Minimizing scattered radiation dose in cardiac catheterization laboratory during interventional procedures using lead free drape – MILD study

Objective: RADPAD is a lead-free sterile drape that reduces scattered radiation during fluoroscopic procedures. We aimed to study the effect of using RADPAD on primary operator (PO) and secondary operator (SO) during coronary angiography (CAG) as well as percutaneous coronary intervention (PCI). Methods: 137 patients undergoing elective CAG and PCIwere randomized in a 1:1 pattern with or without the RADPAD. The ratio of PO received dose in mrem to total Air Kerma (AK) in mGy, Dose Area Product (DAP) in mGycm2 and Cine Adjusted Screening Time (CAST) in minute, at the end of the procedure with or without RADPAD were measured and designated as dose relative to AK, DAP and CAST. The exposure ratios were compared for both cohorts. Results: There was no significant difference in CAST, DAP and AK between the two patient cohorts. PO radiation dose relative to CAST was 0.15 ± 0.18 mrem/min for RADPAD cohort and 0.43 ± 0.31 mrem/min for No RADPAD cohort (p < 0.00001). PO dose relative to DAP was 0.00042 ± 0.00049 mrem/mGycm2 for RADPAD cohort and 0.0011 ± 0.0013 mrem/mGycm2 for No RADPAD cohort (p ¼ 0.000014). PO dose relative to AK was 0.0030 ± 0.0037 mrem/mGy for RADPAD cohort and 0.0071 ± 0.0049 mrem/mGy for No RADPAD cohort (p < 0.00001). All PO doses relative to CAST, DAP and AK were significantly reduced in the RADPAD cohort compared to the No RADPAD cohort. Similar findings were observed for the SO also. Conclusion: RADPAD significantly reduces radiation exposure to both PO and SO during CAG and PCI. © 2022 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Cardiological Society of India

Coronary Artery Disease in Young Indians: A Different Entity

Objective: To study the angiographic profile, treatment andoutcome of Coronary Artery Disease (CAD) in young (< 45years) individuals in India.Methods: Consecutive 132 young adults with CAD reporting totwo tertiary care centres over a period of 1 ½ years wereenrolled as a case control observational study. Subjects whopresented with acute coronary syndrome (ACS), chronic stableangina (CSA), Heart failure or AsymptomaticElectrocardiogram (ECG) abnormalities but confirmed CAD onCoronary Angiogram (CAG) were included. Angiographicprofile, treatment and outcome were analysed with a follow upof one year.Results: Risk factors of abdominal obesity, lipoprotein (a)[Lp(a)] and tobacco consumption were significantly higher instudy group. ST elevation Myocardial Infarction (STEMI) wasthe commonest presentation (71.21%). Single vessel disease(56.06 %) was the commonest angiographic profile with LeftAnterior Descending Artery (LAD) involvement (40.91%).Primary Angioplasty in Myocardial Infarction (PAMI) was donein 42.5% of STEMI and Thrombolysis in 48.9%. Three types ofcoronary involvement were noticed with Type I having discretelesions/thrombus and Type III having multiple segment/arteryinvolvement with differing risk factor profile and outcome.Diffuse and more severe CAD was associated with tobaccouse, abdominal obesity and elevated Lp (a). Late presentation,diffuse disease and persistence of smoking predicted pooreroutcome.Conclusions: CAD in Young commonly presents with AcuteMI and single vessel LAD involvement. Less than half haveaccess to PAMI. Most require stenting although selectedpatients do well with intracoronary thrombolysis. Delayedtreatment and failure to modify risk factors portend badprognosis.

