Study of risk factors associated with adverse outcome in a severe coronary artery disease (syntax score >22) with different therapeutic strategies

Background: The specific question of whether PCI or surgical treatment offers any advantage over MT in patients with stable angina and multivessel disease remains unanswered. Objective of our research was to study various risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease.Methods: This was prospective observational study carried out in a tertiary care center from July 2014 to July 2016. A total of 98 subjects undergoing different therapeutic strategies were followed up. Risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease (CAD) were studied.Results: There was a significant difference in mean SYNTAX score (P = 0.003), urine micro albumin levels (P=0.006), and body mass index (0.046) between those who had MACE and who did not have MACE.Conclusions: The urine micro albumin >30 mg/l and highest SYNTAX score were significantly associated with MACE at 1 year in subject with severe CAD.

A Rare Presentation of an Unusual Foreign Body: A Case Report.

Foreign bodies within the submandibular gland are found to be a rare phenomenon and when it occurs is most frequently found within the submandibular duct. Here, we present a case of a 33-year-old male who presented with submandibular sialadenitis caused by the foreign body penetrating the submandibular gland.

A study of prescription pattern in the drug therapy of ear, nose, and throat infections at a tertiary care hospital in Mangalore.

Background: Diseases of the ear, nose, and throat (ENT) constitute among the most common causes of hospital visits worldwide and account for most of the antibiotics prescribed and used. They are responsible for significant school and work absenteeism and have generated 94.6 disability-adjusted life years lost worldwide. Due to the high incidence of these diseases and the different varieties of drugs in use, it becomes imperative for us to know the present prescribing patterns, so that appropriate adjustments can be made for the benefit of patients. Methods: Over a period of 1-year, the outpatient department (OPD) records of 608 patients with ENT infections, reporting to the ENT OPD of Justice K S Hegde Charitable Hospital, Deralakatte, Mangalore, were scrutinized and the data collected in a specially designed proforma. Descriptive analysis of the data was done. Results: Of the total 608 prescriptions analyzed, 309 (50.8%) belonged to male patients and 299 (49.2%) belonged to female patients. Highest numbers of patients were in the age group of 16-25 years (29.44%). The most common diseases reported were chronic suppurative otitis media (19.24%), followed by otitis externa (13.49%) and furunculosis (9.87%). Average number of drugs per prescription was found to be 3.0. Oral antibiotics were prescribed to 540 patients (88.81%). Most common antibiotics prescribed were amoxicillin-clavulanate (53%), levofloxacin (17%), and cefixime (14%). Antihistamines were prescribed in 52.47% prescriptions, and nonsteroidal anti-inflammatory drugs were prescribed to 298 patients (49.01%). Conclusion: This study shows that the diseases were treated rationally in accordance with the standard guidelines of therapy.

Pacemaker follow up guidelines for physicians.

Use of pacemakers has become fairly common even in developing country like India. Implantation of appropriate pacemakers, their optimal programming to exploit the various available function and their trouble shooting requires advanced training and should preferably be carried out by specifically trained cardiologists or cardiac electrophysiologists. However internists and general physicians should familiarize themselves with certain basic functions of pacemaker, and must acquire the knowledge needed to follow up the patients with pacemakers. They also should be able to assess the patients and ascertain whether the particular patient needs to be referred to the trained cardiologist for further evaluation or replacement of pacemaker. This article is aimed at providing such information to the noncardiologist physicians.

Late prosthetic valve endocarditis due to Cardiobacterium hominis, an unusual complication.

We report a case of prosthetic valve endocarditis caused by Cardiobacterium hominis in a patient who had undergone atrial septal defect closure and mitral valve replacement of the heart in 1978. He presented with pyrexia of unknown origin and congestive cardiac failure. Investigations revealed infective endocarditis of prosthetic valve in mitral portion. Blood culture samples grew C. hominis. The patient was empirically started on vancomycin and gentamicin intravenously and ceftriaxone was added after isolation of the organism. Though subsequent blood cultures were negative, patient remained in congestive cardiac failure and died due to complications.

Emergency transcatheter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts.

BACKGROUND: Modified Blalock-Taussig shunts are used to palliate a variety of cyanotic heart diseases associated with reduced pulmonary blood flow. Acute shunt thrombosis in patients with shunt-dependent pulmonary blood flow can result in life-threatening hypoxia. We describe our experience of emergency transcatheter recanalization in 5 severely hypoxic children with acute shunt occlusion. METHODS AND RESULTS: Five patients with ages ranging between 5 and 24 months (median 11 months) and weight ranging from 4 to 8 kg (median 5 kg) presented with severe hypoxia, acidosis and hypotension following acute occlusion of modified Blalock-Taussig shunts placed 11 days to 12 months ago. As severe hypoxia (saturation range 3 5%-5 0%), acidosis and a state of shock in all the patients increased the risk for a redo surgical procedure, they were taken up for emergency transcatheter recanalization within 2-6 hours of hospitalization. This was done by positioning a Judkin's right coronary catheter at the mouth of the thrombosed shunt, crossing the shunt with a guidewire and serial dilatations with coronary and/or peripheral angioplasty balloons to the size of the graft. This technique was immediately successful in 4 of the 5 patients, thereby avoiding a repeat palliative operation. In 2 patients with residual stenosis, stents were used to restore luminal patency. One patient with acute stent thrombosis was managed successfully with local delivery of thrombolysis for 36 hours, which resulted in good luminal patency. At follow-up after 6 and 12 months, the shunts in both the stented patients are patent, with an oxygen saturation of 78% and 80%, respectively. In 2 other patients who had undergone plain balloon angioplasty, the shunts remained patent for 11 days (died of bronchopneumonia and septicemia) and 3 months, respectively. The procedure was unsuccessful in one very sick patient in whom the shunt had a tortuous course. CONCLUSIONS: Transcatheter recanalization of an acutely thrombosed Blalock-Taussig shunt is feasible. It can offer satisfactory short-term palliation in selected patients. Stents may play a role in patients with residual narrowing after dilatation. The procedure can be expeditiously accomplished in an emergency situation in a severely hypoxic child and may be a realistic alternative to surgery or thrombolysis.

Anti-idiotype antibodies and circulating immune complexes after immunisation with tetanus-toxoid.

OBJECTIVES: To determine if anti-idiotype antibodies and circulating immune complexes in individuals before and after immunisation with tetanus toxoid play a role in the immune response. DESIGN: A study of individuals who were administered a single dose of tetanus toxoid (TT) and who were unimmunized. SETTING: Out patient departments of a large public hospital in Bombay, India. SUBJECTS: Thirty eight individuals pre-immunisation and forty five individuals post-immunisation with tetanus toxoid, tested at 1, 3, 6, and 12 months. MAIN OUTCOME MEASURE: Development of anti-tetanus anti-idiotype antibodies and circulating immune complexes. RESULTS: Pre-immunisation cases did show presence of anti-tetanus antibodies but in lower titres than post-immunisation up to six months, after which there was a reduction. Specific anti-idiotype antibodies were detected in 19 cases. One and three months after immunisation more cases had high titre antibodies and circulating immune complexes, though after six months, there was a fall in anti-tetanus antibody titres. Circulating immune complexes were seen in those samples having anti-idiotype antibodies. CONCLUSIONS: Though a significant rise in anti-tetanus antibody anti-idiotype antibodies, protective levels in mice and circulating immune complexes are seen after immunisation with TT it lasts for six months. When followed up for a period of one year it is observed that in cases having auto anti-idiotype antibodies, the anti-tetanus antibodies are maintained for a longer period.