Long term prognostic significance of thrombolysis in myocardial infarction risk score after revascularization in non-ST elevation acute coronary syndrome

Background: Non-ST elevation acute coronary syndrome (NSTE-ACS) patients are complex and varied population. Primarily thrombolysis in myocardial infarction (TIMI) risk score was developed to guide therapy and assess the short term (14 days) prognosis of these patients. However, few studies have evaluated the long term prognostic significance of TIMI risk score after revascularization. This study aims at assessing the long term prognostic significance of TIMI risk score, 36 months after revascularization in NSTE-ACS.Methods: This was a retrospective observational cohort study of consecutive NSTE-ACS patients (n=150) treated by percutaneous coronary intervention between January 2017 to June 2017 in a tertiary care center. TIMI risk score was calculated for each patient at admission. The primary endpoint was a composite of MACE (death, repeat target-vessel revascularization, and non-fatal recurrent MI) at the end of 36 months of follow up. Clinical secondary endpoints included the individual components of the primary endpoint, death, nonfatal recurrent MI, and repeat target vessel revascularization.Results: Baseline characteristics for 150 participants were as follows, age 56±9.5 years, 78.7% male, 25% diabetics, 82% hypertensives, and 36% had hypercholesterolemia. The event rates of the primary endpoint and its components after 36 months were 26.6%. Event rates increased significantly as the TIMI risk score increased as determined by regression analysis (p=0.004). The relative risk increased by 66% as the TIMI risk score increased from low risk category (TIMI score 0-2) to high risk (TIMI score 5-6).Conclusions: TIMI risk score can be used for long term prognostication of NSTE-ACS patients after revascularization, and thus can be used by clinicians for therapeutic decision making.

Pattern of congenital heart diseases in Western Rajasthan: an echocardiographic study

Background: Congenital heart disease (CHD) accounts for nearly one third of all major congenital anomalies. Globally the prevalence of CHD is 1.01 to 17.5 per 1000 live births. In India it is 1.3 to 26.4 per 1000 study population. CHD is an important cause of mortality and morbidity representing a global health burden. Early diagnosis and treatment may lead to improved prognosis in patients suffering from CHD. The aim of this study was to assess the pattern of CHD in Western Rajasthan, India by echocardiography.Methods: This was a retrospective study carried out at Dr. S. N. Medical College and attached group of hospitals in Jodhpur, Rajasthan, India. The study period was from July 2014 to June 2017. Records of all patients undergoing transthoracic echocardiography from newborn to 25 years of age were analyzed for age, sex and CHD findings.Results: In the study period, a total of 24,914 patients underwent echocardiography, of which 877 patients were identified as having CHD. Prevalence of CHD was 35.20 per 1000 study population. Amongst the total diagnosed CHD cases, 489 (55.76%) patients were male, with male to female ratio of 1.2:1. CHDs were diagnosed more commonly between 1 month and 1 year of age (41.28%). The commonest type of acyanotic CHD in the present study was ventricular septal defect (21.44%) and cyanotic CHD was tetralogy of Fallot (18.24%).Conclusions: Prevalence of CHD in Western Rajasthan, India was 35.20 per 1000 study population. Profile of CHDs in the present study was similar to that in published literature.

Evaluation of clinical outcome of thrombolytic therapy in elderly patients in Western Rajasthan: a single centre experience

Background: Heart disease is the leading cause of mortality in population above the age of 65 years. Severity and prevalence of coronary artery disease (CAD) increase with increasing age. Thrombolysis remains the standard of care in the management of acute ST-elevation myocardial infarction (STEMI) in developing countries like India where primary percutaneous coronary intervention (PCI) is still not possible in the majority of patients. The risks and benefits of thrombolytic reperfusion therapy among the elderly patients with STEMI is much less known. Authors aimed to evaluate the outcome and complications of thrombolytic therapy in elderly patients admitted with acute STEMI.Methods: The present observational study was done between January 2017 and January 2019 in the department of cardiology, Dr. S.N. Medical College, Jodhpur, India. It included a study group comprising 102 consecutive elderly patients who had acute STEMI and underwent thrombolytic therapy and a control group comprising 102 consecutive elderly patients who had STEMI who were not given thrombolytic therapy. Both groups were evaluated for an outcome (in-hospital mortality) and complications.Results: The overall in-hospital mortality was less in thrombolytic therapy group as compared to control group although not statistically significant (8.82% versus 14.70%, p=0.277). Similarly, in-hospital mortality was less in thrombolytic therapy subgroup A (age 66-74 years) as compared to control subgroup A (6.45% versus 10.75%, p=0.583) and also less in thrombolytic therapy subgroup B (age 75-85years) as compared to control subgroup B (12.50% versus 21.62%, p=0.445).  Among the traditional risk factors, co-morbid conditions and complications, there was less prevalence of diabetes mellitus (4.90% versus 15.68%, p=0.021), hypertension (5.88% versus 6.86%, p=1.000), cardiogenic shock (8.82% versus 9.80%, p=1.000), left ventricular failure (LVF) (0.98% versus 3.92%, p=0.365) and atrioventricular (AV) block (0% versus 4.90%, p=0.245) but more acute kidney injury (AKI) (2.94% versus 0%, p=0.070) in thrombolytic therapy group patients as compared to control group patients.  Cerebrovascular accident (CVA) did not occur in both group patients.Conclusion: Despite the higher prevalence of co-morbidities and high risk features in elderly patients of acute STEMI, timely thrombolysis is beneficial. A mortality benefit was seen in all groups suggesting net benefit regardless of increasing age up to the age of 85 years.

