ABSTRACT
Context: Left ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off‑pump coronary artery bypass grafting (OPCABG) surgery. Aims: The aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al. in patients undergoing OPCABG. Settings and Design: The study was conducted in a tertiary care level hospital; this was a prospective, observational study. Subjects and Methods: Fifty consecutive patients undergoing OPCABG were enrolled. Hemodynamic and echocardiographic parameters were measured at 6 stages in every patient namely after anesthetic induction (baseline), during left internal mammary artery (LIMA) to left anterior descending (LAD) grafting (LIMA LAD), saphenous vein graft (SVG) to obtuse marginal (OM) grafting (SVG OM), SVG to posterior descending artery (PDA) grafting (SVG PDA), during proximal anastomosis of SVG to aorta, and postprotamine. The patients were classified in grades of LVDD as per simplified algorithm proposed by Swaminathan et al. using only intraoperatively measured E and E’. Results: The success rate of measurement and classification of LVDD was 98.92% (277 out of 280 measurements). The grades of LVDD varied significantly as per surgical steps with maximum downgrading occurring during OM and LAD grafting. During OM grafting, none of the patients had normal diastolic function while 29% of patients exhibited restrictive pattern (Grade 3 LVDD). Patients with normal baseline LV diastolic function also exhibited downgrading during OM and LAD grafting. Postprotamine, 37% of patients with normal baseline diastolic function continued to exhibit some degree of DD. Conclusions: The LVDD changes dynamically during various stages of OPCABG, which can be successfully monitored with simplified algorithm.
ABSTRACT
Background: Breast cancer, second commonest malignancy in women is a multifactorial disease. Key role of chronic low grade inflammation has been linked with pathophysiology of breast cancer. High sensitivity C-Reactive Protein (hsCRP) is an acute phase reactant proinflammatory protein synthesized in hepatocytes. Present case control study was aimed with primary objective of estimation of serum hsCRP levels in newly diagnosed breast cancer patients and to correlate them with the staging of the disease. Methods: We enrolled 60 newly histologically diagnosed cases of breast cancer and 60 healthy age matched controls. Demographic features, anthropometric measures were recorded. After overnight fast, blood samples were collected and analyzed for serum hsCRP levels. Results: We observed significant differences between cases and controls in anthropometric parameters BMI and waist: hip (P <0.05) and hsCRP levels (P <0.001). Depending of the stage, serum hsCRP levels were associated with advanced stage. In stage I, association of hsCRP was not significant with disease while in stage II and III there was significant association. In stage IV patients with distant metastasis, serum hsCRP values were highly significantly raised compared to stage II and III. This suggests significant association of state of inflammation with stage of breast cancer. Conclusion: Inflammatory component plays key role in all stages of tumourigenesis from initiation of the tumor, infiltration, local and systemic invasion. Estimation of hsCRP may be simple, inexpensive and useful tool for risk assessment, screening of high risk individuals and to predict outcome in diagnosed cases.