A Lady with a Broken Heart

Broken-heart syndrome (BHS) is an acute reversible myocardial injury of left or right ventricular myocardium in the absence of coronary occlusion. We, herein, discuss a case of a postmenopausal female presenting with angina equivalent with surface electrocardiogram (ECG) and echocardiography consistent for acute coronary syndrome. The patient was subsequently diagnosed and treated as BHS.

Hindi translation and validation of quality of life score in Indian patients with epidermolysis bullosa; and its correlation with the clinical severity assessment scores: A cross-sectional study

Background: Quality of life (QoL) has not been evaluated in Indian patients having epidermolysis bullosa (EB). Aims: The aims of the study were to measure health-related QoL in Indian patients having EB using the quality of life in epidermolysis bullosa (QoLEB) questionnaire, and to find its correlation with clinically measured disease severity. Methods: In this observational cross-sectional study, the QoLEB questionnaire was translated from English to Hindi (QoLEB-Hin) and culturally adapted without a change in concept following standard guidelines. QoLEB-Hin and three clinical scores that have been independently validated in EB, that is, Birmingham Epidermolysis Bullosa severity score (BEBs), Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB) and Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI), were administered to EB patients/their parents in the presence of an expert. This was followed by validity and correlation studies. Results: Fifty-four patients were recruited (19-females, 35-males; median age 5 years, range 0.025–36 years and 12 patients with an age >13 years). The parents answered the questions for 42 patients (age <13 years). Dystrophic epidermolysis bullosa was diagnosed in 32 (59.2%) patients (dominant dystrophic epidermolysis bullosa [DDEB]-19 [35.2%] and recessive dystrophic epidermolysis bullosa [RDEB]-13 [24.1%]). Junctional epidermolysis bullosa (JEB) and epidermolysis bullosa simplex (EBS) were each diagnosed in 11 (20.4%) patients. The mean ± standard deviation (SD) of QoLEB-Hin score of all epidermolysis bullosa patients was 11.3 ± 7.6 (range 0–28; median and interquartile range [IQR], 10, 10) and reflected an overall moderate degree of affliction on QoL of patients. Mean ± SD of QoLEB-Hin scores for EBS, JEB, DDEB and RDEB were 5.4 ± 3.7 (range, 1–13; median and IQR, 6, 6), 11 ± 6.2 (range, 1–22; median and IQR, 10, 6), 9 ± 5.7 (range, 0–19; median and IQR, 10, 10) and 20.1 ± 6.4 (range, 12–28; median and IQR, 19, 12.5), respectively (P < 0.001, Kruskal–Wallis analysis of variance). Cronbach’s alpha coefficient of 0.946 was obtained for all items indicating excellent internal consistency and reliability. Mean sample adequacy was 0.91; absolute fit based off diagonal values was 0.99; indices root mean square error of approximation and root mean square residual were 0.04 and 0.05, respectively, and Tucker Lewis index was >1 indicating overfit. The mean time taken to complete the questionnaire was 6.1 min (range, 6–8 min). QoLEB-Hin correlated significantly (P < 0.001) with BEBs (ρ = 0.79), iscorEB (ρ = 0.63) and EBDASI (ρ = 0.77). Three multiple linear regression models were used to ascertain the strength of relationship between QoL-Hin, and BEBs, iSCOREB and EBDASI, respectively, after adjusting for age, gender and disease subtype. The EBDASI clinical score accounted for approximately 74% (R2 = 0.736, P < 0.001) of the variability in QOL-Hin, as compared to 73% and 55% by BEBs (R2 = 0.731, P < 0.001) and iscorEB (R2 = 0.545, P < 0.001), respectively.Limitations: Parents filled out the questionnaires for many patients and probably led to an overall moderate degree of affliction of QoL. Comparison with Dermatology Life Quality Index and other QoL scores were not done in this study. Furthermore, the scoring was done at one point in time, and test-retest measurements could not be performed. Conclusion: This study validated QoLEB-Hin in an Indian population finding an overall moderate reduction in QoL due to EB. Maximally affected QoL was seen in patients with RDEB. Furthermore, QoLEB-Hin had a variable positive correlation and association with all clinical severity assessment scores