Pattern of rheumatic heart disease in Western Rajasthan- an echocardiographic study: a single centre experience

Background: Rheumatic heart disease (RHD) is a common form of heart valve disease associated with episodes of rheumatic fever. Despite the developments achieved in the field of cardiology, the consequences of acute rheumatic fever remain significantly high in developing countries like India.  Objectives of current study aims to evaluate the pattern of valvular involvement in patients of RHD in Western Rajasthan assessed by echocardiography.Methods: This is an observational study conducted at the department of Cardiology, Dr. S. N. Medical College, Jodhpur, India between September 2015 and February 2019. The study includes analysis of echocardiograms of RHD patients performed during this period.Results: Total 502 echocardiograms of RHD patients between 4 and 75 years of age with mean age of 35.6±11.6 years were evaluated, in which the most common age group was 21-40 years.  There were 191 (38.04%) males, and 311(61.95%) females. Mitral valve was most commonly involved in which mitral stenosis (MS) was seen in 345(68.72%) and mitral regurgitation (MR) was seen in 350(69.72%) patients. Aortic stenosis (AS) was seen in 61(12.15%) and aortic regurgitation (AR) was found in 224(44.62%) cases. Organic tricuspid valve (TV) disease was seen in 18(3.58%). In combined valvular involvement MS+MR was seen in 234(46.61%) cases; followed by MR+AR in 171(34.06%); MS+AR in 161(32.07%); AS+AR in 62(12.35%); MR+AS in 46(9.16%) and MS+AS in 42(8.36%) subjects.Conclusion: The echocardiographic pattern of RHD patients of Western Rajasthan showed a predominant involvement of mitral valve, followed by aortic and tricuspid valves. Further amongst multi-valvular involvement the sequence was predominantly MS+MR followed by MR+AR, MS+AR, AS+AR, MR+AS, and MS+AS.

Anomalous left coronary artery from pulmonary artery in an adult

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive till adulthood. Here we present the case of a 28-year-old lady with exertional dyspnoea and chest pain who was diagnosed to have ALCAPA.

Cancer biomarkers - Current perspectives.

In the recent years, knowledge about cancer biomarkers has increased tremendously providing great opportunities for improving the management of cancer patients by enhancing the efficiency of detection and efficacy of treatment. Recent technological advancement has enabled the examination of many potential biomarkers and renewed interest in developing new biomarkers. Biomarkers of cancer could include a broad range of biochemical entities, such as nucleic acids, proteins, sugars, lipids, and small metabolites, cytogenetic and cytokinetic parameters as well as whole tumour cells found in the body fluid. A comprehensive understanding of the relevance of each biomarker will be very important not only for diagnosing the disease reliably, but also help in the choice of multiple therapeutic alternatives currently available that is likely to benefit the patients. This review provides a brief account on various biomarkers for diagnosis, prognosis and therapeutic purposes, which include markers already in clinical practice as well as various upcoming biomarkers.

Inhibitors of topoisomerases as anticancer drugs: problems and prospects.

DNA topoisomerases, which solve topological problems associated with various DNA transactions, are the targets of many therapeutic agents. Various topoisomerase inhibitors especially, topo-poisons, camptothecin (topo-I) and etoposide (topo-II) are some of the drugs that are used in the current treatment protocols, particularly for the treatment of leukemia (AML, ALL etc). However, tumor resistance, normal and non-specific tissue cytotoxicity are the limitations for successful development of these drugs as one of the primary therapeutic agents for the treatment of tumors in vitro. This brief review presents the current understanding about cytotoxicity development and outlines various approaches to overcome the limitations for enhancing the efficacy of topo-poison based anticancer drugs.

Alterations in radiation induced cell cycle perturbations by 2-deoxy-D-glucose in human tumor cell lines.

In the present studies, effects of glucose analogue, 2-deoxy-D-glucose (2-DG) on radiation-induced cell cycle perturbations were investigated in human tumor cell lines. In unirradiated cells, the levels of cyclin B1 in G2 phase were significantly higher in both the glioma cell lines as compared to squamous carcinoma cells. Upon irradiation with Co60 gamma-rays (2 Gy), the cyclin B1 levels were reduced in U87 cells, while no significant changes could be observed in other cell lines, which correlated well with the transient G2 delay observed under these conditions by the BrdU pulse chase measurements. 2-DG (5 mM, 2 hr) induced accumulation of cells in the G2 phase and a time-dependent increase in the levels of cyclin B1 in both the glioma cell lines, while significant changes could not be observed in any of the squamous carcinoma cell lines. 2-DG enhanced the cyclin B1 level further in all the cell lines following irradiation, albeit to different extents. Interestingly, an increase in the unscheduled expression of B1 levels in G1 phase 48 hr after irradiation was observed in all the cell lines investigated. 2-DG also increased the levels of cyclin D1 at 24 hr in BMG-1 cell line. These observations imply that 2-DG-induced alterations in the cell cycle progression are partly responsible for its radiomodifying effects.