Metabolic risk factors in first acute coronary syndrome (MERIFACS) Study

Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective caseecontrol observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n ¼ 2153) were compared with matched controls (n ¼ 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p ¼ 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p ¼ 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p ¼ 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF

A rare case of Vitamin D dependent rickets type II: a case report

Vitamin D-dependent type II rickets (VDDRII) is a rare autosomal recessive disorder caused by mutation in the vitamin D receptor gene, leading to end-organ resistance to 1,25(OH)2 vitamin D3. It presents with refractory rickets and growth retardation presenting in the first year of life. It is frequently associated with alopecia totalis. Due to target organresistance, its response to vitamin D is poor. The recommended treatment is giving supra physiological dose of 1,25(OH)2 vitamin D3 and a high dose of oral or intravenous calcium. The response of alopecia to treatment is generally poor. We present a 3 ' year-old male child with VDDR II whose alopecia and rickets partially responded to 1,25(OH)2 vitamin D3.

Effect of preservatives, temperature and storage duration on stability of nucleic acids of pleopod tissues of Penaeus vannamei (Boone) and screening of viral infections.

In shrimp farming, screening for economically significant viral pathogens in nucleic acids of shrimps is vital for disease surveillance programmes and further, to take necessary precautions to ensure the sustainability of the farms and thereby the shrimp industry. Different preservatives, temperature and storage durations of the pleopod tissues of Penaeus vannamei broodstock were tested to investigate its effect on the quality and quantity of the nucleic acids. The pleopods were subjected to two preservation regimes and the yield and stability of the extracted nucleic acids were monitored over a time period of 12 months. Stability of the nucleic acids was assessed with nested polymerase chain reaction, and the yield was checked spectrophotometrically. Data was analysed by performing two way ANOVA and Tukeys Paired test. Preservation treatments included storage at −20°C and 5°C in RNAlaterTM and in 70 % ethanol. Significant variation (P<0.05) was observed in both DNA and RNA yield and stability from ethanol and RNAlaterTM stored pleopods at 5°C. However, the yield and stability did not differ (P >0.05) in both the preservatives at −20°C. The RNA was degraded and yielded lesser quantity when pleopod tissues were stored in ethanol at −20°C than when stored in RNAlaterTM during storage duration of 9 months. This study would help the shrimp farmers and researchers to adopt better preservation strategy, vital for shrimp disease surveillance programmes and for traceability studies in the event of any disease outbreak.

Toe thumb: A musculoskeletal disorder related to transesophageal echocardiography.

The musculoskeletal disorders (MSD) are common in healthcare providers and those who are doing sonography are also affected. There are reports of MSD in healthcare providers who do transthoracic echocardiography. Transesophageal echocardiography (TEE) is being regularly used in peri‑operative setting. We describe MSD of hand in a cardiovascular and thoracic anesthesiologist who has been performing TEE scanning for 10% of his work‑time in operating room and critical care area for the last 8 years. As the role of TEE is increasing and many doctors are doing it on a routine basis, the knowledge of association of MSD with TEE and measures to prevent it is important.

Primary pulmonary synovial sarcoma: a rare case report.

Primary lung sarcoma is an extremely rare tumor, accounting for less than 0.5% of all lung tumors. Histological subtypes are differentiated on the basis of immunohistochemical markers, such as vimentin, desmin, actin, CD99, and epithelial membrane antigen. A 50-year-old male presented with progressively increasing shortness of breath with cough for 2 months. On Contrast Enhanced Computed Tomography (CECT) of thorax a large heterogeneous mass with multiple areas of necrosis, occupying almost whole of left hemithorax was seen. CT-guided Fine Needle Aspiration Cytology (FNAC) revealed spindle cell neoplasm. Histopathological examination revealed a spindle cell sarcoma. On immunohistochemistry the tumor cells expressed both epithelial membrane antigen and vimentin. Hence, final impression from immunohistochemistry was primary monophasic synovial sarcoma of lung.

Tricuspid Valve Replacement in an Adult with Destroyed Tricuspid Valve and Refractory Right Heart Failure.

22 year old woman with no previous heart disease history, presented with progressive worsening of right heart failure symptoms due to severe tricuspid valve regurgitation which had become refractory to medical management. Echocardiogram revealed probable rare case of dysplastic tricuspid valve with large calcified mobile masses attached to leaflets. Calcified masses were thought to be due to healed vegetations from silent infective endocarditis of abnormal tricuspid valve which she had suffered in the past. There were no known acquired causes of tricuspid valve endocarditis. She had successfully undergone tricuspid valve replacement with bio-prosthetic valve along with a right atrial reduction surgery after which her heart failure symptoms improved markedly.

