ABSTRACT
Background: Deep vein thrombosis is a disease of potentially serious consequences and is still often unsuspected. The present study was undertaken to look into etiological factors, management approaches and complications in patients presenting primarily with DVT at a tertiary care centre.Methods: This was a descriptive study profiling 75 confirmed DVT cases admitted at a tertiary care government hospital over two years. Detailed assessment included thorough clinical examination, duplex venous ultrasound and basic investigations, along with special investigations and CT angiography in selected few. Appropriate management was provided, and details recorded. Patients were followed up clinically and by ultrasound after 1 week, 2 weeks and 3 months. The complications, if any were also recorded.Results: The mean age of participants was 39.5±14.4 years, with 28% between 30-39 years. Majority (40%) did not have any obvious predisposing factor and most of them presented with pain and swelling. Most (52%) of the cases had involvement of both proximal and distal veins, 45.33% cases had involvement of only proximal veins whereas only 2.67% had restricted involvement of distal veins. Around 60% of cases have complete clinical resolution and approximately 50% cases have complete ultrasonographic resolution at the end of 3 months.Conclusions: Young adults without any obvious risk factors may develop and present with DVT and hence factors leading to thrombosis in them are recommended to be thoroughly evaluated. Duplex venous ultrasound is reliable non-invasive diagnostic modality and is recommended for diagnosis of DVT in clinically suspected cases.
ABSTRACT
Background: Endothelial dysfunction in young healthy first-degree relatives with family history of premature coronary artery disease was assessed in the present study using vascular doppler ultrasonography.Methods: Thirty young (10-40 years) first degree relatives of 17 patients with premature CAD without risk factors were selected for the study. Age and gender matched healthy subjects were enrolled as controls. Non- invasive assessment of endothelial dysfunction was done by vascular doppler study of brachial artery. Brachial artery diameter, velocity and blood flow were estimated in every study subject and control at rest, after stress and again at rest and after glyceryl-trinitrate (GTN) by vascular Doppler ultrasonography.Results: The percent rise in lumen diameter of brachial artery after stress i.e. reactive hyperaemia, labelled as percent rise in flow mediated dilatation (FMD), was significantly lower in family history group than in controls (8.42±3.47% vs 12.22±4.31%, p<0.05). The statistically significant difference in percent rise in FMD was observed to be consistent across different ages/genders (p<0.05). The mean percent rise in FMD among family history group with positive maternal history (8.06±3.65) was lower as compared to those with positive paternal history (8.57±3.12), but the difference was not statistically significant (p>0.05).Conclusions: Apparently healthy young subjects with family history of premature CAD have impaired endothelium dependent FMD in systemic circulation. Simple, non-invasive, cost-effective vascular doppler ultrasonography is recommended as a potential screening tool to detect subclinical atherosclerosis.
ABSTRACT
Background: Stroke is a disease of paramount public health significance. The role of plasma fibrinogen in determining incidence and severity of stroke has been postulated time and again. Present study was undertaken to determine the correlation between mean plasma fibrinogen level and infarct volume on CT scan in patients with acute stroke.Methods: Present prospective observational study of two years duration at our tertiary care government centre entailed enrollment and radiological assessment (CT scan/MRI) of 50 consecutive patients with first-ever stroke admitted within 24 h after stroke onset along with measurement of their plasma fibrinogen levels at admission.Results: Thirty (60%) cases reported ischemic stroke while haemorrhagic stroke was observed in 20 (40%) cases. The mean fibrinogen levels in ischemic (584±62mg/dl) and haemorrhagic stroke (52±28mg/dl) were found to be significantly higher (p<0.05) than normal range of (200-400mg/dl). The mean infarct volume in patients with ischemic stroke was 62.79±9.51cm3 while mean plasma fibrinogen level was 584±62mg/dl. There was significant correlation between infarct volume and fibrinogen levels (r coefficient =0.61; p<0.05). The fibrinogen levels in patients who died was insignificantly higher as compared to patients who survived.Conclusions: We report significantly higher than normal mean fibrinogen levels in ischemic and haemorrhagic stroke with the correlation between infarct volume and fibrinogen levels being significant in ischemic stroke. Limited mortality numbers probably didn’t allow the present study to reach the level of significance. Similar studies with larger sample size are recommended.
ABSTRACT
Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p<0.05). Of the total 22 (14.67%) deaths in the present study, 18 (12%) had associated RVMI and 4 (2.66%) isolated IWMI, the difference being statistically significant.Conclusions: Involvement of right ventricle increases rate of complications as well as the mortality rate in patients with inferior wall myocardial infarction.