Importance of carotid intimal medial thickness measurement in patients with coronary artery disease

Background: Prevalence of CAD in urban India is about double that of rural India and about 4-fold higher than in United States. Mortality related to CAD is high in Indian Population. Early diagnosis can prevent the CAD related morbidity and mortality. Aims and objectives is to study and compare the CIMT among the patients with CAD and asymptomatic control group.Methods: Hundred patients with CAD were studied for the CIMT and compared with age and sex matched asymptomatic control subjects in Department of Medicine of G. R. Medical College, Gwalior for one year from 2012 to 2013. Details on history, risk factors and presenting symptoms were recorded for all. High resolution B mode ultrasonography was performed to assess CIMT of carotid arteries.Results: CAD was more prevalent among males (78%) having mean age of 56.82±8.91 years. Majority of CAD patients had dyslipidemia (42%) followed by hypertension (21%), diabetes (13%) and smoking (17%). Majority of the CAD patients had chest pain (98%) followed by breathlessness (54%) and sweating (12%) as the most common presenting symptom. Mean CIMT was significantly more among the CAD patients (0.76±0.34) as compared to those without it (0.63±0.22) (p<0.001).Conclusions: CIMT was found to be more in CAD as compared to asymptomatic control subjects. CIMT can be an important tool for assessing CAD and atherosclerosis.

Carotid Intimal Medial Thickness (CIMT) in Patients of Chronic Kidney Disease (CKD) and its Association with CKD Staging

Introduction: Association between Chronic kidney disease(CKD) and increased risk of cardiovascular disease (CVD)is well established. Relationships of carotid intima-mediathickness (CIMT) as a measure of subclinical atherosclerosisin CKD patients is a matter of debate. Current research aimedto study the role of CIMT in CKD patients and its associationwith the CKD staging.Material and Methods: Hundred CKD patients werestudied and compared with 50 subjects without CKD in theDepartment of Medicine, G.R. Medical College & J.A. Groupof Hospitals, Gwalior (M.P.) India. GFR was determined byMDRD (Modification of diet in renal study) equation. Studypopulations were subjected for high resolution B - modeCarotid ultrasonography.Results: In case group, majority were males (68%) havingage between 30-60 years (62%). Majority had stage V CKD(67%), 21% had stage III and 14% had stage IV CKD.Majority of the cases had CIMT between 0.9-1.0 mm (42%)followed by 0.7-0.8 mm (17%) as compared to 0.5-0.6 mm(42%) in control. Mean CIMT was significantly higher incases (0.87±0.24) as compared to control (0.61±0.34) group(p<0.001). No significant difference in mean CIMT was foundbetween different stages of CKD (p=0.649).Conclusion: CKD patients have significantly more carotidarterial wall thickness in comparison to age matched controls.The CIMT does not differ in different stages of CKD.

Study of risk factors and its correlation with constraint induced movement therapy for atherosclerosis in patients of coronary artery disease and their offspring

Background: A significant percent of cardiovascular event occurs without well-known modifiable risk. A new tool for early identification for atherosclerosis is required for early intervention. Aims and objectives of the study was to study the risk factors for CAD and its correlation with CIMT.Methods: One hundred and forty subjects were studied for the risk factors of CAD in Department of Medicine of G.R. Medical College, Gwalior from 2012 to 2013. Out of 140 subjects, 100 were patients having CAD and 40 age matched subjects were included as control group. Data was also recorded from their offspring. High resolution B mode ultrasonography was performed to assess CIMT of carotid arteries. The maximum CIMT of any one side of carotid artery was taken for study.Results: CAD was more prevalent among males (78%). Majority of the offspring of cases had age between 28-42 years and majority were male (73%). Most common risk factors for CAD was dyslipidemia (48%), hypertension (24%), diabetes (12%) and smoking (21%), whereas in offspring’s of CAD patients, dyslipidemia was seen in 28%, hypertension in 3%, diabetes and tobacco smoking in 12% and 24% respectively. The CIMT of CAD patients was significantly increased with increasing the number of risk factors and the same pattern was also seen in controls. The CIMT of asymptomatic offspring’s having positive family history was significantly more than the asymptomatic offspring without positive family history of CAD.Conclusions: CIMT measurements can be used as a surrogate marker of atherosclerosis as it has showed a direct link with number of risk factors of CAD.

