Coronary Angiographic Profile of Left Ventricular Systolic Dysfunction of Unknown Causes in Kashmir

Introduction: Disseminated tuberculosis is a form ofwidespread bacilli infection with typical involvement ofthe lungs and other extra pulmonary organs. It is a raremanifestation of mycobacterial infection and rare amongimmune competent individuals.Case report: We present a case of disseminated extrapulmonary tuberculosis co-occurring tuberculous meningitis,CNS tuberculomas and Liver tuberculomas. Our patientdeveloped atypical respiratory complications in the form ofARDS like features which also called as Landouzy Sepsis,despite apparent normal Chest x-ray following initiation ofAnti Tubercular Therapy. Also patient developed paradoxicalreactions to tuberculous meningitis during the treatment.Conclusion: Awareness about paradoxical reactions intuberculous meningitis is very much crucial as paradoxicalreactions may lead to confusion about diagnostic accuracy andresistance of ATT drugs. Paradoxical reactions do not affectthe outcome but require prompt treatment to the complicationslike hydrocephalus and respiratory distress.

Penetrating Cardiac Trauma with Retained Intra - Myocardial Pellets - A Case Report

Introduction: Penetrating ballistic cardiac injury is usuallyfatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few caseshave been reported in the literature.Case report: We describe a young patient who presentedwith multiple life threatening pellet injuries involving chest,abdomen, and limbs. Patient had CT and echocardiographydocumented retained pellets in the heart with pericardialeffusion. Patient was managed successfully using conservativeapproach without any surgical intervention.Conclusion: this case highlights the importance of carefulmonitoring and conservative approach in such critically illpatients for a better outcome.

Comparison of Radiation Exposure in Patients Undergoing Single Vessel PCI (Requiring Single Stent) with and without Clear Stent and Clear Stent Live Technology

Invasive cardiology procedures provide great diagnostic and therapeutic benefit to patients but also subject them to considerable radiation exposure. CLEAR stent Live is the unique real time stent enhancement and gives a clear display of the undeployed stent. Aims & Objectives: To compare the radiation exposure in patients requiring single stent having single vessel coronary artery disease With & Without CLEAR stent and CLEAR stent Live Technology. Methods: It was a non-randomized study and included 246 patients. Group A included 123 patients who underwent Single vessel stenting using Clear stent technology as compared to group B who underwent stenting with conventional flouroscopic imaging. Radiation exposure between the two groups was compared. Results: The mean age of patients in Group A was 57.3±11.87 years while as in Group B it was 58.6±10.72 years (p=0.368). Majority of patients were males [(89(72.4%) vs 94(76.4%) (p=0.46) Group A vs B respectively] in both groups. The fluoro time in Group A was 10.6 minutes vs Group B = 11.2 minutes(p=0.15) The difference in procedure time between two groups(37.8 vs 35.9 min ,Group A vs Group B p=0.2) was statistically insignificant.The number of cine shots was significantly less in Group A as compared with Group B( 26.9 vs 30.1( Group A vs Group B) (p<0.002 ). The mean radiation exposure (mGy) in GroupA was significantly less as compared to Group B(581.7 ±293.6 vs 658.4 ±287.1 p= 0.039). The benefit of less radiation of Clear Stent technology was consistent across all vessels. Conclusion: The present study suggests that in selected patients, compared with conventional X-ray fluoroscopy imaging, the use of live clear stent technology can be performed with less radiation dose to patient.

Clinicoechocardiographic Profile of Paediatric Pulmonary Artery Hypertension Patients

