Metabolic risk factors in first acute coronary syndrome (MERIFACS) Study

Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective caseecontrol observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n ¼ 2153) were compared with matched controls (n ¼ 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p ¼ 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p ¼ 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p ¼ 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF

Zika virus modulates blood-brain barrier of brain microvascular endothelial cells

@#Zika virus (ZIKV) is a mosquito-borne Flaviviruses. ZIKV is known to cause birth defect in pregnant women, especially microcephaly in the fetus. Hence, more study is required to understand the infection of Zika virus towards human brain microvascular endothelial cells (MECs). In this study, brain MECs were infected with ZIKV at MOI of 1 and 5 in vitro. The changes in barrier function and membrane permeability of ZIKV-infected brain MECs were determined using electric cell-substrate impedance sensing (ECIS) system followed by gene expression of ZIKV-infected brain MECs at 24 hours post infection using one-color gene expression microarray. The ECIS results demonstrated that ZIKV infection enhances vascular leakage by increasing cell membrane permeability via alteration of brain MECs barrier function. This was further supported by high expression of proinflammatory cytokine genes (lnc-IL6-2, TNFAIP1 and TNFAIP6), adhesion molecules (CERCAM and ESAM) and growth factor (FIGF). Overall, findings of this study revealed that ZIKV infection could alter the barrier function of brain MECs by altering adhesion molecules and inflammatory response.

A Prospective Study On Cvt In Young Males

Background :Cerebral venous thrombosis (CVT) is one of the common causes of stroke in young people. CVT is a disease with potentially serious consequences and usually affecting young to middle-aged people. Strokes in the young account for nearly 30% of all cases of stroke in India and cerebral venous thrombosis (CVT) accounts for 10-20% of these cases Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term squelae. CVT can be caused by a number of prothrombotic states and disorders of clotting system such as inherited causes like Protein C resistance secondary to Factor V Leiden polymorphism, Protein C and S resistance, and antithrombin III deficiency. Many other etiological factors like drugs ,infections,etc. Aim: To analyse the clinical profile and the outcome of young males with CVT. Methodology: This prospective study was carried out over a period of one year in the Neurology department in whom the diagnosis were confirmed by magnetic resonance imaging (MRI), MRV venogram , plain/contrast CT were included in the study. A total of 42 patients were enrolled for the study in the period of one year. The patients demographic details including the diabetic and hypertensive status along with their family history was obtained by using a detailed questionnaire. Results: Majority of them were between the age group of 18 - 35 years. Headache was found to be the most common symptom followed by nausea vomiting and seizures. Majority of the patients with CVThad a history of alcoholism in this study. In our study exactly 33% were unknown factors, 32% Alcohol, 28% Dehydration, 7% infections. Conclusion: . Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term sequelae

Angiographic Aspects of Myocardial Bridges.

Introduction: The segment of epicardial coronary artery that traverses intramurally through the myocardium and bridged by a bunch of cardiac muscle fibers is called tunneled artery or intramural artery. The band of cardiac muscle fibers passing over the tunneled artery segment is named as myocardial bridge. During angiography milking effect is observed during systole due to the external pressure of muscle fibers on the tunneled artery that leads to narrowing of vessel lumen and further ischemia. Materials & Methods: It is a prospective study performed from 2012- 2015 in cardiac centers available around Tirupati, Andhra Pradesh, South India. A total number of 2015 adult patients who underwent diagnostic coronary angiography were evaluated to detect myocardial bridges. With the informed consent the relevant data was collected from the patients and analyzed. Results: The prevalence of myocardial bridges was 3.17%. Among the 2015 patients 70.7% are males and 29.2% are females. Among 64 myocardial bridge positive cases 62.5% were male and 37.5% were female patients. Regarding coronary dominance 84% were right dominant and 14.4% were left dominant and 1.6% are balanced. The percentage incidence of myocardial bridging according to dominance was 3.01% for right dominant patients, 4.12% for left dominant patients and 3.1% for balanced dominant patients. In all the myocardial bridge positive cases they were located on the left anterior descending artery (LAD). According to diagnosis the patients with normal coronaries were 22.6%, patients with MILD CAD were 17.9%, patients with single vessel disease were 23.4%, patients with two vessel disease were 14.7% and the patients with triple vessel disease were 21.3%. The 64 myocardial bridging cases were grouped in to three groups according to their age. Incidence of double bridges was observed in 3 cases of which 66.7% males & 33.3% in females. Conclusion: These results shows that Andhra Pradesh population are with high angiographic incidence of myocardial bridges (MB’s), when compared with other population in India. We observed more lengthy bridges which may cause luminal reduction of coronary vessel and myocardial ischemia (MI), we also observed higher incidence of MB’s in male patients but systolic luminal reduction is more in female patients then in males. These observations suggest that the risk of MI will be more for the female patients with MB’s.

Plasma chitotriosidase activity in children with lysosomal storage disorders.