Hearing Loss in Thalassemic Children on Chelation Therapy

Background: Thalassemia is a common genetic hematological disorder worldwide. It is also common in North India includingJammu region. These patients need lifelong repeated blood transfusions and iron chelation therapy for their survival. Chelationtherapy is known to be associated with various complications including sensorineural hearing loss (SNHL). Till now, no dataare available regarding SNHL in pediatric thalassemia major patients in Jammu region. Hence, we planned a study to assessthe prevalence of hearing loss in children with thalassemia major in the age group of 10–20 years.Methods: All the children with beta-thalassemia major in the age group of 10–20 years registered with Thalassemia Day CareCenter, Department of Pediatrics, SMGS Hospital, Government Medical College, Jammu, were enrolled in this cross-sectionalstudy. Hearing was assessed by pure tone audiometry. Clinical and demographic data of these patients were recorded onpretested pro forma and analyzed.Results: A total number of 34 children with thalassemia in the age group of 10–20 years were enrolled in this study whichcomprised 18 males and 16 females. Out of these 34 patients, 5 (14.7%) were found to have SNHL and 1 (2.9%) had conductivehearing loss. Four of the five patients in SNHL group had low- as well as high-frequency mild hearing loss (25–40 db) whileone patient had high-frequency mild hearing loss at 4000 HZ. Four out of these five patients had unilateral hearing loss on theleft side while one had bilateral SNHL. Two out of five patients in the SNHL group were taking chelation therapy in the form ofcombination of deferiprone and deferasirox at the dose of 75–100 mg/kg/day and 30–40 mg/kg/day, respectively, for more than5 years. The other three patients were taking only deferasirox at the dose of 30–40 mg/kg/day for more than 5 years.Conclusions: Regular blood transfusions and chelation therapy are essential for long-term survival of thalassemia majorpatients but are also associated with complications like SNHL.

Comparative Study Of Effectiveness Of Dexamethasone Injection After Orif In Mandible

Aims & objectives The purpose of this study was to compare the effects of 4mgm inj dexamethasone IV intra operatively after ORIF on post operative oedema, pain & trismus in fracture mandible. Material & Method. THis prospective study included 162 cases of fracture mandible. Patients were divided into two groups randomly. Patients who received IV injection of 4 mgm Dexamethasone intraoperatively were study group (Group 1) & those who didn’t receive injections of Dexamethasone were categorised as controlled group (Group 11) with 81 patients each. Clinically mouth opening, swelling, infection pain, post operative discomfort were assessed on 2nd, 4th 7th, 10 day Th day followed by 4, 8 & 12 weeks time Result Pain ,Mouth Post operative oedema & other postoperative discomfort was significantly less in study group as compared to controlled group

Pharmacotherapy of Opportunistic Infections in HIV Patients: A Review.

With the introduction of antiretroviral therapy, there is a dramatic decrease in the morbidity and mortality related to human immunodeficiency virus (HIV) infections. Due to varying degree of immunosuppression, patients are prone to various number of infections in their lifetime. Respiratory system, central nervous system, gastrointestinal tract and the skin are the most susceptible for opportunistic infections. Timely management of these microbial infections followed by chemoprophylaxis is essential as per the guidelines for the management of opportunistic infections in HIV. The development of drug toxicities and drug resistance in managing patients with HIV has always remained a clinical challenge. Consideration is given to the numerous pharmacokinetic interactions between drugs used to treat and prevent opportunistic infections and antiretroviral drugs, along with complications like immune reconstitution inflammatory syndrome. Clinicians must be aware about optimal strategies present for diagnosis, prevention and treatment of opportunistic infections in order to improve health and provide high quality of care for the patients.

ENT Manifestations in Pregnancy.

