Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.

Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value,alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 Naik N, Patel G, Parmar H. Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis. IAIM, 2016; 3(1): 46-50. Page 47 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.

A comparative study of inguinal hernia repair by Shouldice method vs other methods

"Background:Hernia is one of the most common surgical conditions encountered in day to day practice. It is a common problem, more in industrial workers who are doing strenuous work over a long period of time. Any method which reduces the recurrence rate as well as lowers the morbidity and post-operative complication rate, must however be considered superior. The common aim in treatment of hernia is to restore the anatomical integrity of the disrupted tissue, performing a strong repair and to prevent further recurrences. Material and methods:This review was based on the study of 80 selected cases of uncomplicated inguinal hernias treated in our institution by random sampling. All the patients were investigated pre-operative check-up in out-patient clinic forplanned surgery. All patients were admitted in our hospital and surgery done under anesthesia (spinal, general, local). All patients in our studyreceived pre-operative antibiotic. In operative technique, the difference lies in the repair of the posterior wall. In the present study comparison of inguinal hernia repair by Shouldice versus other three methods modified Bassini’s repair, pre-peritoneal mesh repair and Lichtenstein tension-free repair hadbeen studied with a regular follow up. The selection of the patients for type of anaesthesia was done on the basis of associated cardiac and respiratory diseases. Results:Out of 80 patients,Shouldice repair was done in 20 patients and other three method of repair was also done in 20 patients each. In present study, wound haematoma occurred in three patients, which may be attributed to the extensive dissection. Seven patients developed wound infection, treated by antibiotics and dressing. Three patients developed scrotal oedema, which was treated by scrotal support andanti-inflammatory agents. Two patients developed urinary retention, relieved by Gohel J, Naik N, Parmar H, Solanki B. A comparative study of inguinal hernia repair by Shouldice method vs other methods. IAIM,2016; 3(1):13-17.Page14 analgesics, hot water bag and ambulation. None of them required catheterization. In the present study we encountered two cases of recurrences (2.5%). Conclusion:In S houldice repair,double breasting ensures the strong repair. In this method of repair minimal tension on the suture line, so relaxing incision are not necessary. Deep inguinal ring is narrowed in the lateral aspect of the repair. Recurrence rate is remarkably low.But the repair is difficult to perform and extensive dissection required and it takes longer operative time"

The role of serum magnesium level in type 2 diabetes mellitus.

Background: Diabetes mellitus is one of the most common metabolic disorder and leading cause of death and disability in the world. The incidence of diabetes is increasing globally and in India. Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in patients with type 2 diabetes. Hypomagnesaemia can lead to development of complications in diabetes. Hence there is need for the study to explore the status of magnesium in type 2 diabetes. Objectives: To estimate and compare the serum magnesium levels in type 2 diabetes patients with age/sex matched non diabetic controls. Methods: A case control study was done in randomly chosen 100 type 2 diabetic patients and 100 non diabetic age/sex matched controls. Estimation of serum magnesium was done by enzymatic end point method. Results: 37% of diabetic patients had low serum magnesium levels (Mg2+ level ≤1.5 mg/dL) and 9 % of controls had low serum magnesium levels. The mean serum magnesium levels were 1.96 ± 0.54 mg/dL and 2.375 ± 0.449 mg/dL in diabetics and controls respectively (P value <0.0001 highly significant). Hypomagnesaemia (Mg2+ level ≤1.5 mg/dL) was correlating with retinopathy (P = 0.041 significant). Conclusion: This study demonstrated that low serum Mg2+ status is common in type 2 diabetes mellitus patients when compared to non-diabetic controls. It may be prudent in clinical practice to periodically monitor plasma Mg2+ concentration in diabetic patients. If plasma Mg2+ is low, an intervention to increase dietary intake of magnesium may be beneficial to prevent the complications.

Non-covalent binding analysis of sulfamethoxazole to human serum albumin：Fluorescence spectroscopy, UV-vis, FT-IR, voltammetric and molecular modeling / 药物分析学报

This study was designed to examine the interaction of sulfamethoxazole (SMZ) with human serum albumin(HSA). Spectroscopic analysis of the emission quenching at different temperatures revealed that the quenching mechanism of human serum albumin by SMZ was static mechanism. The binding constant values for the SMZ–HSA system were obtained to be 22,500 L/mol at 288 K, 15,600 L/mol at 298 K, and 8500 L/mol at 308 K. The distance r between donor and acceptor was evaluated according to the theory of F?ster energy transfer. The results of spectroscopic analysis and molecular modeling techniques showed that the conformation of human serum albumin had been changed in the presence of SMZ. The thermodynamic parameters, namely enthalpy change (ΔH0) -36.0 kJ/mol, entropy change (ΔS0) -41.3 J/mol K and free energy change (ΔG0) -23.7 kJ/mol, were calculated by using van’t Hoff equation. The effect of common ions on the binding of SMZ to HSA was tested.

Lactose maldigestion in different age groups of north Indians.

Lactase activity with age has been reported in a wide variety of population globally. However, most of these studies in human have ignored to assess age stratified lactose maldigestion. Therefore, the present study was planned to determine lactose maldigestion in different age groups of north Indians adults. Two hundred apparently healthy north Indians (age rage 10-80 years) were subjected to a 50g lactose hydrogen breath test by standard method using a Model 12 Microlyzer from Quintron, USA. The percentage of lactose maldigestion was calculated for different age groups with an interval of 10 years. The results of this study revealed that the frequency of lactose maldigestion did not differ significantly among the age groups. Thus, this study suggests that lactose maldigestion is not associated with age stratification among north Indians.

Graded balloon atrial septostomy in severe pulmonary hypertension.

