A review of role of lung ultrasound and clinical congestion score in acute left ventricular failure

Congestive cardiac failure (CCF) is a worldwide phenomenon and affects millions of people years and is accompanied with high mortality. The present review is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF. A review of literature was done to find the role of lung ultrasound and clinical congestion score in acute left ventricular failure from search engines such as PubMed, google scholar. Major exclusion criteria were the studies that included patients with Right Ventricular Failure, renal insufficiency, other respiratory causes of breathlessness like pneumonia, pulmonary embolism, pneumothorax and pleural effusion. This review concluded that lung ultrasonography is as a rapid, non-invasive, bedside tool for the diagnosis and risk assessment of pulmonary congestion in Acute LVF.

A rare case of inflammatory myopathy

Idiopathic inflammatory myopathies (IIMs) happened to be the group of heterogeneous, systemic rheumatic diseases including adult polymyositis (PM), adult dermatomyositis (DM), myositis accompanied with another connective disease or cancer. A 52 years old male patient with known history of type 2 diabetes mellitus presented with complaints of muscle pain and swelling over left arm. These cases was successfully treated by using Corticosteroids. This cases study described the clinical presentation and features of inflammatory myositis. Although this is a rare case, its clinical features and treatment procedure helps in management of similar cases.

Multiple myeloma with primary systemic amyloidosis affecting cutaneous, gastro intestinal and cardio-vascular system

Amyloidosis refers to a group of disorders characterized by extracellular deposition of protein fibrils. Primary systemic amyloidosis is commonly due to an underlying plasma cell dyscrasia. Infiltrative amyloid cardiomyopathy is a rare cause of predominantly diastolic myocardial disease. Restrictive cardiomyopathy is the main finding in cardiac amyloidosis and results from the replacement of normal myocardial contractile elements by infiltration and interstitial deposits of amyloid, leading to alterations in cellular metabolism, calcium transport, receptor regulation, and cellular edema. Injury can also occur from circulating light chains in the absence of amyloid fibril formation. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease. This is a case report where an unusual extensive cutaneous and cardiac involvement provided the sign of widespread systemic deposition of amyloid protein which eventually led to the diagnosis of multiple myeloma.

Evaluation of aspartate amino transferase to platelet ratio index as a non invasive marker for liver cirrhosis

Background: Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic long lasting injury. Liver biopsy is considered as a gold standard for the diagnosis of cirrhosis and has many problems like bleeding, infective peritonitis which limit use of liver biopsies in all patients.Methods: A comparative study was done (90 cases and 90 controls) who fulfilled the inclusion criteria in a tertiary center.Results: The present study was conducted using a total of 180 participants, 90 USG diagnosed cases of liver cirrhosis was compared with 90 healthy controls. The mean AST level in the cirrhosis was 66.50±27.06 as compared to 21.26±6.52 in controls which was statistically significant. In this study the sensitivity and specificity of APRI was found to be 100.0% and 84.44% respectively, and the positive and negative predictive values were 86.54% and 100% respectively with significantly Area under the curve (AUC) (0.999, P>0.01).Conclusions: A simple index like Aspartate platelet ratio index, consisting of 2 readily available laboratory results (AST level and platelet count), can predict cirrhosis with a high degree of accuracy.