Lipoprotein [a] levels in relation to severity of coronary artery disease in north Indian patients

Lipoprotein [a] [Lp [a]] is an established risk marker of coronary artery disease which is independent from other risk factors. The aim was to address the association between Lp [a] and CAD risk in North Indians. To evaluate whether high levels of lipoprotein [a] [Lp [a]] is a predictor of risk and is related to the severity of CAD. This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein [a] level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Lipoprotein [a] 21.0 mg/dL is associated with the presence of coronary lesions [P = 0.0001]. A highly significant difference in Lp [a] levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease [P < 0.0001]. Body mass index [BMI] was significantly raised in CAD group compared to normal coronary. Multivariate analysis found that Lp [a] was considered an independent predictor for severity of CAD and Lp [a] levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis

Lipoprotein[a] and SYNTAX score association with severity of coronary artery atherosclerosis in North India

This cross-sectional study investigated the association of lipoprotein[a] [Lp[a]] levels as an atherosclerosis predictor and their relationship to the severity of coronary artery disease [CAD]. 360 consecutive patients at Sanjay Gandhi Postgraduate Institute of Medical Sciences and King George's Medical University hospitals, Lucknow, North India, with chest pains, CAD symptoms and on lipid-lowering therapy were enrolled between June 2009 and October 2011. Before coronary artery angiography [CAG], a fasting blood sample was assessed for lipid and Lp[a] levels. The synergy between percutaneous coronary intervention with taxus and cardiac surgery [SYNTAX] score was calculated according to the CAG results. Patients were divided into 3 groups based on CAD severity and SYNTAX scores. Angiography revealed CAD in 270 patients. Lp[a] levels were higher in CAD compared to non-CAD patients [48.7 +/- 23.8 mg/dl versus 18.9 +/- 11.1 mg/dl [P <0.0001]]. The levels of Lp[a] were lower in single than in double and triple vessels [39.3 +/- 18.4 mg/dl versus 58.0 +/- 23.0 mg/dl, and 69.2 +/- 24.1 mg/dl, [P <0.05]]. Lp[a] levels were significantly higher in severe CAD with SYNTAX score >30 [88.0 +/- 24.0 mg/dl]. Lp[a] levels correlated significantly with SYNTAX scores [r = 0.70, P <0.0001]. In this study, Lp[a] levels were positively associated with a patient's SYNTAX score in diseased vessels. Furthermore, an elevated Lp[a] level was a causal, independent risk factor of CAD. Lowering Lp[a] levels would reduce CAD in primary and secondary prevention settings. There is an urgent need to define more precisely which patients to treat and which to target for earlier interventions

Management of facial gunshot wounds

To determine pattern and presentation in terms of site of injury, airway, associated injuries; and management of facial gunshot wounds. Case series. Oral Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, between January 2001 and December 2008. All patients with gunshot wounds of the face managed at the Oral Surgery Department during the study period were included by convenient sampling method. Patients were treated by a multidisciplinary team of maxillofacial surgeon, otorhinolaryngologist and plastic surgeon. Descriptive statistics were used to determine frequencies and mean+SD for qualitative and quantitative variables respectively. A total of 38 patients with gunshot wounds to the face were identified. Age ranged from 15 to 42 years with mean of 28+4.98 years. There were 32 [84%] males and 06 [16%] females. Twenty two [57%] patients required airway management. The most frequent site involved was mandible in 25 [65%] patients while midface was involved in 13 [35%] patients. Open reduction and internal fixation [ORIF] was performed in 17 [44%] patients, while 21 [56%] patients were managed conservatively. Out of 38 patients, 15 [39%] patients had some complications; trismus, sinusitis and infection being the most frequent [10.5% each]. Facial gunshot wounds frequently involve mandible with more likely requirement of establishment of emergency airway and open reduction and internal fixation [ORIF]. Early management of gunshot wounds results in better psychosocial profile, aesthetics, reduced hospital stay and early return to function