Patterns and prevalence of Paediatric PAH have not been characterized in our local population. Aims & Objectives: To study the clinico-echocardiographic profile of children diagnosed as pulmonary arterial hypertension (PAH). Methods: The study was a prospective non-randomized study conducted .The study group included all the children in the age group of 0-15 years who were diagnosed as pulmonary arterial hypertension on Transthoracic Doppler Echocardiography. Detailed history, examination besides other investigations including Chest X ray, complete blood counts, ABG analysis, ECG, screening for connective tissue disorders and HIV, PBF, LFT, KFT were done as per standard guidelines. Results: The total number of admissions during the study period were 22150.Total number of PAH cases were 40. PAH case represented 0.18% of the total admissions. Mean age at the time of diagnosis was 7.3 months, 23 (57.5%) of the PAH patients were females whereas 17 (42.5%) were males. The most common clinical features were irritability (82.5%), tachypnea (75%), cyanosis (70%) followed by poor feeding (65%), features of right heart failure (35%) and syncope (5%). Idiopathic PAH constituted 42.5% of the study group, whereas 50% of the PAH cases were associated with CHD. 7.5% cases were diagnosed as PPHN. The mean systolic Pulmonary Artery Pressure in the study group was 63.17 mmHg. Most of the cases had severe PAH (65%), whereas moderate and mild PAH cases were 25% and 10% respectively. Conclusion: In view of relatively higher incidence of idiopathic PAH observed in this study in children of Kashmir, further studies are needed to identify the role of possible genetic and familial factors.

Survival in Paediatric Pulmonary Arterial Hypertension

Introduction: Outcome of paediatric PAH has not beenstudied in our population. Current study aimed to see theoutcome of children over a study period of one year who werediagnosed as pulmonary arterial hypertension.Material and Methods: Study was done on all children0-15 years age diagnosed with PAH on TransthoracicEchocardiography with systolic pulmonary artery pressure(sPAP) of >35 mmHg. Only Group 1 PAH (WHO) wereincluded and were followed for 1 year. Various clinical andechocardiographic variables affecting outcome were noted.Results: Total number of PAH cases were 40. Mean ageat the time of diagnosis was 7.3 months. 23 (57.5%) of thePAH patients were females whereas 17 (42.5%) were males.Idiopathic PAH constituted 42.5% of the study group, whereas50% of the PAH cases were associated with CHD. 7.5% caseswere diagnosed as PPHN Out of the total of 40 cases studied10 patients died representing 25% mortality over 1 year.Conclusion: Paediatric PAH is associated with high mortalityin our population.Those having Right heart failure and RightVentricular Dysfunction need close follow up.

Effect of Nano-Pulsed Cold Laser (NPCL) Light on Calcium and Phosphate Loss from Dental Enamel During In-office Bleaching with High Concentrated Hydrogen Peroxide Using Atomic Absorption Spectophotometer

To assess calcium and phosphate loss from enamel using 37.5% hydrogen peroxide (HP) gel with additional application of light emitting diode (LED), Diode laser and Nano-Pulsed Cold laser (NPCL) light sources compared to that of 37.5% HP alone using atomic absorption spectrophotometer (AAS). Methods: Twenty teeth were sectioned to obtain mesiobuccal, distobuccal, mesiopalatal and distopalatal specimens. The specimens were randomly assigned to four equal groups. 37.5% HP of 1mm thickness was applied to the enamel surface of each specimen. Each group received three cycles of bleaching of 8 minute’s duration. Group II, III & IV received additional application of LED, Diode laser & cold laser light respectively. Results: Data was analyzed by means of descriptive statistics. Group III showed the maximum loss of ions while Group IV showed the least loss and the differences were statistically significant (P < .05). Conclusion: Teeth treated with 37.5% hydrogen peroxide with application of Nano-Pulsed Cold Laser (NPCL) light presented with significantly minimal calcium and phosphate loss

Effect of Bioceramic Sealers on Post Endodontic Pain in Single Visit Endodontics: A Clinical Study

Background: Aim: to evaluate the effect of bioceramic sealers on post endodontic pain following single visit endodontics. Methods: Ninety patients requiring endodontic treatment were selected for the study. Patients were treated in single visit endodontically using three different bioceramic based sealers. Results: No significant difference was found in post endodontic pain scores between the sealers groups. Conclusion: Any of the three bioceramic sealer can be used forsingle visit endodontics without fear of post operative pain.