Study Of Carotid Intima Media Thickness In Patients Of Chronic Kidney Disease.

Background: Patients with Chronic Kidney Disease (CKD) are at high risk for developing cardiovascular disease (CVD). Carotid intima media thickness (CIMT) has been found to correlate with coronary artery atherosclerosis. Methodology: This was a prospective study of carotid intima media thickness in patients of CKD, done in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.), India. A total of 70 patients of CKD and 35 age and sex matched controls were enrolled. Bilateral assessment of intima media thickness was done in common carotid artery and higher value of CIMT of any one carotid artery was recorded. Results: Out of total 70 patients of CKD, 42 were males. Clinical findings in CKD patients were anemia (92.5%), edema (71.4%), decreased urine output (41.42%), obesity (12.5%). Proteinuria (>300mg/24 hrs) was seen in 91.4% patients. CIMT in CKD patients was between 0.9-1.0mm whereas in controls was between 0.5-0.6mm. 62.5% of total patients (CIMT 0.91±0.24 to 1.15±0.24) were having mean BP between 90 to 130 mmHg, 12.7% of total patients (CIMT 1.00±0.26) were having mean BP>130 mmHg. CKD patients with dyslipidemia were having mean CIMT 1.08±0.19 in comparison to controls with dyslipidemia having mean CIMT 0.67±0.22. Conclusion: CIMT was increased in CKD patients with increased age, progression of stage of CKD and proteinuria. Mean CIMT was increased in all stages of CKD and there was no significant difference in CIMT in different stages of CKD. Patients having high mean blood pressure was having higher mean CIMT in comparison to patients having lower mean blood pressure, patient with dyslipidemia had high mean CIMT as compared to mean CIMT of controls having dyslipidemia.

Intrarenal Abscess: When to Suspect.

Renal abscess is not so common therefore hardly suspected and often missed. Situation worsens when there is comorbid illness like malaria, which repeatedly tests positive further misleading the clinician leading to prolonged or recurrent fever or abdominal emergencies. When to suspect renal abscess is crucial, hence this report.

Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.

Outcome of sixty four cases of ethylene dibromide ingestion treated in tertiary care hospital.

BACKGROUND AND AIMS: In view of high incidence and mortality due to ethylene dibromide poisoning, a prospective study was planned to assess demographic, toxicological, clinical profile and outcome. MATERIAL AND METHODS: Prospectively collected data of sixty four patients with ethylene dibromide poisoning were reviewed. All the patients were from Gwalior and neighbouring districts. RESULTS: Majority were males in the age group 21-30 years. Out of sixty-four cases 26 patients (40.6%) survived and 38 patients (59.4%) expired. Nausea vomiting and pain abdomen were most common symptoms at presentation. Diarrhoea, drowsiness, palpitations and oliguria were other features. Pulse rate was normal (< 100) in 22 (84.6%) survived patients whereas it was > 100 in 24 (63.1%) of expired patients at the time of admission (p value = 0.0004199). Half ampoule (1.5ml.) of ethylene dibromide was sufficient as fatal dose. Mortality was 20% and 46.15% with half and one ampoule respectively. Best outcome was when the patient presented to the hospital within six hours. Death occurred anywhere between twelve hours and five days. Gastrointestinal toxicity was predominant at presentation. Nausea, vomiting and abdominal pain was present in all the patients. Nephrotoxicity 32 (50%), hepatotoxicity 28 (43.8%), cardiotoxicity 28 (43.8%), central nervous system 8 (12.5%) toxicity and hypoglycemia 24 (37.5%) were also observed. CONCLUSION: Ethylene dibromide is highly toxic. Patients who consumed half to one ampoule usually survived with supportive care provided they presented to the hospital within six hours. Pulse rate more than 100 at presentation was a poor prognostic factor. Patients with normal pulse and blood pressure at admission had better prognosis.