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Background: Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function. Aims: The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries. Setting and Design: Prospective randomized double-blinded controlled study at a tertiary care institution. Materials and Methods: Sixty adult patients aged 15� years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively. Results: All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively. Conclusions: The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.
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揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.
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Introduction: Cardiovascular disease (CVD) is the leading cause of mortality for women in India and globally. Coronary arterydisease (CAD) has traditionally been considered a disease of men.Aims and Objectives: The aim of the study was to study the clinical profile, risk factors, and extent of CAD in women with anacute coronary syndrome.Materials and Methods: A total of 50 patients fulfilling the inclusion criteria will be a part of this study. Patients admitted in theCardiology Department of Nizam’s Institute Of Medical Sciences, Telangana.Observations and Results: Atotal of 50 subjects were enrolled in the study after meeting the inclusion criteria. The enrollmentperiod was from November 2018 to December 2018. Out of these 36 (72%) had ST segment elevation myocardial infarction(STEMI), 9 (18%) were non-STEMI, and 5 (10%) were diagnosed as unstable angina.Conclusions: The incidence of CAD increases with age in females with more adverse outcomes in elderly females. Riskscoring systems such as Killip’s Class and TIMI score were fairly accurate in female patients in predicting adverse outcomesand complications.
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Introduction: Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality in the world and hasnearing its epidemic proportions. Although CAD mortality rates worldwide have declined over the past four decades, CADremains responsible for about one-third or more of all deaths in individuals overage.Aims and Objectives: The primary objective of the study is to see the correlation between global longitudinal strain assessedby tissue Doppler imaging or two-dimensional (2D) speckle tracking echocardiography and CAD as assessed by coronaryangiography in intermediate-risk patients.Materials and Methods: This was a prospective clinical study, Department of Cardiology, Nizam’s Institute of Medical Sciences,Hyderabad. Patients admitted with symptoms of stable CAD during the period June 12 to November 30, 2017 were studied.Results: Total number of patients with a clinical diagnosis of stable angina at intermediate risk of CAD as per FraminghamRisk Score admitted to the hospital during the study period is 50. Out of 50 patients, five patients refused coronary angiogram.Conclusion: Global longitudinal strain (GLS) assessed by 2D-STE at rest is a predictor of significant CAD. GLS has highsensitivity for early detection of significant CAD in intermediate risk patients. 2D-STE has the potential to improve the value ofchocardiography in the detection of the CAD, identifying high-risk patients.
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HLA-B 27 is a human leukocyte antigen [HLA] class I cell surface molecule located on the short arm of chromosome 6. It is strongly associated with Acute anterior uveitis [AAU] and Ankylosing spondylitis [AS], the disorders are not only by genetic inherited disease. Several genetic and environmental factors likely play a vital role in determining the risk of developing these disorders. In this study, we try to find out the structure and functional relationship of HLA-B 27 sub types [HLA B[asterisk]27:112, HLA B[asterisk]27:04:01, HLA B[asterisk]27:06, HLA B[asterisk]27:05:02]. The molecular modeling [3D structure] of these subtypes are constructed and ligand binding sites are predicted. The HLA-B 27 gene were amplified from the DNA isolated from the patients with AS and AAU are sequenced. The protein sequences of the HLA-B 27 subtypes obtained from the IMGT/HLA database are aligned with each other and structure of all the subtypes models were constructed by in-silico method. The binding sites of the HLA-B 27 protein and their subtypes was predicted using 3DLigandSite server. The accurate prediction of ligand binding sites on the HLA-B 27 protein surface can be very helpful for rational drug design of AAU and AS
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In acute decompensated heart failure [ADHF], diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia [serum sodium concentration, <135 mEq/L] is a predictor of death among patients with heart failure. We prospectively observed the short term efficacy and safety of low dose [15 mg] tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. A total of 40 patients with ADHF along with hyponatremia [<125 mEq/L] on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline [P < 0.02]. There was a significant improvement in symptoms and New York Heart Association [NYHA] class after starting tolvaptan [P