BACKGROUND: The prognosis of patients with severe primary pulmonary hypertension is poor. The role of balloon atrial septostomy as a palliative procedure in these patients is not well defined. We retrospectively analyzed our data regarding the safety, clinical outcome and survival benefit of graded balloon atrial septostomy in patients with severe pulmonary hypertension. METHODS AND RESULTS: Eleven patients (7 males), aged 6 to 30 years (mean age 16.2+/-8.9 years), with severe pulmonary artery hypertension (mean pulmonary artery pressure of 76+/-16.9 mmHg) and refractory congestive heart failure and/or recurrent syncope underwent balloon atrial septostomy. Graded balloon dilatation under echocardiographic guidance and arterial oxygen saturation monitoring was done in all the patients. Procedure-related mortality was 18.2%. Significant acute hemodynamic improvement was seen in the survivors (pre-balloon atrial septostomy cardiac index 1.88+/-0.48 L/min/m2; post-balloon atrial septostomy cardiac index 2.18+/-0.37 L/min/m2, p<0.009). Patients were followed up for a mean period of 20.3 months after the procedure (range: 3 months-5 years). There was functional improvement and increased exercise tolerance in all the patients for a mean follow-up period of 14.6 months (NYHA functional class 3.62+/-0.69 to 2+/-0.50). The estimated probability of survival in this cohort at 1 year was only 48%; but 7 of 8 patients (87%) who survived the procedure were alive at 1 year. CONCLUSION: We conclude that balloon atrial septostomy improves clinical status, hemodynamic variables and possibly also improves survival in selected patients with severe pulmonary artery hypertension. It remains a definite palliative option for refractory primary pulmonary hypertension. However, the procedure-related risks are high in very sick patients and, therefore, balloon atrial septostomy may be advocated early in the course of the disease.

Management of cardiomyopathy resulting from incessant supraventricular tachycardia in infants and children.

BACKGROUND: Radiofrequency ablation is considered to be the treatment of choice in patients with ventricular dysfunction related to incessant supraventricular tachycardia. However, reservations regarding its use in infants and children prompted us to try alternative strategies for this group. METHODS AND RESULTS: Eight children (age range: 1 day to 10 years) were diagnosed to have tachycardia-related ventricular dysfunction in the past 6 years. They presented with symptoms of palpitation, dyspnea and/or generalized swelling over the body of 3 months to 2 years'duration. The cardiothoracic ratio at presentation was 64% (52%-70%) and ejection fraction was 22.2% (15%-45%). In 7 patients tachycardia was diagnosed to be ectopic atrial and in 1 it was permanent junctional reciprocating tachycardia. Six of these children were managed with intravenous/oral amiodarone in combination with digoxin (3) and/or propranolol (2). In one child addition of amiodarone to digoxin and propranolol led to polymorphic ventricular tachycardia, and amiodarone was withdrawn. Only one child underwent radiofrequency ablation as the first choice because regular follow-up was not possible due to logistic reasons. Sinus rhythm with normalization of ventricular function was achieved in 6 of the 7 children treated medically. One child continued to have frequent episodes of tachycardia and underwent successful radiofrequency ablation of a high right atrial ectopic focus. Two out of the 6 patients on amiodarone could be managed with only digoxin and propranolol after their ventricular function had returned to normal. A third patient relapsed on stopping amiodarone and underwent successful radiofrequency ablation of a left atrial ectopic tachycardia. CONCLUSIONS: Short-term amiodarone in combination with digoxin/propranolol is a safe and effective treatment strategy for infants/children with tachycardiomyopathy. Control of tachycardia is achieved in the majority, leading to recovery of ventricular function. This approach may avoid unnecessary ablations in children or at least postpone it till the procedure would be safer.

Preimplantation genetic diagnosis of chromosomal abnormalities by multicolour fluorescence in situ hybridisation.

Preimplantation genetic diagnosis (PGD) is an early diagnosis of genetic disorders, prior to the onset of pregnancy. PGD incorporates the latest techniques in assisted reproduction and molecular genetics. Embryos or oocytes are biopsied during culture in vitro and genetic analysis is carried out on the blastomeres or polar bodies. Embryos shown to be free of the genetic disease under investigation are transferred to the uterus. Multicolour fluorescence in situ hybridisation (FISH) is used to diagnose numerical and certain structural abnormalities of chromosomes in the embryo. The common probes used are for chromosomes 13, 18, 21, X and Y. FISH can also be used for PGD of translocations, when one of the parents is a carrier. PGD was carried out recently in 4 cases using multicolour FISH. In one of the embryos, trisomy 18 was detected. Tetraploidy was seen in another embryo. Only chromosomally normal embryos were transferred back to the uterus. Care has to be taken while interpreting FISH signals as the signal may be split, diffused, superimposed or in a different focus.

Aneurysm of the vein of galen in neonates: report of four cases.

In neonates, aneurysm of the vein of Galen often masquerades as cyanotic congenital heart disease. We report 4 cases of neonates presenting with malformation of the vein of Galen at our insititution. An increased awareness of this entity seems warranted.

Aortic valve balloon dilatation in a newborn for critical aortic stenosis diagnosed during fetal life.

A young primigravida was diagnosed to have a fetus with critical aortic stenosis at 30 weeks' gestation. A decision to follow-up the fetus till term was taken as there was no evidence of congestive heart failure. Post-natal retrograde aortic valve balloon dilatation was performed 36 hours after birth. There was marked improvement in left ventricular function and the baby is doing well at 1-year follow-up. The need for accurate assessment of intracardiac anatomy during fetal life in critical aortic stenosis and its impact on therapeutic interventions is highlighted.