Correlation of lipoprotein (a) levels and plaque morphology in very young acute coronary syndrome patients using optical coherence tomography

Introduction: Levels of lipoprotein (LP) (a) are useful marker for risk stratification of cardiovascular disease. This genetic biomarker is suggestive of patient predisposition to acute coronary event. The present study was to study correlation of LP(a) levels and plaque morphology in very young patients (<35 years) with acute coronary syndrome (ACS). Methods: A prospective, single-center, observational study consisting of very young patients with ACS and fit for optical coherence tomography (OCT) guided invasive coronary angiography was conducted at tertiary-care centre. LP(a) levels were compared between healthy controls and very young ACS patients. Correlation of LP(a) levels and plaque characteristics in very young ACS patients was done using OCT imaging. Results: Out of enrolled 80 subjects, 40 were very young ACS and 40 were matched healthy controls. In very young patients, plaque rupture and erosion were mechanism of ACS in 67.5% and 32.5% patients, respectively. Mean levels of LP(a) were 28.10 ± 13.96 nmol/l in healthy controls and 47.19 ± 29.85 nmol/l in very young patients with ACS (p ¼ 0.022). Among very young ACS patients, patients with LP(a) levels<75 nmol/l and 75 nmol/l had mean thin cap fibroatheroma thickness of 117.08 ± 52.542 mm and 95.00 ± 36.286 mm, respectively (p ¼ 0.2355). Conclusion: Higher levels of LP(a) were seen in younger patients with ACS compared with matched healthy individuals. Plaque rupture was the commonest mechanism of ACS in very young ACS patients. Patients with high LP(a) levels had lesser thickness of fibrous cap in OCT imaging compared with low levels of LP(a).

Study of Thyroid Functions in critically ill Patients admitted in Medical Intensive Care Unit and its Correlation with Critical Care Scoring Acute Physiology and Chronic Health Evaluation III

Background: Thyroid hormones have a crucial role in adapting the metabolic functions during stress and critical illness. Patients who are critically ill may have profound changes in thyroid hormone metabolism. Non-thyroidal Illness Syndrome (NTIS) is one among them, in which there is marked abnormality seen in the thyroid hormone levels. Hence this study is to understand the alterations of the thyroid function tests (TFTs) encountered in critically ill patients admitted in medical intensive care unit (MICU) without primary thyroid disease and to correlate with the severity of Acute Physiology and Chronic Health Evaluation (APACHE III) scoring. Methods: The study was conducted on 100 critically ill patients with no previous thyroid disorders, admitted in MICU in the Department of General Medicine in a tertiary care hospital between September 2017 and August 2019 who fulfilled the inclusion and exclusion criteria. Results: Out of 100 critically ill patients the abnormal thyroid function prevalence was seen in 78% patients. The most common abnormality seen in our study was low total triiodothyronine (TT3) (61%) followed by low free triiodothyronine (FT3) (36%), low total thyroxine (TT4) (29%), high thyroid-stimulating hormone (TSH) (18%), and low free thyroxine (FT4) (12%). Low TT3, TT4, and FT3 values had a significant correlation with increasing critical severity score of APACHE III with a p value which was statistically significant (p < 0.05). Conclusions: With increase in severity of critical illness assessed by APACHE III, TFT, that is, TT3, TT4, and FT3 levels were decreasing, suggestive of increasing non-thyroidal illness in critically ill patients.

Evaluation of only heparin-based rota-flush solution against alternative rota-flush solution in patients with severe coronary artery calcification undergoing rotational atherectomy

Objective: There is limited evidence on feasibility and safety of only heparin rota-flush(OHRF)solution in rotational atherectomy (RA). We compared the safety and efficacy of OHRF solution with alternative rotaflush (ARF) solution in patients who underwent RA. Methods: A total of 48 patients who underwent RA were enrolled in the study. In 25 patients OHRF solution and in 23 patients ARF solution was utilized. The study end points were procedural success rateandrota-related adverse cardiovascular event (RRAE) including slow flow, no reflow, bradycardia, and hemodynamic instability. Results: Procedural success was achieved in all patients in both the OHRF and ARF groups. There was no statistically significant difference in RRAE between the two groups(32.0% vs. 34.7%, p ¼ 0.83). Conclusion: OHRF solution appears a more simplistic solution while performing rotablation as compared to ARF solution. Side effects such as hypotension and bradycardia can be circumvented with OHRF solution during rotablation

Cardiac Output Assessment by Transthoracic Electrical Bio-impedance in Patients of Acute Myocardial Infarction: Comparative Analysis with Echocardiography.

Objectives: Transthoracic electrical bio-impedance (TEB) has been proposed as a non-invasive and continuous method of cardiac output (CO) measurement, but it still has not found wide usages in clinics. The present study measured CO, using a new instrument NICOMON, and compared it with Echocardiography (ECHO) in acute myocardial infarction (AMI) patients. Methods: In the present study 100 patients of AMI were assessed by both ECHO and NICOMON for cardiac output and ECHO is considered as a reference method for comparison. TEB CO was measured by passing an alternating current and measuring the bio-impedance across the thorax. End diastolic volume (EDV), End systolic volume (ESV) & Left ventricular outflow tract (LVOT) diameter, measured by ECHO were used to calculate CO. Various statistical methods like “t”-test & correlation coefficient (r) were used where found suitable. Results: Mean TEB-CO (4.03±1.11 l/min) was significantly higher (p<0.001) than mean ECHO-CO (3.80±1.28 l/min) with a mean difference of 0.25±1.02 l/min. Conclusions: NICOMON measures CO non-invasively but, it needs more elaborative studies on a larger sample to establish it as an alternative method of ECHO for cardiac output measurement on regular basis.

Delusional Parasitosis.

A patient with delusional parasitosis, who responded to amisulpride is described.