Life style patterns and adherence to pharmacotherapy after acute coronary syndrome: one year follow up study from a tertiary care center in Kashmir, India

Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and 44.88% patients at 3, 6 and 12 months follow up. Uncontrolled diabetes at 3, 6 and 12 months was found in 58.82%, 66.17% and 73.52% patients. 5.42%, 15.06% and 21.08% cases continued to smoke at 3, 6 and 12 months respectively. Drug non-compliance overall was noted in 9.61%, 17.69% and 23.84% cases at 3, 6 and 12 month follow up.Conclusions: This study highlights the under prevalence of modifiable risk factor change in practice and drug non-compliance after an acute coronary event.

Clinical Profile and Complications of Continuous Ambulatory Peritoneal Dialysis in Kashmir

Introduction: Diabetes Mellitus is a syndrome characterizedby chronic hyperglycemia and disturbances of carbohydrate,fat and protein metabolism with absolute or relative deficiencyof insulin secretion and/or insulin action. It is one of themost common non-communicable diseases in the world.Adiponectin is a protein secreted exclusively by adipocytesthat regulates glucose and lipid metabolism. It has been foundto influence the body’s response to insulin thereby modulatinginsulin action and resistance. Several studies have found thatadiponectin levels are inversely associated with the severityof diabetes mellitus. Our study, thus, aims to compare theassociation between levels of adiponectin, fasting bloodglucose, body mass index and waist-hip ratio in patients ofdiabetes mellitus.Material and Methods: This case control study was done inpatients of type 2 diabetes mellitus attending Medicine OPDand ward from October 2016 to September 2018. A total of 88people were included in the study; 44 cases and 44 controls.Results: This study shows that serum adiponectin level issignificantly decreased in type 2 diabetes mellitus patients ascompared to controls and it also shows negative correlationwith fasting blood glucose, body mass index and waist-hipratio.Conclusion: It can be concluded that serum adiponectinestimation may be a useful biomarker for the diagnosis oftype 2 diabetes mellitus and it may be a useful adjunct in thetreatment of type 2 diabetes mellitus.

Coronary Angiographic Profile of Left Ventricular Systolic Dysfunction of Unknown Causes in Kashmir

Introduction: Disseminated tuberculosis is a form ofwidespread bacilli infection with typical involvement ofthe lungs and other extra pulmonary organs. It is a raremanifestation of mycobacterial infection and rare amongimmune competent individuals.Case report: We present a case of disseminated extrapulmonary tuberculosis co-occurring tuberculous meningitis,CNS tuberculomas and Liver tuberculomas. Our patientdeveloped atypical respiratory complications in the form ofARDS like features which also called as Landouzy Sepsis,despite apparent normal Chest x-ray following initiation ofAnti Tubercular Therapy. Also patient developed paradoxicalreactions to tuberculous meningitis during the treatment.Conclusion: Awareness about paradoxical reactions intuberculous meningitis is very much crucial as paradoxicalreactions may lead to confusion about diagnostic accuracy andresistance of ATT drugs. Paradoxical reactions do not affectthe outcome but require prompt treatment to the complicationslike hydrocephalus and respiratory distress.

Penetrating Cardiac Trauma with Retained Intra - Myocardial Pellets - A Case Report

Introduction: Penetrating ballistic cardiac injury is usuallyfatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few caseshave been reported in the literature.Case report: We describe a young patient who presentedwith multiple life threatening pellet injuries involving chest,abdomen, and limbs. Patient had CT and echocardiographydocumented retained pellets in the heart with pericardialeffusion. Patient was managed successfully using conservativeapproach without any surgical intervention.Conclusion: this case highlights the importance of carefulmonitoring and conservative approach in such critically illpatients for a better outcome.

Clinical profile in arrhythmogenic cardiomyopathy and a recessive plakophilin-2 gene mutation

Objective Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir valley. This study was designed to document various clinical features and to sequence exons 11 and 12 of plakophilin 2 (PKP2) gene in these patients. Methods ACM patients who attended cardiology outpatient department of our institute from January 2014 to April 2015 were included in the study. Their records were reviewed. Controls were randomly selected, who had no history or family history of cardiac illness and had a normal cardiac examination. A blood sample was also taken from both the groups for sequencing of exon 11 and 12 of PKP2 gene. ACM patients were followed up until July 2016. Results Eleven ACM patients and seven controls were included in the study. Most common mode of presentation was ventricular tachycardia (VT). Two patients had left ventricular (LV) systolic dysfunction. One patient had a splice site mutation in exon 12 of PKP2 gene and one patient died during follow-up. One of the controls had an intronic variation that has no pathogenic significance vis-à-vis ACM. Conclusion Our study describes various clinical parameters in ACM patients and a recessive plakophilin 2 mutation after a limited PKP2 gene sequencing.

Sheehan's syndrome with central diabetes insipidus / Síndrome de Sheehan e diabetes insípido central

Sheehan's syndrome refers to the occurrence of hypopituitarism after delivery, usually preceded by postpartum hemorrhage. The condition still continues to be a common cause of hypopituitarism in developing countries like India. The disorder usually presents with anterior pituitary failure with preservation of posterior pituitary functions. Posterior pituitary dysfunction in the form of central diabetes insipidus is rare in patients with Sheehan's syndrome. We describe the clinical course of a young lady who after her sixth childbirth developed severe postpartum hemorrhage followed by development of panhypopituitarism which was confirmed by hormonal investigation and demonstration of empty sella on imaging. In addition, she developed Polyuria. The water deprivation test and response to vasopressin test results indicated central diabetes insipidus. She needed oral desmopressin on a continuous basis to control polyuria.

A síndrome de Sheehan está relacionada à ocorrência de hipopituitarismo pós-parto, geralmente precedido por hemorragia pós-parto. Essa condição clínica ainda constitui causa comum do hipopituitarismo observado em países em desenvolvimento como a Índia. Essa síndrome se caracteriza pela insuficiência da glândula hipofisária anterior, porém com a conservação das funções da glândula hipofisária posterior. A disfunção da hipófise posterior, sob a forma de diabetes insipidus central, é algo raramente observado em pacientes que apresentam a síndrome de Sheehan. Neste artigo, descrevemos o caso de uma jovem que, após o sexto parto, apresentou hemorragia pós-parto grave, seguida pela evolução de pan-hipopituitarismo que foi confirmado por pesquisa hormonal e exames de imagem que evidenciaram sela vazia. A jovem também apresentou poliúria. Os resultados do teste de privação de água e exame de resposta à vasopressina indicaram diabetes insípido central. A paciente fazia uso contínuo de desmopressina para controlar a poliúria.