Disease Patterns of Juvenile Dermatomyositis From Western India.

A retrospective assessment of clinical characteristics, complications/ associations, laboratory investigations, treatment modalities and outcome in an inceptional cohort of 22 (male-13) children with juvenile dermatomyositis (JDM) receiving treatment at Jaslok Hospital, Mumbai during 1997- 2012 was performed . Mean age at diagnosis was 7.52 ± 3.99 years. Typical skin rash and muscle weakness were present in all children. Common complications included cutaneous ulcers (27.27%), dysphagia (22.72%) and calcinosis (18.18%).All patients presented with at least one of the serum muscle enzymes elevated. Absence of mortality and cardio-pulmonary complications and a monocyclic course in 72.7% of our patients are at variance from Western series.

Seasonal variations in physico-chemical characteristics of pond and ground water of Tiruchirapalli, India.

The aim of this study was to assess the open pond and groundwater quality of Tiruchirapalli city of Tamil Nadu, India. The groundwater quality viz., pH, electrical conductivity, total hardness, calcium ion, magnesium ion, chloride, carbonate, bicarbonate, inorganic nitrate, nitrite, phosphate, ammonia and reactive silicate were analysed with respect to various seasons and recorded in the range of 7.1 to 8.1, 97.67 to 533.67 mhos cm-1, 7.07 to 186 mg l-1, 4.67 and 112.0 mg l-1, 2.40 to 92.80 mg l-1, 15.23 to 661.73 mg l-1, 60 to 480 mg l-1, 22.7 to 544.9 mg l-1, 15.33 to 68.00 mg l-1, 0.001 to 0.480 mg l-1, 0.01 to 0.42 mg l-1, 0.02 to 0.75 mg l-1 and 1.1 to 2.96 mg l-1 respectively. The present findings concluded that the quality of ground waters can be considered suitable for human consumption. But the pond water available in and around Tiruchirappalli city was not fit for human usage, agricultural or industrial purposes.

Traction of Horizontally Impacted Central Incisor: A Case Report.

Impactions of maxillary central incisors occur uncommonly. Treatment of such impactions is challenging, as they interfere with facial esthetics and other clinical problems. Early detection of such teeth is most important if complications are to be avoided. We report a case of 13 year old female patient with impacted maxillary central incisor located high in the vestibule, parallel to the occlusal plane at the level of adjacent teeth root tips, with rotated right central incisor and mesially tipped left lateral incisor towards midline with barely 4-5 mm space left between the right central incisor and the left lateral incisor. The impacted tooth was surgically exposed and traction was done with orthodontic intervention.

An Epidemlological Study of Missing Teeth Among The North Indian Population.

There are numerous epidemiologic studies of missing teeth focusing white population which may not represent the status of other people. Aim: The aim of this study was to estimate the distribution of missing teeth in sample taken from North Indian adolescent. Material and Methods: Panoramic radiographs of unrelated adolescent of age ranging from 12 to 18 years were examined for missing teeth. Results: The study shows significant sex differences only for third molar which was absent in most of females. Conclusion: The present study concluded that third molars, maxillary lateral incisors, mandibular incisor and mandibular second premolar were most commonly congenitally missing permanent teeth among North Indian population.

Prognosis V/S Etiology : Midline Papilla Reconstruction After Closure of Median Diastema.

Reconstruction of lost interdental papilla once the contact point is restored in midline diastema cases are as well important in restoring the esthetics as closure of diastema. Aim: The purpose of this study was to predict the midline papilla reconstruction in treated median diastema of variable etiology. Method : The treated sample consisted of 40 patients with variable etiology of midline diastema (6 of abnormal labial frenum, 6 of mesiodens ,8 of anodontia or microdontia, 8 of para functional habits, 6 of flared or rotated incisors and 6 of dentoalveolar disproportion) with otherwise healthy periodontium. The method used was PPI (papilla presence index) by D.Cardaropoli. Results: The study suggests that prognosis for papillary reconstruction is not good in cases of mesiodens. Conclusion: In spite of getting a good contact point, various other factors are playing a role in achieving good esthetics in cases of median diastema.

Pediatric Vasculitides: A Generalists Approach.

