Chronic infections & coronary artery disease with special reference to Chalmydia pneumoniae.

Background & objectives: Studies on cardiovascular diseases (CVD) in India have shown about 10-20 per cent of cases with no obvious risk factors, raising a suspicion of infections as a cause. There is a paucity of data on this possible role of infections. This study was, therefore, undertaken to find out the association between infection due to Chlamydia pneumoniae and other organisms and coronary artery disease (CAD). Methods: Patients with CAD were selected in group I (acute myocardial infarction, AMI) and group III (patients undergoing coronary artery bypass graft (CABG) surgery), and normal controls in group II. Routine biochemical, haematological and inflammatory tests [C-reactive protein (CRP), total leucocyte count (TLC), fibrinogen, ESR], serodiagnostic tests for IgA and IgG antibodies to C. pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), Mycoplasma pneumoniae and Parvovirus B-19 by ELISA kits, C. pneumoniae antigen by microimmunofluorescence and PCR from endothelial tissue obtained at CABG were carried out. Aortic punch biopsies were done in patients who underwent CABG. Results: Acute MI patients had a significantly higher association with accepted cardiac risk factors, lipid profile, inflammatory and thrombogenic tests. IgG and IgA antibodies levels against C. pneumoniae were not significantly different in the controls as against the AMI group. However, C. pneumoniae antigen seropositive group had significant association with HDL cholesterol, lipid tetrad index (P<0.001) and with triglycerides. Parvovirus B antigen was detected in 8.3 per cent of tissue specimens by PCR and of 44 patients with AMI (6.8%) were also positive for parvovirus B-19 IgG antibodies. Interpretation & conclusions: There was no direct evidence of the involvement of C. pneumoniae and other infective agents and viruses in CAD. It is possible that such infections produce an indirect adverse effect on the lipid profile.

Cardiovascular disease incidence in some asian-pacific countries

A cooperative survey of general hospitals in Australia, India and the Philippines during 1954-1956 showed that the cardiovascular incidence and distribution pattern in the Philippines was intermediate between those of Australia and India in a similar manner as the Philippines is, culturally speaking, intermediate between the two. However, no good correlation was observed between the cardiovascular incidence of hypertensive and arteriosclerotic heart diseases with the reported values of serum cholesterol and dietary fats in these countries. (Summary and Conclusions)

Present status of rheumatic fever and rheumatic heart disease in India.

This paper examines the present status of Rheumatic fever (RF) and Rheumatic heart disease (RHD) in India with reference to both prevalence and incidence, and evaluates the currently available methods of control. Data available over the last 10 years shows that the prevalence of RF/RHD in the most vulnerable group i.e. school children between 5 to 15 years of age is still unacceptably high. RHD is encountered in 1 to 5.4 per 1,000 in large samples of school children and RF in 0.3 to 0.5 per 1,000 children. There appears to be no obvious decline in its prevalence in school children over a 20 year period. Because of preoccupation with adult cardiac diseases specially ischemic heart disease (IHD), the problem of RF/RHD has been sidelined and studies on prevalence, treatment and prevention receive scant attention. Only exotic palliative methods such as balloon mitral valvotomy (BMV) have become the centre stage. Studies are needed on the lines of WHO recommendations for the regional prevalence of RF/RHD in school children throughout the country to detect regional variations. The most effective method for control is primary prevention by treating streptococcal sore throat and secondary prevention by early detection and continuous penicillin prophylaxis. This could be done most effectively by general physicians (GP's) who need motivation and education and through school health services. The latter needs to be organised on a state-wise basis throughout the country as it is available in only a few cities. Public health education by all available media specially, through video films is also recommended. The lacunae in our knowledge of RF/RHD calls for further research.

Thrombolytic therapy in clotted prosthetic mitral valve.

Thrombosis of a Bjork-Shiley valve in the mitral position was suspected clinically and confirmed by echocardiography and cine fluoroscopy. Streptokinase therapy followed by intravenous heparin infusion was given and the clot lysed successfully. The patient was asymptomatic upto two years of follow-up.

An evaluation of cardiac function in malnourished children by non-invasive methods.

Forty-six malnourished children between 3-48 mo with varying grades of malnutrition (PEM) were evaluated for left ventricular function by echocardiography. None of these children had any pre-existing cardiac disease, chronic illness or significant anemia. Children with Grades III and IV PEM had significantly smaller cardiac chamber size and ventricular wall thickness as compared to normally nourished children. Cardiac output as well as other indices of left ventricular function (percentage fractional shortening, mean rate of circumferential fibre shortening and ejection fraction) were also significantly decreased in severe PEM. The atrophic PEM heart does appear to show left ventricular dysfunction in moderately severe malnutrition.