Chitotriosidase (ChT) is an enzyme that is selectively activated in tissue macrophage. This property of ChT makes it a potential marker for many disease process and prognostication. Present study has been carried out to know the significance of ChT as a screening marker in lysosomal storage disorders (LSDs) where tissue macrophage activation is commonly observed due to accumulation of substrate in various organs of the body. Study comprises of 20 healthy children in the age range of 10 days to 5 yrs and 56 children in the age range of 2.5 months to 13 yrs with regression of milestones, skeletal dysplasia, neuroregression and hepatosplenomegaly were selected for plasma ChT who had confirmed LSDs as carried out by specific lysosomal enzyme study from the leukocytes or fibroblasts. Plasma ChT was 55.21 ± 20.81 nmol/ml /hr in twenty healthy age matched controls. Plamsa ChT level was 42.88 to 79.78 nmol/ml/hr in thirteen of 56 (23.21%) children with LSDs like Morquio- B, Pompe, Metachromatic leucodystrophy (MLD), Sandhoff and Niemann-Pick disease type C (NPD-C). While in 43 (76.78%) children it was in the range of 213.74 to 23,511.40 nmol/ml/hr. who had LSDs like Morquio-B, Sly syndrome, MLD, GM2 Gangliosidosis, NPD-A/B and Gaucher disease (GD). Marked elevated ChT (4,000 to 23,511 nmol/ml/hr) was observed in all cases of GD (n=7) and NDP-A/B. It can be concluded from the present study that moderately raised activity of ChT can be utilized as a positive predictive test for certain LSD’s. Those with marked elevated ChT have confirmed GD or NPD-A/B making it a strong screening marker for this group of diseases.

Antimicrobial stewardship in institutions and office practices.

Medically inappropriate, ineffective and economically inefficient use of antimicrobials is commonly observed in the health care units throughout the world especially in the developing countries. Antimicrobial stewardship programs attempt to balance the demand for these life-saving drugs with the need to preserve their future efficacy. A comprehensive evidence-based stewardship program should include elements chosen from the recommendations based on local antimicrobials use and resistance problems and on available resources that may differ, depending on the size of the institution or clinical setting. For success of antibiotic stewardship it is essential to increase awareness amongst medical professionals. Discipline in antimicrobial prescribing is most vital in clinical settings. A careful assessment of the benefits of prescribing against the risk of non-prescribing of antibiotics should be considered. It should be an endeavor of every physician to justify antibiotic prescription in case of empirical use. Integration of advanced information technology into antimicrobial stewardship programs holds the potential to both reduce antimicrobial overuse and improve outcomes.

Modifiable risk factors for acute lower respiratory tract infections.

OBJECTIVE: Acute respiratory infection is a leading cause of morbidity and mortality in under five children in developing countries. Hence, the present study was undertaken to identify various modifiable risk factors for acute lower respiratory tract infections (ALRI) in children aged 1 mth to 5 yr. METHODS: 104 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 1 mth to 5 yr were interrogated for potential modifiable risk factors as per a predesigned proforma. 104 healthy control children in the same age group were also interrogated. RESULTS: The significant sociodemographic risk factors were parental illiteracy, low socioeconomic status, overcrowding and partial immunization, [p value < 0.05 in all]. Significant nutritional risk factors were administration of prelacteal feeds, early weaning, anemia, rickets and malnutrition, [p value < 0.05 in all]. Significant environmental risk factors were use of kerosene lamps, biomass fuel pollution and lack of ventilation [p value < 0.05 in all]. On logistic regression analysis, partial immunization, overcrowding and malnutrition were found to be significant risk factors. CONCLUSION: The present study has identified various socio-demographic, nutritional and environmental modifiable risk factors for ALRI which can be tackled by effective education of the community and appropriate initiatives taken by the government.

Transfusion related acute lung injury

TRALI [Transfusion related acute lung injury] is a devastating complication of Blood transfusions or its components irrespective of the blood grouping and cross match, We report a case of a Philipino house wife who had blood transfusion for her vaginal lacerations and developed acute pulmonary edema immediately afterwards. Antigranulocyte antibodies were not found in the donors. The patient recovered after supportive treatment. TRALI is not an uncommon complication of Blood transfusion that is under-reported and under-diagnosed

Pertussis vaccine controversies and acellular pertussis vaccine.

Pertussis still continues to cause significant morbidity and mortality worldwide. Because of the high reactogenicity of whole cell pertussis vaccine, it had evoked public controversy in several countries. In 1970 Japan abandoned use of whole cell pertussis vaccine and mounted efforts to develop better vaccine. To date, nearly 24 acellular pertussis vaccines have been developed, using different number and quantity of components. No acellular vaccine is most or least immunogenic with respect to all included antigens. Vaccine efficacy and duration of immunity is comparable with whole cell pertussis vaccine. The adverse events are two thirds less compared to whole cell vaccine.

Thoracoscopy in management of empyema thoracis in children.

The usual treatment for empyema in children varies from a simple thoracocentesis to thoracotomy and open decortication. We studied the role of thoracoscopy in the management of empyema thoracis in 10 immunocompetent children after failure of medical management. All children recovered well with an early removal of intercostal tube and reduced postoperative hospital stay and showed complete resolution of empyema on follow up. Thoracoscopy has come as a new ray of hope for the patients with empyema, with the advantages of complete evacuation, minimal pulmonary dysfunction, reduced pain and hospital stay.

Immunotherapeutic modification by an ayurvedic formulation Septilin.

Effect of Septilin, an ayurvedic formulation proven to be effective in the therapy of chronic infections, was investigated on the phagocytic system and humoral response in rats and mice. Septilin exhibited significant protection in E. coli-induced abdominal sepsis in normal mice and in Staphylococcus aureus-induced sepsis in neutropenic mice. It significantly reduced the viable E. coli cells when incubated with neutrophils in rats. Septilin stimulated the phagocytic function of the reticuloendothelial system in mice. In normal rats, Septilin enhanced anti-SRBC hemagglutination antibody titre by 5.7-fold and showed significant protection in cyclophosphamide-induced humoral suppression.