ABSTRACT
Objective Information available on acid–base imbalance in ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous intervention is limited and no data were present on intracoronary blood analysis, extracted from obstructed artery. Methods This was a prospective study conducted over 12 months in which STEMI patients presenting in emergency and undergoing primary percutaneous coronary intervention were included. Blood gas analysis of intracoronary arterial blood from obstructed vessel and peripheral arterial blood was performed. Patients in whom adequate intracoronary sample could not be obtained were excluded. Intracoronary and peripheral arterial blood gas measurements were correlated and relationship of intracoronary parameters were compared with clinical parameters, investigational markers and short-term outcome. Results The mean age of study population was 54.8 years and average symptom onset to door time was 162 min. On comparing intracoronary blood with peripheral blood arterial obtained, pH (95% confidence interval [CI] −0.01 to 0.02;p = 0.44), lactate (95% CI 0.03–0.1;p = 0.28), bicarbonate (95% CI 0.6–1.5;p = 0.64), pCO2 (95% CI 1.1–2.4;p = 0.79) and pO2 (95% CI 3.2–47.5; p = 0.06) were all found to be statistically insignificant. Intracoronary hyperlactatemia was present in patients presenting with higher symptom onset to door time (p = 0.025). Systolic blood pressure (SBP) (p = 0.03) was also significantly lower in patients who had high intracoronary lactate levels. Conclusion The evaluation of intracoronary blood provides no additional information regarding the prognosis and short-term (30-day) outcome of the patients when compared with peripheral blood. However, there was a significant intracoronary hyperlactatemia in patients presenting late after symptom onset. SBP was also significantly less in patients with high intracoronary lactate, which signifies that predominant cause of hyperlactatemia was systemic hypoperfusion rather than local increase in lactate levels.
ABSTRACT
Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by the entire group of submitting authors. We expect these recommendations to be utilitarian in improving STEMI care in developing countries.
ABSTRACT
PURPOSE: A porous polyethylene channel implant(PPCI) has internal channels that accept mini- or microplates, using fixation to bone in the large, complex orbital fractures. We assessed the effects of this implants in orbital fracture repairs. METHODS: We assessed the effects of PPCIs in 15 orbital fracture patients of minimal 3 months follow-up. RESULTS: Among 15 cases, 9 were men and 6 were women. Average age was 35.7 years. Average followup period was 8.1 months. The surgery was performed less than two weeks after injury in 5 patients and more than two weeks after injury(delayed) in 10 patients. Among these, 13 cases had combined medial and inferior wall fractures, 2 cases had large, posterior inferior wall fractures. Excellent results were obtained in all 13 patients with ocular motility disturbance and diplopia. The mean correction of enophthalmos was 3.1mm. We obtained marked improvement of inferior and medial dystopia in 9 cases. There were no cases of visual loss, implant infection, migration, or exposure. CONCLUSIONS: A PPCI has malleability that permits easy shaping and contouring, and semirigid structures provide structural stability. PPCIs are suited for reconstruction of large fractures(greater than 50%) or posterior fractures which cannot secure fixation without significant complications.