Expert Consensus Document on Management of ST-Elevation Myocardial Infarction: Adaptation of 2012 ESC Guidelines.

In 2012, the European Society of Cardiology (ESC) guidelines provided recommendations on the management of ST-elevation myocardial infarction (STEMI). The recommendation from these guidelines is restricted to the European subcontinent. To adapt the updated recommendations for Indian subset of STEMI patients, a panel of experts in the management of STEMI provided their expert opinions. This document provides expert consensus on adapting 2012 ESC STEMI guidelines recommendations in Indian setting. Document also discussed "India-specific" relevant literature to support the consensus opinions provided in the management of STEMI.

Association of Physicians of India: Position Statement on Role of Chirally Pure Molecules in Clinical Practice.

Chirally pure molecules or enantiomers are non-superimposable mirror images of each other with a chiral center (such as carbon, sulphur, nitrogen or phosphorous atom). An equimolar mixture of enantiomers forms a racemate. Chirally pure molecules (single enantiomers) are important in the field of drug discovery as the drug targets such as enzymes and receptors are enantioselective in nature. Clinical studies have demonstrated that chirally pure drugs exhibit different pharmacokinetic and metabolic profiles, reduced adverse events, improved safety profiles and similar therapeutic activity at lowered drug dosage as compared with the racemate in many therapeutic areas. However, since there is a low level of awareness on the advantages of chirally pure molecules among clinicians, pharmacists and patients in India, the Association of Physicians of India (API) developed this position statement to increase awareness on the concept of chirality and the associated advantages of using chirally pure drugs in certain therapeutic areas to maximize patient outcomes. This includes the clinical evidence associated with single enantiomers such as S-metoprolol, S-amlodipine, esomeprazole, escitalopram, levobupivacaine, cisatracurium, S-etodolac, dexketoprofen, levofloxacin in terms of efficacy and safety as compared with their racemates. In addition, the API also provides some tactical recommendations for clinicians, pharmacists, patients, regulatory body and pharmaceutical companies to increase awareness on chirally pure drugs and puts forth the need for expedited availability of chirally pure drugs in the Indian market.

Polymorphism of ACE gene as the genetic predisposition of coronary artery disease in Eastern India.

AIM: A case control study was designed to assess whether the prevalence of ACE gene polymorphism has any role in the development of CAD. METHODS: The study included unrelated 217 cases with CAD and 255 healthy controls. PCR was done using primers followed by agarose gel electrophoresis for study of different ACE gene polymorphisms. Multiple logistic regression analysis was carried out to find association between studied genotypes and lifestyle as well as biochemical risk factors. RESULTS: Both DD [OR: 2.16; 95%CI: (60.60-67.40)] and ID [OR: 1.48; 95%CI: (93.28-97.72)] genotypes of the ACE gene showed significant associations in the development of CAD. Coexistence of diabetes and hypertension found to be risk modifier of the disease. Tobacco intake in various forms elevates the risk of the disease among the cases with risk genotypes. CONCLUSION: ID and DD genotypes of ACE gene came out to be predisposing factors for the CAD cases in our study population.

Polymorphisms of methylenetetrahydrofolate reductase gene as the genetic predispositions of coronary artery diseases in eastern India.

BACKGROUND: Gene-environment interaction is an important aspect in the development of coronary artery disease (CAD). The mutation (677C-T) of methylenetetrahydrofolate reductase (MTHFR) gene results in a decrease of the enzyme activity that leads to mild hyperhomocysteinemia. Elevated plasma level of homocysteine has been recognized as an independent risk factor for cardiovascular disease. A case-control study was designed to assess whether the prevalence of some MTHFR gene polymorphisms have any role in the development of CAD. MATERIALS AND METHODS: The study included unrelated 217 cases with CAD and 255 healthy controls. DNA was extracted from peripheral blood. MTHFR genotypes were identified by seeing the presence or absence of 677C→T mutation obtained by PCR followed by Hinf1 restriction digestion. Multiple logistic regression analysis was carried out to find association between studied genotypes and lifestyle as well as biochemical risk factors. RESULTS: The T allele was found to be associated with the disease. Significant associations were found with smoking, hypertension, diabetes, and family history of CAD. CONCLUSION: The results indicate that MTHFR 677C-T polymorphism has significant association with CADs in the population of eastern India.

Contrast-induced nephropathy.

Contrast-induced nephropathy (CIN) is a fairly common yet under-recognized clinical condition in the interventional cardiological practice. A 25% or more than 0.5 mg/dl rise of serum creatinine is generally accepted as defining CIN. The most important risk factors for CIN are pre-existing renal disease, volume of contrast media, nature of contrast media, and diabetes mellitus. Among the various postulated pathophysiological mechanisms for the precipitation of CIN, intra-renal vasoconstriction, and oxidative tubular injury are the best documented. Effective strategies to prevent CIN include adequate peri-procedural hydration with normal saline, use of N-acetylcysteine, keeping the volume of contrast media as low as feasible, and avoiding high-osmolal ionic contrast media. However, more efficient and cost-effective strategies are being developed and the search for the ideal contrast media is still on.