional study was carried out to evaluate the influence of stent length on peri– procedural myocardial injury by measuring post procedural release of Troponin I after percutaneous coronary intervention. Patients with e”70% stenosed single vessel disease undergoing percutaneous coronary intervention with single stent were considered. Exclusion criteria were pre-procedural elevation of cardiac Troponin I above the 99th percentile of upper reference, severely ill patients. Total 90 consecutive patients were included. Among them 45 patients had d” 20mm long stent (group A) and rest 45 patients had > 20mm long stent (group B). Blood samples for Troponin I were collected before procedure and 12 hours after procedure. Results: Baseline characteristics including age, sex, risk factor for ischaemic heart disease and clinical diagnoses were almost similar between the two groups. During procedure no complications concurred 93.3% patients in group A and 68.9% patients in group B (p<0.05). Post procedural Troponin I level in group A was 0.47 ± 0.54 and in group B was 0.99 ± 1.09 (p<0.05). The stent length and post procedural Troponin I level had moderate correlation (r=0.41) (p<0.05). In hospital complications in two groups include persistent angina (6.7% vs. 11.1%), new ischaemic episode (0.0% vs. 4.4%) (p>0.05). There were no myocardial infarction, acute left ventricular failure, emergency CABG, arrhythmia and death in both groups. Durations of hospital stay were significantly higher in group B then group (4.53 ± 0.63 vs. 4.07 ± 0.65, p<0.05). Conclusion: The incidence of procedural myocardial injury and procedural complications are more in longer stent group. So limiting the stent length by spot-stenting the lesions rather than covering the entire vessel between lesions may reduce peri-procedural release of cTnI and improve post procedural prognosis.

Prolong Fever with Murmur in Heart in a patient with History of Intravenous Drug Abuse- A Case Report.

Right sided endocarditis accounts for 10% of all IE in population based surveys1 and a higher proportion of IE in injection drug users. Among injection drug users presenting with fever, 13% will have Echocardiographic evidence of IE.2 Staphylococcal endocarditis in injection drug users is now the dominant form of the disease in many urban communities where there is a high incidence of injection drug use and homelessness. Modern echocardiographic techniques have considerably augmented our ability to diagnose IE and to understand its natural history. Despite this, there are many areas in which our understanding of right sided IE remains incomplete.3

Percutaneous Coronary Intervention in Chronic Total Occlusion – In Hospital Outcome.

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure. Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed.

Prevention of Stroke in Nonvalvular Atrial Fibrillation.

Cerebro-vascular Disease (CVD) is the third most common cause of death in developed world after cancer and IHD. Atrial fibrillation (AF) is responsible in 45% of cases cardioembolism leading to CVD. Atrial fibrillation is considered to be one of the growing cardiovascular epidemics in the 21st century. Warfarin is a proven drug for prevention of stroke in patients with atrial fibrillation. Newer anticoagulants are being tried, fibrillation. Newer anticoagulants are being tried, but not yet well established by clinical trials. Separation of left atrial appendage from circulation by surgery or device implantation is a promising one in this field.

The possible role of surface charge in membrane organization in an acidophile.

Thiobacillus ferrooxidans, an obligate acidophile, possesses an electron transport chain that uses oxidation of ferrous iron to generate proton motive force. The cells possess an efficient machinery for inter-conversion of the two components of the free energy, namely pH gradient and membrane potential. Incidentally, unlike most of the naturally occurring membranes, surface in T. ferrooxidans appears to be positively charged at or near its physiological pH. Independent estimate of such charge was obtained from binding studies with anionic optical and fluorescent probes. When the external pH is lowered below a critical value the inter-conversion of the two components of the proton motive force was no longer operative. A surface charge mediated phase separation of membrane is suggested as one of the possible mechanisms for the failure of such inter-conversion process.

A short communication on occurrence of rheumatic diseases attending hospital.

A total of 4800 patients suffering from rheumatic diseases, attending Department of Physical Medicine, Burdwan Medical College Hospital, West Bengal, during the period from January 1991 to June 1991, were studied. Out of these 4800 cases, soft tissue rheumatism cases were maximum (57%), followed by osteo-arthrosis cases (36%), rheumatoid arthritis (5.2%), rheumatic arthritis (0.4%), ankylosing spondylitis (0.6%), osteo-chondrosis (0.7%) and gouty arthritis (0.1). Soft tissue rheumatism cases were common (62.8) in age group 20-40 years, mainly (58.4%) in female and maximum (37%) of lumbosacral strain. Osteo-arthrosis cases were highest (53.9%) in 40-60 years of age with female preponderance (57.2%) and mainly (49%) of cervical spondylosis.

An investigation of an outbreak of viral hepatitis in a residential area of Delhi.

Epidemiological investigation of a focal outbreak of jaundice in the KD block of Pitampura, Delhi during February-March 1992 revealed that 7.0 per cent of the population of the block suffered from viral hepatitis. There was no age or sex predilection. Epidemiological findings and Serological studies suggest that the epidemic was due to Hepatitis E (Enterically transmitted Non A and Non B) virus.

Prediction of recovery of Bell's palsy from clinical manifestations.

Sixty patients of Bell's palsy aged between 8 and 72 years, comprising 31 males and 29 females, were studied clinically to find out a method of prediction of recovery in early stage. It was found that young patients with incomplete palsy, unaccompanied by postauricular pain, loss of taste sensation over anterior 2/3rds of tongue hyperacusis and dry eye and recovery beginning within 4 weeks of onset of palsy are likely to make complete recovery, while older patients with complete palsy accompanied by severe postauricular pain, loss of taste sensation, hyperacusis and dry eye and beginning of recovery after 4 weeks of onset of palsy are most likely to have incomplete recovery.

Epidemiological profile of Japanese encephalitis in Gorakhpur district, Uttar Pradesh, 1982-1988.

An in-depth study of Japanese Encephalitis (JE) situation in Gorakhpur district of Uttar Pradesh from 1982-1988 showed increasing trend in the incidence of JE. Total number of annual cases and case fatality rate (CFR) rose from 118 and 23.7 per cent in 1982 to 772 and 32.2 per cent in 1988 respectively. A definite increase was noticed in the number of cases per block following lull years in 1984 and 1987. Among the total affected 1201 villages, 1083 were affected only once. All age groups were affected and the disease showed marked seasonality during August to November. JE, which came in epidemic form in earlier years has established in the area in endemic form.

Management of oral cancer in late stages: a review.

Sixty cases of oral cancer (2 were of stage II and other 58 were of stage III and stage IV) were treated and observed over a period of 2 years. In patients of oral cancer with bone involvement and mobile cervical nodes (44 cases) local excision which included partial or hemimandibulectomy with radical neck node dissection was performed. Out of these 44 cases, 18 cases received radiotherapy pre-operatively and 26 cases postoperatively. Better results were observed in these cases. When the growth was inaccessible and/or nodes were fixed (13 cases) radiotherapy was found to be suitable. Fistula formation and reconstructive flap necrosis were common following surgery after radiotherapy. Combined modalities of treatment with pre- and postoperative radiotherapy and radical neck node dissection showed excellent results (86.4%) in majority of cases. The remaining one patient received chemotherapy and local excision was performed in 2 cases.