Perspective on coronary interventions & cardiac surgeries in India.

Cardiovascular disease has become the leading cause of morbidity and mortality in India during the last 3 decades. The genetic predisposition and acquisition of traditional risk factors at a rapid rate as a result of urbanization seems to be the major cause. While efforts are being made to contain this epidemic by educating public and applying preventive measures, the ever increasing burden of patients with symptomatic and life threatening manifestations of the disease is posing a major challenge. This requires a concerted effort to develop modern facilities to treat these patients. The healthcare facilities to manage these high risk patients by contemporary methods like percutaneous coronary revascularization and surgical methods have shown a very promising trend during the last decade. The facilities of modern diagnostic methods and new proven techniques to offer symptomatic relief and improve their prognosis are available in most parts of the country. The lack of social security and health insurance for the large majority of the population, however, is a serious limitation. Unregulated availability of some of the newer devices for these techniques had become a very concerning issue. However, in the last few years serious efforts have been made to streamline these procedures. Indigenous research and scientific data acquisition in relation to the modern technology for achieving coronary revascularization has also started on a promising note.

Angiographic follow-up of genous bioengineered stent in acute myocardial infarction (GENAMI)-a pilot study.

OBJECTIVE: GENAMI, an angiographic follow-up study was undertaken to evaluate the safety and efficacy of a new generation endothelial progenitor cell (EPC) capture stent, GENOUS during primary angioplasty for ST-elevation myocardial infarction (MI). METHODS: Eleven consecutive patients with acute ST-elevation MI underwent primary percutaneous coronary intervention (PCI) using a bio-engineered GENOUS EPC stent. RESULTS: Procedural success was 100%. Ten patients who survived underwent a follow-up angiography at 8 months. There was no instance of stent thrombosis during the follow-up period up to 12 months. The quantitative angiographic (quantitative coronary analysis [QCA]) follow-up data showed a late loss at 8 months of 0.97 +/- 0.94 mm and the late loss index was 44.35 +/- 40.47% with angiographic restenosis seen in 5 of 10 patients (50%). One of these patients with provocable ischemia underwent repeat PCI. CONCLUSIONS: The QCA data of this study shows a high late loss with frequent angiographic restenosis during follow-up with this stent during primary PCI for acute STEMI. This observation, with important clinical implications, needs to be confirmed in larger studies.

Myocardial Bridge in association with fixed atherosclerotic lesions treated with drug-eluting stents: a follow-up report with quantitative coronary analysis.

Stenting of muscle bridge is still a controversial issue with concerns regarding high restenosis rates, plaque prolapse and stent fracture. We report a case with significant atherosclerotic disease of right coronary artery and left anterior descending artery associated with a muscle bridge, proximal to the diseased segment which became more prominent after stenting the fixed lesion. This was managed by implanting another drug eluting stent, covering the bridge. Angiographic follow-up at 9 months revealed no difference in quantitative coronary angiography parameters in the stented segment of the bridge, as compared to other stented segments.

Air travel and pulmonary embolism: "economy class syndrome".

Air travel is implicated as a predisposing factor for thromboembolism, which at times can have catastrophic consequences. We present 3 cases who developed deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) after transatlantic air travel. The relevant literature is discussed.

Common errors in ECG diagnosis of coronary artery disease.

A variety of clinical conditions not associated with ischemic heart disease can have ECG features mimicking those of ischemic etiology. Some of these entities are: ventricular hypertrophy, intraventricular conduction defects, pre-excitation syndrome, pericarditis, electrolyte disturbances, etc. This can lead to erroneous diagnosis and uncalled for hazardous treatment. A careful comprehensive evaluation with in depth analysis of the ECG can overcome such errors. We have reviewed some of these conditions and elaborated upon the differentiating features.

Diffuse unilateral pulmonary arteriovenous fistulae-a rare anomaly.

Diffuse pulmonary arteriovenous fistulae are rare, more so when unilateral. This article describes a 12-year-old boy with diffuse right-sided pulmonary arteriovenous fistula in whom prior percutaneous transcatheter coil occlusion has been attempted without success.The patient was subjected to ligation and transection of the right pulmonary artery and he is presently doing well.

TB and human rights.

Health is defined as a state of complete physical, mental and social well-being and is fundamental to human rights. TB affects nearly all aspects of health-physical, mental and social. The poor are vulnerable to TB and TB continues to be a stigma in large sections of society. TB is curable and an effective strategy ie, DOTS is now available. DOTS is perhaps the answer for protecting human rights of TB patients. The five components of DOTS are: Political commitment, diagnosis by sputum microscopy, directly observed therapy, uninterrupted supply of drugs and accountability. TB needs to be designated by a full acknowledgment.

Involvement of private practitioners in RNTCP.

Private Practitioners are often the first point of conduct for a significant proportion of TB patients. For long-term success of RNTCP involvement of them is very essential. All Private Practitioners can support and encourage effective TB control by ensuring prompt referral, providing reassurance to patients, giving RNTCP recommended drug regimens and only starting treatment with rifampicin containing regimens if the full course of treatment can be ensured to be completed under direct observation. Schemes for Private Practitioners' involvement in RNTCP are: Scheme 1 referral services, scheme 2 provision of Directly Observed Treatment, scheme 3a designated MC--microscopy only, scheme 3b designated paid MC-microscopy and treatment, scheme 4a designated MC-microscopy only, scheme 4 b designated MC-microscopy and treatment. Nationwide Public--Private Mix (PPM) services involving 1500 private practitioners are providing RNTCP services successfully.