A hospital based cross-sectional study to evaluate the ENT manifestations in pregnancy included 100 pregnant women attending departments of Obst & Gynae and ENT, SMGS Hospital, GMC Jammu for ENT manifestations. In the present study, majority of pregnant women were primigravidas in age group of 21-30 years and mostly reported in third trimester. Out of 49 cases diagnosed with otological conditions, tinnitus was found in 10 cases (20.4%), ET dysfunction in 10 cases (20.4%) and least common was otosclerosis in only one case (2%). Out of 52 cases diagnosed with rhinological conditions, most common condition was epistaxis in 22 cases (42.36%), rhinitis in 15 cases (28.8%) and only one case (1.9%) of nasal pyogenic granuloma. Out of 30 cases diagnosed with laryngopharyngeal and esophageal condition, GERD was most common i.e. in 29 cases (96.6%) and dysphonia in only one case (3.33%). Out of 100, 11 cases were related to neck, out of which hypothyroidism was most common i.e in 7 cases (63.6%). Out of 100, 17 pregnant women were reported with oral cavity conditions with 8 cases (47%) of dysguesia, 2 cases (11.7%) of ulcerative stomatitis, 1 case each of gingivitis, pyogenic granuloma palate, pyogenic granuloma of gingiva, submandibular abscess and Parotid abscess. The changed hormonal milieu during pregnancy causes otological conditions leading to hearing impairment, epistaxis, rhinitis , GERD etc. Hypothyroidism is common as our area falls in the area of goiter belt.

Intravitreal anti-VEGF monotherapy for thick submacular hemorrhage of less than 1 week duration secondary to neovascular age-related macular degeneration.

Aim: To investigate the role of anti‑VEGF monotherapy in patients with thick submacular hemorrhage (SMH) of ≤1 week duration secondary to neovascular age‑related macular degeneration (N‑AMD). Materials and Methods: A retrospective chart review of 14 eyes of 14 patients presenting with acute decrease in central vision of ≤1 week duration secondary to a thick SMH measuring ≥ 2 MPS disk areas from N‑AMD was performed. Intravitreal injections of bevacizumab 1.25 mg (13 eyes) or ranibizumab 0.5 mg (1 eye) were given monthly until resolution of SMH and less frequently thereafter, based on treat-and-extend approach utilizing spectral domain optical coherence tomography (SDOCT). Patients with follow‑up of ≥6 months were included. Results: Patients presented after a median of 4 (range 1-7) days from the onset of SMH. Mean lesion size was 27.9 mm2 (range 5.47-100, median 15), with blood comprising 77-98% of the lesion. Presenting visual acuity (VA) ranged from 20/60 to hand motions (median 20/200). Patients received a mean of 11.4 (range 5-20) injections over 18.4 (range 7-50) months. SMH resolved in all eyes in a mean of 4.8 (range 2-8) months. At 6 months follow‑up, mean VA gain was −0.54 logMAR (range: −1.5 to +1, Snellen range 20/25‑20/400, median 20/100, P = 0.0037), with 11 gaining ≥0.2 logMAR. Mean change in VA from baseline at final follow‑up was −0.58 logMAR (range −1.6 to +1, Snellen range 20/30-20/400, median 20/60; P = 0.0022). Conclusion: A good anatomical and visual outcome can be accomplished in patients with thick SMH secondary to N‑AMD treated with anti‑VEGF monotherapy within 1 week.

Progressive atrophy of retinal pigment epithelium after trypan-blue-assisted ILM peeling for macular hole surgery.

We report a case of progressive atrophy of the retinal pigment epithelium (RPE) after trypan-blue-assisted peeling of internal limiting membrane (ILM) for macular hole surgery. A 68-year-old Caucasian female underwent a 20-g pars plana vitrectomy for a chronic stage-3 macular hole. The ILM was stained with 0.06% trypan blue (VisionBlue™, DORC Netherlands) for 2 min after fluid air exchange. Dye was reapplied for another 2 min due to poor staining. The ILM was completely removed around the macular hole with forceps. RPE atrophy was noticed at the edge of the hole 1 month after surgery. It progressively increased in intensity and enlarged over 2 years. Her final visual acuity was counting fingers, significantly worse compared to her presenting visual acuity of 20/200. Progressive atrophy of RPE in our patient was most likely due to the toxicity of trypan blue. Reapplication of the dye may increase the likelihood of toxicity.

Pattern of Abnormal Findings in Adult with Nasal Obstruction on Rhinoscopy and Nasal Endoscopy.

