Correlation of serum ST2 levels with severity of diastolic dysfunction on echocardiography and findings on cardiac MRI in patients with heart failure with preserved ejection fraction

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged _x0001_18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r ¼ 0.837), peak TR velocity (r ¼ 0.373), LAVI (r ¼ 0.74), E/A (r ¼ 0.420), and T1 values in milliseconds (r ¼ 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r ¼ 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF

Role of suture material and technique of closure in wound outcome following laparotomy for peritonitis.

Background: There are no accepted guidelines for the closure of laparotomy incisions in patients of peritonitis. As these patients differ from the patients undergoing elective abdominal surgery, the same recommendations for closure may not be applicable in both groups. Aim: To compare wound outcome parameters following closure of the laparotomy incision with absorbable and non-absorbable suture material using the continuous and interrupted techniques in patients of peritonitis. Method: A single blinded randomised controlled trial using Polygalactin–910 and Polypropylene, number 1 sutures, to close midline vertical incisions, placed in continuous and interrupted manner, was performed on 174 patients. Patients were randomised into four groups: Group A (Polygalactin-910 continuous suturing, n=40), B (Polygalactin-910 interrupted suturing, n=47), C (Polypropylene continuous suturing, n=45) and D (Polypropylene interrupted suturing, n=42). The incidence of wound infection, dehiscence, suture sinus formation and incisional hernia was recorded. Patients were followed up for a period of four years. Statistical analysis involved the chi-square and Fisher’s exact tests. A ‘p’ value of <0.05 was considered significant. Results: The study included 139 male and 35 female patients between the ages of 10 and 75 years. The incidence of wound infection (p=0.656), dehiscence (p=0.997), and incisional hernia (p=0.930) at 3 months and four years (p= 0.910) was not statistically significant. There was no sinus formation in groups A and B, however 2 patients of group C and 6 patients of group D did develop suture sinus (p=0.003). Conclusion: Suture material and technique of closure does not influence wound outcome in patients of peritonitis except for a significantly lower incidence of sinus formation when non-absorbable sutures are used.

A Clinical Psychiatric Study of Non-Psychotic Young Adolescents.

Background : Only a few clinical psychiatric studies have been done on adolescents in India. Non-psychotic psychiatric disorders in Indian adolescents require greater clinical attention. Aim: To clinically evaluate, diagnose and classify non-psychotic adolescents, aged 13 to 16 years, attending the child and adolescent psychiatry OPD. Methods and Material : 40 subjects were assessed on Kiddie Schedule for Affective Disorder and Schizophrenia, Present and Lifetime version (K-SADS-PL) or clinically for non-psychotic clinical psychiatric disorders. ‘Parent Interview Schedule’ and ‘Interview Schedule for Children’ were used to assess abnormal psychosocial situations, and Children’s Global Assessment Scale for psychosocial disability. Subjects were diagnosed using ICD-10 DCR and ICD-10 multi-axial classification. Results: Common adolescent non-psychotic psychiatric disorders found were mood disorders (27.5%), conduct disorder (17.5%) and dissociative disorder (12.5%). 7.5% adolescents had a specific disorder of psychological development. Abnormal psychosocial situations were present in 40% of the adolescents. Nearly half the adolescents (47.5%) had moderate social disability. Comorbidity was present in 17.5% adolescents. Conclusion :Common imparing psychiatric disorders among young clinic adolescents were mood disorders, conduct disorders, and dissociative disorders. More and larger studies in Indian general population and clinic settings are needed in this age group.

Plasticobezoar-another new entity for Rapunzel syndrome.

Rapunzel syndrome- a form of trichobezoar occurs when a gastric trichobezoar extends beyond the pylorus into the bowel. We report two cases of Rapunzel syndrome, one of them caused by ingestion of plastic material, so as to name it as a 'Plasticobezoar'. To the best of our knowledge no Rapunzel syndrome due to this material has been reported so far.

Unusual rectal stricture.

The aetiology of rectal stricture is varied, with malignancy being the commonest cause. We report the case of a 26-year-old man, from the state of Bihar, India, who presented with features of large bowel obstruction. Investigations revealed a rectal stricture. Biopsy from the affected site demonstrated non-specific inflammation. An anterior resection was carried out as it was not possible to convincingly rule out malignancy. Histopathological examination of the resected specimen reaffirmed the nonspecific inflammation. This case illustrates that long stricture of rectum my have a benign cause.

Gangrene of Meckel's diverticulum.

Gangrene of Meckel's diverticulum is uncommon and its pre-operative diagnosis is difficult. We report three cases with different presentations--simulating acute appendicitis, intestinal obstruction, and strangulation of the bowel.

Appendico-cutaneous fistula: a diagnostic dilemma.

Appendicular inflammation can present as a discharging fistula on the abdominal wall. This faecal fistula can be difficult to diagnose even with the assistance of advanced radiological techniques. Many pathological conditions of the appendix can present as appendico-cutaneous fistulae, and these have been defined to be distinct from those external appendicular fistulae that follow appendicectomy for acute appendicitis. Appendico-cutaneous fistula is a rare disease, and we could retrieve only 16 cases from a (Pubmed) search. An exploratory laparotomy is the gold standard for confirmation of this rare condition and, simultaneously, it allows treatment by appendicectomy and excision of the fistulous tract. We report and discuss one such case that we managed.