Comparison of Diode Laser With Maleic Acid and Ethylenediaminetetraacetic Acid on Smear Layer Removal From Root Canals: A Scanning Electron Microscope Study

Background: Aim: To evaluate the effect of diode laser with maleic acid and ethylenediaminetetraacetic acid (EDTA) on the smear layer removal from root canals. Methods: A total of 160 mandibular premolars were decoronated to working the length of 12 mm and prepared with protaper gold rotary files up to size F3. Group 1 canals irrigated with 1 ml 17% EDTA followed by 3 ml of 3% NaOCl. Group 2 canals were initially irrigated with 0.8 ml of 17% EDTA the remaining 0.2 ml was used to fill the root canals, and diode laser application was done. Group 3 canals were irrigated with 1 ml of 7 % maleic acid followed by 3 ml of 3% NaOCl. Group 4 canals were irrigated with .8 ml of maleic acid and remaining .2 ml was used to fill canal and activated by diode laser followed by 3% NaOCl. Scanning electron microscope examination of canals was done for remaining smear layer at coronal middle and apical third levels. Results: Maleic acid with and without diode laser had the least smear layer scores. Conclusion: Diode laser with maleic acid performed significantly better than EDTA.

Coronary CT Angiography in Asymptomatic Diabetes Mellitus.

Background: Coronary artery disease is often asymptomatic in diabetic patients until the onset of myocardial infarction or sudden cardiac death. . Coronary artery CT angiography can detect Coronary artery disease with high specificity and sensitivity. Aims &objectives: To evaluate the prevalence of coronary artery disease by CT angiography in type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additive risk factors for coronary artery disease. Methods: This hospital based observational study was conducted from March 2013 to August 2014 at GMC Srinagar. This study was carried out among Type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additional risk factors for coronary artery disease. Total of 52 patients with Type 2 diabetes patient underwent Cardiac CT. Results: Mean age of study population was 57.08 ±9.33 years..34 were males and 18 were females. 65.39% of total patient who underwent CT Angiography had plaque in coronary arteries while 34.61% have no plaque and normal coronary vessels. 19.23% patients have significant stenosis defined by luminal narrowing more than 70%. There was statistically significant relation between those who have patient significant stenosis and nonsignificant stenosis with regards to mean age, BMI, duration of diabetes , HDL ,LDL ,total cholesterol ,TG, HbA1c and coronary calcium score. Conclusion: Asymptomatic diabetics with additional risk factors have high prevalence of atherosclerotic plaques with 19% having obstructive CAD .The timely detection of CAD can help in optimizing treatment.

Clinicoradiological and Histopathological Comparative Study of Nodal Metastasis in Head and Neck Cancers.

Background: Detection of regional lymph nodes in head and neck cancers greatly modifies the staging, treatment and prognosis of the patient and helps in planning the management of these patients. Methods: A prospective study was conducted in the Department of E.N.T., S.M.G.S. Hospital, G.M.C. Jammu, in collaboration with the Department of Radio diagnosis and Imaging, G.M.C. Jammu & Department of Radiation Oncology GMC, Srinagar from 2008 to 2012 in which patients attending / admitted in the Department of E.N.T., with cancer of head and neck, were assessed for lymph node metastasis (at different levels). 16 patients, all cases of squamous cell carcinoma head and neck, underwent appropriate neck dissections. The patients were examined clinically as well as with ultrasonography for detection of various enlarged lymph nodes at different levels. Computed tomography and magnetic resonance imaging were done, wherever indicated. Patients were subjected to fine needle aspiration cytology in cases of palpable lymph nodes. The removed lymph nodes were examined histopathologically. Results: The findings of clinical, radiological and histopathological studies were compared. We concluded that clinical palpation should be supplemented by ultrasonography in every case of head and neck cancer. However, since computed tomography picks up lymph nodes missed by ultrasonography in a significant number, is important in imaging primary tumour and picks up necrosis and extracapsular spread at the most, it should be included in each case of head and neck cancer. Conclusion: Magnetic resonance imaging being equivalent to computed tomography in picking up the nodes, but lagging behind the criteria such as picking up of nodal necrosis and extra capsular spread of lymph nodes, and is too costly, so may be included as an imaging modality wherever computed tomography is contraindicated.