Nasal obstruction is one of the most distressing symptom of nasal and sinus disease.The nasal obstruction may be unilateral or bilateral or is intermittent ,progressive or persistent.The routine anterior and posterior rhinoscopy gives very little information as we can see the structure which lie directly in the line of sight and moreover the posterior rhinoscopy may not be possible in some cases.As a result , the early diagnosis of some unpleasant lesions remained elusive without nasal endoscopy. In addition , the diagnostic nasal endoscopy helps us in precise photodocumentation of pre- and post treatment finding ,which is unsurpassed for teaching .This study , thus , strongly recommend thorough endoscopic examination of nose and postnasal space especially when anterior and posterior rhinoscopy fail to reveal the cause of nasal obstruction.

Protective effects of amlodipine on mitochondrial injury in ischemic reperfused rat heart.

The most significant finding of the present study was the release of nitric oxide (NO). The effect of amlodipine on NO production associated with ischemic reperfused (IR) injury was investigated in rat heart model. Cardiac tissues from animal groups were processed for biochemical, histopathological and electron microscopic studies. There was a significant increase in myocardial catalase (CAT), superoxide dismutase (SOD) and glutathione (GSH) enzymes in amlodipine treated group (1.37, 10.27, 6.39) when compared to IR injured group (0.81, 6.87, 4.53). Histopathology studies showed amlodipine reduce cardiocyte damage in cardiac injury during the cardiac IR. Transmission electron microscopic (TEM) study confirmed the cardioprotective role of amlodipine against IR induced cardiac injury. On the basis of findings, it is hypothesized that a portion of the beneficial actions of amlodipine may involve the release or action of NO and probably by its antioxidant properties.

Effect of bacosides, alcoholic extract of Bacopa monniera Linn. (brahmi), on experimental amnesia in mice.

To investigate the effect of bacosides (alcoholic extract of brahmi) on scopolamine (3 mg kg(-1), ip), sodium nitrite (75 mg kg(-1), ip) and BN52021 (15 mg kg(-1), ip) induced experimental amnesia in mice, using Morris water maze test, all the agents were administered 30 min before the acquisition trials on each day and repeated for 4 consecutive days, and on 5th day during the retrieval trials. Bacosides on anterograde administration (before training) in mice, significantly decreased the escape latency time (ELT) during the acquisition trials for 4 consecutive days and increased the time spent (TS) in target quadrant during the retrieval trials on 5th day, and on retrograde administration (after training) bacosides were found not to affect TS significantly. Bacosides also significantly decreased the ELT and increased the TS in mice treated anterogradely with scopolamine and sodium nitrite. Bacosides did not exhibit any significant effect on TS of mice treated retrogradely with sodium nitrite. On the other hand, bacosides significantly increased the TS of mice treated retrogradely with BN52021. On the basis of the present results it can be concluded that bacosides facilitate anterograde memory and attenuate anterograde experimental amnesia induced by scopolamine and sodium nitrite possibly by improving acetylcholine level and hypoxic conditions, respectively. Beside this bacosides also reversed BN52021 induced retrograde amnesia, probably due to increase in platelet activating factor (PAF) synthesis by enhancing cerebral glutamate level.

Evaluating mental stress test in coronary artery disease treadmill positive patients.

Evaluation of CAD is more routinely done by treadmill test (TMT i.e. physical strain) than the more frequently occurring mental strain, so a study was planned to assess the provocability of ischaemia by various mental tasks in patient with positive TMT. Thirty educated subjects, positive on TMT were put on a 24 hour holter monitoring. During this time, subjects were assessed by Mental Stress Test (MST) by subjecting to various mental tasks - (a) Time stress test (b) Mental arithmetic test (c) Reading test (d) Zeigarnik effect test and observed for heart rate, blood pressure and ischaemic/arrhythmia responses. The results showed that the male : female ratio was 14:1 with a mean age of 57 ± 8.03 years. The mean change produced during MST in (a) heart rate was 9.16 (SD ± 1.24)/min (b) SBP was 8.86 (SD ± 1.32) mmHg (c) rate pressure product was 82x103; which were statistically low (p<0.001) when compared to haemodynamic changes with TMT. Ischaemia was inducible in only one subject by MST and no increased incidence of arrhythmias during MST was noticed. The low yield of inducible ischaemia by MST when compared to TMT could be due to poor haemodynamic responses achieved by MST when compared to responses of TMT (p<0.001). It is concluded that mental stress does produce ischaemic changes. More intense and sustained MST's which could bring about significant haemodynamic changes are required for inducing ischaemia as by TMT.