Vasculitis is defined as the presence of inflammation in a blood vessel that may occur as a primary process or secondary to an underlying disease. Primary vasculitides are rare in children. These are defined by both the size of vessels involved and the type of inflammatory response. Clinical features consist of multi-organ involvement on a background of constitutional features reflecting the size and location of the blood vessels involved. Whilst some vasculitides are best diagnosed clinically, many forms require sophisticated imaging and other investigations (auto antibodies) to reveal the correct diagnosis. Prompt recognition and treatment is crucial as many of the vasculitides cause significant morbidity or mortality. Treatment options range from symptomatic therapy, immunosuppresive agents, intravenous immunoglobulin (IVIG) or biologic agents and are determined by the type of vasculitis, the severity of the inflammation, and the organ systems affected. Early detection and aggressive treatment is crucial for the best outcomes in the most severe forms of childhood vasculitis.

Effects of alachlor on biochemical parameters of the freshwater fish, Channa punctatus (Bloch).

The fresh water fish Channa punctatus (Bloch) were exposed to lethal and sublethal concentrations of a chloroacetanilide herbicide Alachlor and its commercial formulation Lasso 50% Emulsifiable Concentrate EC to study the impacts on some biochemical parameters - the energy dependent sources: such as glycogen, total proteins and metabolic enzymes: Aspartate Amino Transferase (AAT), Alanine Amino Transferase (ALAT), Lactate Dehydrogenase (LDH), Deoxyribonucleic acid (DNA) and Ribonucleic Acid (RNA). The glycogen, total proteins, DNA, RNA were all decreased but the activity of the enzymes AAT, ALAT and LDH were all increased which is due to the toxic stress. The percentage decrease being more pronounced at lethal concentrations than at sublethal concentrations.

Studies on histopathological changes in the gill, liver and kidney of Channa punctatus (Bloch) exposed to Alachlor.

Freshwater fish, Channa punctatus was exposed to sublethal concentration of a chloroacetanilide herbicide alachlor technical grade and lasso 50% EC for a period of 10 days. The histopathological changes in the gill include: necrosis, vacuolar degeneration, fusion and atrophy of primary and secondary gill lamellae. The tissue damages like degeneration of cytoplasm in hepatocytes, atrophy, formation of vacuoles, rupture in blood vessels and disposition of hepatic cords are the histopathological changes observed in the liver. The changes in the kidney include: necrosis, swelling of renal tubules, cellular hypertrophy and granular cytoplasm.

Effect of antiasthmatic medication on dental disease: dental caries and periodontal disease.

The prevalence of asthma has been increasing since the 1980s. Asthma and tooth decay are the two major causes of school absenteeism. There are few studies present in the literature. The objectives of the present study were to know the severity of dental caries and periodontal problems in children before and after taking antiasthmatic medication. The present study was conducted on 105, six- to fourteen-year-old asthmatic children to determine the condition of their dental caries and their periodontal status before and after taking antiasthmatic medication, for a period of 1 year and these were matched with their controls. The results showed that salbutamol inhaler shows increased caries rate with high significance over other groups, which was followed by salbutamol tablets and beclamethasone inhaler respectively. It has been concluded that antiasthmatic medication has its effects on dental caries and periodontal disease and asthmatic patients are recommended to adopt more precautionary oral hygiene practices and keep their caries activity and periodontal health under constant check.

Endovascular stent implantation in the coeliac and superior mesenteric arteries in the treatment of chronic mesenteric ischemia.

Mesenteric ischemia is a rare but serious cause of abdominal pain.We present the case of a man who had symptomatic mesenteric ischemia, secondary to a superior mesenteric artery stenosis in conjunction with a coeliac artery stenosis. He was treated with balloon angioplasty and stent insertion, and showed good symptomatic improvement.

Awareness and training need of biomedical waste management among undergraduate students, Andhra Pradesh.

Total 463 undergraduate students (216 males & 247 females) of ASRAM medical college of Andlira Pradesh were surveyed regarding awareness about biomedical waste management. Most of the students have heard about biomedical waste. Some of them were aware that it causes health hazards. But knowledge about category of wastes, duration of waste storage, responsibility of waste, type of bags used for collection, identification of Biohazard symbol was poor. Awareness of Biomedical waste. management and Handling rule 1998 was also poor. There were gaps in various aspects of Biomedical waste management among medical students. Appropriate training or inclusion of a topic in undergraduate medical curriculum can fulfill this.