ABSTRACT
This study was designed to study the patient characteristics, presenting features and complications of malaria in patients with elevated liver enzymes and to compare these data to those of patients with normal liver enzymes. A convenient sample of 100 patients with malaria was selected from three tertiary care referral hospitals. Study subjects were divided into two groups: [1] patients [controls] with normal liver enzymes and [2] patients [cases] with >3 times the normal liver enzymes in the absence of an alternate explanation for such elevation. Patient characteristics, presenting features and complications of malaria in these two groups were studied. Data were collected using a semi-structured pretested proforma and were analyzed using the statistical analysis program SPSS, version 11.5 [SPSS, Inc., Chicago, IL]. The mean ages were 38.12 years for the cases and 35.20 years for the controls with a non-significant p value of 0.289. Males composed 82% of the cases that were diagnosed with malarial hepatopathy; the remaining 18% were females. Falciparum malaria was present in 56% of the cases, compared to 12% of the controls. Icterus was present in 66% of cases of malarial hepatopathy, compared to 32% of the controls. Of the 66% of these cases, 18.18% had serum bilirubin >3 mg%, whereas out of the 32% of the controls presenting with icterus, only 5.55% had serum bilirubin >3 mg% [p = 0.003]. Of the cases with malarial hepatopathy, 38% suffered from hypoglycemia, compared to 0% of the controls [p < 0.001]; 84% of the cases presented with thrombocytopenia, compared to 70% of the controls [p < 0.001]; 12% of the cases suffered from renal failure with serum creatinine levels >2 mg%, compared to 2% of the controls [p = 0.060]. Plasmodium falciparum infection [either alone or along with P. vivax] is the leading cause of malarial hepatopathy. Jaundice is a common clinical manifestation among these patients. Patients with malarial hepatopathy have increased incidences of hypoglycemia and thrombocytopenia. Malarial hepatopathy occurs in relation to severe infection, most of which are treated with parenteral artesunate
ABSTRACT
Ischemic mitral regurgitation is a frequent complication of acute coronary syndrome. It primarily occurs in patients with a prior myocardial infarction but also may be seen with acute ischemia, a setting in which the MR typically resolves after the ischemia resolves. The vast majority of patients have "functional" ischemic MR. In these individuals, the papillary muscles, chordae, and valve leaflets are normal. However, the leaflets do not coapt and restricted leaflet motion is frequently noted on echocardiography. Ischemic mitral regurgitation indicates a poor prognosis after acute myocardial infarction. This study addresses the clinical characteristics of patients of acute coronary syndrome with mild functional ischemic mitral regurgitation and its impact on immediate in-hospital cardiovascular outcomes and death. From March 2006 through May 2007, patients who underwent 2-dimensional [2D] color doppler echocardiographic quantification of ischemic mitral regurgitation within 10 days of admission for acute coronary syndrome [ACS] in Manipal Teaching Hospital, a tertiary hospital in the western region of Nepal were noted. The demographic details, conventional risk factors of coronary artery disease, clinical and laboratory findings, treatment course and in-hospital outcomes of all the patients with mild functional ischemic MR following ACS in that time duration were recorded in a designated Performa. A total of 94 patients enrolled in the study were divided into two groups: Group I with mild functional ischemic MR and Group II without MR on 2D echocardigraphic assessment. Patient characteristics, risk factors, ejection fraction, and cardiovascular outcome and death among the two groups were compared and analyzed using software package SPSS 17.0 version. Group I constituted 64.89% of the study population and Group II comprised of 35.11%. The patients in Group I was more likely to be elderly diabetic [P<0.05], and smokers with hypertension [P < 0.05]. Mild functional ischemic MR was more common in patients with STEMI as compared to those with unstable angina and NSTEMI [55.7%, 36.1%, and 8.2%; P < 0.05].The mean ejection fraction in the first group was 54.84% in contrast to 58.92% observed in group II [P < 0.05].The type of wall involvement inferred from EKG analysis was homogeneously distributed in both the groups. Finally, there was no difference in immediate in-hospital [within 10 days] mortality or cardiovascular outcomes [heart failure, ventricular tachycardia/fibrillation, hypotension, and cardiogenic shock] between these two groups. Ischemic mitral regurgitation following acute coronary syndrome are more likely in elderly diabetics and hypertensive smokers. It is a more common finding in STEMI. Although mild MR following ACS does reduce ejection fraction, the immediate [within 10 days] in-hospital mortality and cardiovascular outcomes are not significantly altered