Newer therapeutic concept in antiplatelet aggregation inhibition--GPIIb-IIIa receptor antagonists.

Numerous investigators have shown that the glycoprotein IIb/IIIa integrin mediates the final common pathway in platelet aggregation which has led to development of GP IIb/IIIa receptor antagonists. This article reviews the current status of GP IIb/IIIa receptor blockade in the management of coronary artery disease, examining the results of pivotal clinical trials.

Experience in adult population in dengue outbreak in Delhi.

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.

Echocardiographic changes and alterations in lipid profile in cases of subclinical and overt hypothyroidism.

Forty four patients (22 of overt hypothyroidism and 22 of subclinical hypothyroidism) and 11 controls underwent lipid profile evaluation and two dimensional echocardiography. Amongst the various parameters evaluated, mean Interventricular Septal (IVS) dimensions were significantly (p < 0.005) raised in overt hypothyroidism [IVS: end diastolic (ED) = 0.973 +/- 0.223 cm.; end systolic (ES) = 1.300 +/- 0.240 cm.] with respect to control group [IVS : ED = 0.747 +/- 0.118 cm.; ES = 1.073 +/- 0.173 cm.]. Mean Left Ventricular Posterior Wall (LVPW) thickness was also significantly (p < 0.005) raised in overt hypothyroidism [LVPW : ED = 0.944 +/- 0.200 cm.; ES = 1.350 +/- 0.243 cm.] in comparison with control group [LVPW : ED = 0.779 +/- 0.091 cm.; ES = 1.176 +/- 0.128 cm.]. Evidence of diastolic dysfunction was present in both subclinical (n = 2) and overt hypothyroidism (n = 6) while pericardial effusion was seen only in overt hypothyroidism (n = 10). Mean Serum cholesterol was significantly raised in both subclinical (192.13 +/- 47.40 mg%) (p < 0.05) and overt hypothyroidism (231.27 +/- 68.30 mg%) (p < 0.005) with respect to control group (157.63 +/- 37.69 mg%). In overt hypothyroid patients mean serum Triglyceride (235.59 +/- 137.53 mg%) (p < 0.05), LDL (126.09 +/- 54.99 mg%) (p < 0.05) and Apo-B (0.698 +/- 0.354 g/L) (p < 0.05) levels were significantly higher as compared to control group (serum triglyceride 165.45 +/- 49.15 mg%, LDL 88.72 +/- 38.75 mg%, Apo-B 0.474 +/- 0.176 g/L.

Visual Evoked Potential (VEP)--dependable marker for CNS affection in thyroid diseases.

The mean latency and amplitude of P100 component of VEP were studied in forty three controls and eighty nine cases of thyroid dysfunction [Hypothyroid-28; Hyperthyroid-32 and probable Thyroiditis-29 (inclusive of 21 cytology proved)]. The mean latency in hypothyroid, hyperthyroid and probable thyroiditis subjects were 110.69, 111.41 and 109 m.sec in comparison to 101.91, 102.0 and 101.08 m. sec. respectively in controls (p < 0.005). The mean amplitude being 1.34, 6.34 and 2.41 microvolts in hypothyroid, hyperthyroid and probable thyroiditis subjects in comparison to 4.79, 4.16 and 4.59 microvolts respectively in controls (p < 0.005).

Assessment of thyroid functions and its role in body growth in thalassemia major.

The present study was done to establish the role of thyroid gland in causing growth retardation in regularly transfused thalassemic children. Growth, skeletal maturation and thyroid functions were assessed in 25 patients of thalassemia major in the age range of 5-17 years (mean age 10.3 +/ 3.6 years). Thirteen patients were migrants from Pakistan and 12 were of Indian origin. Twenty-five age and sex matched children who were not anemic served as controls. Thalassemic children received multiple blood transfusions ranging from 36-350 units with a mean of 168.4 +/ 98.9 (+/ 1 SD). The mean pretransfusion hemoglobin was 8.7 +/ 1.6 g/dl. Twenty eight per cent patients were below the 5th percentile for height and another 24% between 5th and 10th percentiles. The height age retardation was more pronounced than bone age retardation. The mean serum total T3 and T4 levels were significantly lower (p < 0.001) and the mean serum TSH levels were significantly higher (p < 0.005) in patients with thalassemia major as compared to the controls. Eight patients had high TSH levels; of these 5 had compensated primary subclinical hypothyroidism (elevated TSH with normal T3 and T4) and 3 had uncompensated primary sub-clinical hypothyroidism (elevated TSH, low T4 and normal T3). Two patients had low T4 with normal T3 and TSH levels. Thyroid dysfunction was not related to age, sex, hemoglobin levels and country of origin but transfused iron load (units/kg, units/year) was significantly higher in patients with hypothyroid function compared to those with euthyroid function (p < 0.005). Height age, weight age and bone age retardations were more pronounced in patients with hypothyroid function; however, the difference was not statistically significant. It is concluded that hypothyroidism is unlikely to be the sole cause of growth retardation; however, it may have a potentiating or permissive role. The strong association of high transfused iron load and decreased thyroid function stresses the need for intensive chelation therapy.

Evaluation of thyroid functions in critically ill infants.

The degree to which thyroid functions are affected by non-thyroid illness and an assessment of its correlation with mortality was evaluated. Thirty infants (20 M, 10 F) with a mean age of 433 +/- 3.28 months (+/- 1 SD), with severe acute systemic illness and 30 healthy controls, age and sex matched, were studied for total serum T3, T4 and TSH levels at admission and recovery or before death. Serum thyroid hormones were measured using standard techniques. There was no significant change in thyroid indices with age, sex, nutritional status, serum protein and C-reactive protein. Serum T3 levels in infants were significantly lower (0.62 +/- 0.63 ng/ml) than the controls (1.90 +/- 0.62) (p < 0.001), with normal T4 and TSH levels at admission. Both serum T3 and T4 levels increased with recovery. Out of 30 infants studied, 14 died whereas 16 were discharged. It was noticed that T3 and T4 values were significantly reduced at or near death when compared with the admission levels (p < 0.001). Prognosis could not be determined at the time of admission, as thyroid indices at admission of patients who died, when compared to infants who were discharged, showed no significant difference in T3, T4 or TSH levels. The above mentioned changes in thyroid indices probably occur as a temporary adaptive mechanism to limit catabolism in states of stress such as infection. Hence, it is suggested that thyroid function tests be interpreted with caution in patients with non-thyroid illness.

Ankle reflex photomotogram in thyroid dysfunctions.

The tap to half relaxation time of tendon achilles reflex was measured in thirty control subjects, forty-five thyrotoxic and sixty hypothyroid patients. The half relaxation time in the control males and females was 279.33 +/- 76.39 msec and 320.00 +/- 52.37 msec. respectively. In thyrotoxic males and females the half relaxation time was 256.67 +/- 31.62 msec (P less than 0.01) and 252.50 +/- 47.68 msec (P less than 0.01) respectively. Amongst the hypothyroid male and female patients the half relaxation time was 405.0 +/- 35.56 msec (P less than 0.01) and 422.5 +/- 115.36 (P less than 0.01) respectively. As all these values were statistically significant, we consider the photomotographic measurement of ankle reflex as an important aid to the diagnosis of thyroid hormone imbalances.