Role of yoga therapy on lipid profile in patients of hypertension and prehypertension

Background: Hypertension and dyslipidemia are one of the most prevalent cardiovascular disorders affecting 20% of world抯 population. There is emerging data that yoga therapies may be useful in managing modest elevations in BP. Yoga, specific yogic exercise (Sudarshan kriya) taught as a training protocol under Art of living course (AOL), is especially attractive as a candidate therapy in the management of elevated BP because of its combination of gentle physical activity. Hence, this study was undertaken to compare the effects of SDK on blood lipid levels.Methods: A total of 300 patients of hypertension and prehypertension were taken in the study where control group were given drugs treatment and life style modification and yoga group additionally had undergone yoga training. Lipid levels were estimated in both groups at entry, 06 months and 12 months and analyzed.Results: Lipid levels at entry were same in both while the yoga therapy group showed decrease in TG, LDL and VLDL at six months and 12 months but decrease was not significant. HDL levels showed significant increase in yoga group (P<0.05) at six months which was maintained at 12 months more so in diabetic patients.Conclusions: Yoga therapy has beneficial effect on serum lipid levels and should be included in therapy along with other measures.

Markers of inflammation following percutaneous coronary intervention (PCI) and its effect on adverse events

Background: Number of markers of inflammation has been associated with coronary artery disease and various studies have shown increased levels during chronic stable angina, acute myocardial infarction, and percutaneous coronary intervention. However, co-relation to final outcomes of percutaneous coronary intervention with these markers has not been studied. Aim of this study was to try and find a correlation between markers of inflammation released during percutaneous coronary intervention and incidence of restenosis on follow up at 06 moths on patients undergoing percutaneous coronary intervention with Bare Metal Stent (BMS).Methods: 36 consecutive only Bare Metal Stent (BMS) angioplasties done at our centre between July 2015 and June 2016 were analysed for markers of inflammation from peripheral venous sample before the procedure and coronary sinus sample after the procedure. Pts were kept on follow up for 6 months and assessed as per their clinical symptoms and Coronary Angiogram was done where indicated and results tabulated.Results: There was increase in the studied markers of inflammation post percutaneous coronary intervention but they did not correlate with or predict possible restenosis.Conclusions: This study showed that markers of inflammation are elevated during percutaneous coronary intervention but none of these markers correlates with subsequent restenosis.

Echocardiographic evaluation of diastolic dysfunction in diabetes mellitus without covert cardiac involvement

Background: Diabetic patients develop systolic and diastolic dysfunction without even associated coronary artery disease. But diastolic dysfunction is more prevalent in diabetic patients than systolic dysfunction and usually occurs before onset of symptoms. Recognition of early diastolic dysfunction is likely to make management better and avoids progression of cardiac dysfunction. This study was conducted in patients of Diabetes mellitus without other comorbidities.Methods: The present study which is cross sectional and was carried out among outpatients and inpatients of tertiary care hospital of Armed forces and involved army personnel and their dependents and sample size was 100 patients.Results: The prevalence of diastolic dysfunction among our study participants was found to be 36%. Diastolic dysfunction was found to be significantly higher among elderly individuals (60%) when compared to young study participants. (p<0.0001). Prevalence of diastolic dysfunction was found to be non-significantly higher among males and with longer duration of diabetes as compared to lesser duration and female gender.Conclusions: Diastolic dysfunction, evaluated by echocardiography, was found to be fairly prevalent (36%; 95% CI = 27-45%) among individuals with type 2 diabetes mellitus. Poor Glycaemic control and increasing age were found to be significantly associated with presence of diastolic dysfunction among individuals with diabetes mellitus.

Prevalence of Vitamin D Deficiency among Geriatric Patients

Background: Vitamin D deficiency is recognized as a global public health problem. In India Vitamin D Deficiency is prevalent, a finding that is unexpected in a tropical country with abundant sunshine. This study evaluated prevalence of vitamin D deficiency among geriatric patients.Methods: The present study was a hospitalized based cross sectional study conducted among geriatric patients attending the ortho. OPD of CIMS, Lucknow. Those elderly (>60 yrs) consenting to participate were including in this study .Patients who were on vitamin D3 & calcium supply (6 month) were excluded. Results: In this study we have taken 200 sample size. Geriatric patients who were not on vitamin D and calcium supplements for last 6 months were included for the study. Out of 200 participants, only 27(13.5%) participants had normal vitamin D levels and 173 (86.5%) study participants had low vitamin D levels among them 112 (56%) participants had vitamin D deficiency, 61(30.5%) participants had vitamin D insufficiency. Conclusions: Present study confirmed that Vitamin D deficiency is a major public health problem among geriatric age group.