Effect of diabetes mellitus on markers of left ventricular dysfunction in chronic kidney disease.

OBJECTIVES: To identify markers of left ventricular dysfunction in chronic kidney disease (CKD) and the effects of diabetes mellitus on them. METHODS: This was a cross sectional study of 200 consecutive chronic kidney disease patients (stage III-V). Echocardiographic assessment of left ventricular function including left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left atrial volume, grade of diastolic dysfunction, E/E', left and right ventricular myocardial performance indices (LVMPI, RVMPI) were compared between diabetic and non-diabetic CKD. RESULTS: LVMI significantly increased with increasing stage of CKD (p < 0.001) in both diabetics (158.82 ± 48.76 gm/m2 in stage III to 201.06 ± 63.62 gm/m2 in stage V) and non-diabetics (133.14 ± 43.06 gm/m2 stage III to 196.24 ± 58.75 gm/m2 in stage V). This was significantly higher among diabetics of similar CKD stage compared to non-diabetics (p = 0.001). The LVEF worsened with increasing stage of CKD (p = 0.002) and was significantly reduced in diabetic patients (LVEF 61.96 ± 8.48 % in stage III CKD to 51.62 ± 13.45 % in stage V CKD) (p < 0.001). Diastolic dysfunction (Grades ≥2) and LA volume increased significantly with stage of CKD (p < 0.001) and was higher among diabetics (p = 0.048). Pulmonary artery systolic pressure (PASP) increased with increasing stage of CKD (p < 0.001), and was higher among diabetics (p = 0.035). E/E' worsened significantly with increasing stage of CKD and was also significantly higher in diabetics (p < 0.001). LVMPI (p < 0.001) and RVMPI (p < 0.001) were significantly reduced with worsening stage of CKD and in diabetics. CONCLUSION: Advancing CKD stage was linearly associated with progressive left ventricular dysfunction which was significantly greater in diabetics.

Achieving highly efficient and selective cesium extraction using 1,3-di-octyloxycalix[4]arene-crown-6 in n-octanol based solvent system: experimental and DFT investigation.

Due to the long half-life of 137Cs (t 1/2 ∼ 30 years), the selective extraction of cesium (Cs) from high level liquid waste is of paramount importance in the back end of the nuclear fuel cycle to avoid long term surveillance of high radiotoxic waste. As 1,3-di-octyloxycalix[4]arene-crown-6 (CC6) is suggested to be a promising candidate for selective Cs extraction, the improvement in the Cs extraction efficiency by CC6 has been investigated through the optimization of the effect of dielectric media on the extraction process. The effects of the feed acid (HNO3, HCl, and HClO4) and the composition of the diluents for the ligand in the organic phase on the extraction efficiency of Cs have been investigated systematically. In 100% n-octanol medium, Cs is found to form a 1 : 1 ion-pair complex with CC6 (0.03 M) providing a very high distribution ratio of D Cs ∼ 22, suggesting n-octanol as the most suitable diluent for Cs extraction. No significant interference of other relevant cations such as Na, Mg and Sr was observed on the D Cs value in the optimized solvent system. Density functional theory (DFT) based calculations have been carried out to elucidate the reason of ionic selectivity and enhanced Cs extraction efficiency of CC6 in the studied diluent systems. In addition to the ionic size-based selectivity of the crown-6 cavity, the polarity of the organic solvent system, the hydration energy of the ion, and the relative reorganization of CC6 upon complexation with Cs are understood to have roles in achieving the enhanced efficiency for the extraction of Cs by the CC6 extractant in nitrobenzene medium.

Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry.

BACKGROUND: Coronary artery disease (CAD) occurs at younger age in India but only a limited number of studies have evaluated risk factors and management status. This is a multisite observational registry to assess risk factors and treatment patterns in young patients presenting with acute coronary syndrome (ACS) and stable ischemic heart disease (IHD). METHODS: We recruited 997 young patients (men <55, women <65y) presenting with ACS or stable IHD successively at 22 centers across India. Details of baseline risk factors and management status were obtained. Descriptive statistics are reported. RESULTS: Mean age of participants was 49.1±8y, 72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had "possible familial hypercholesterolemia". Metabolic risk factors (high BMI, diabetes and hypertension) were significantly greater in women (p<0.01). Women were older at diagnosis of CAD and presented more often with non-ST elevation ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent percutaneous coronary intervention while coronary bypass surgery was performed in 10.4%. CONCLUSIONS: Conventional risk factors including family history continue to play a pivotal role in premature CAD in Indians. Women have more of metabolic risk factors, present at a later age and have non-ST elevation ACS more often. There is a need to focus on improving use of evidence-based drug therapies and interventions.

Heel pain and phonophoresis.

A review of 25 cases of heel pain treated conservatively with phonophoresis, using the anti-inflammatory gel containing a combination of flufenamic acid, salicylic acid and mucopolysaccharide polysulphate is being reported here. The purpose of the study was to assess the effectiveness of a noninvasive procedure called phonophoresis in treating hell pain. It involved usage of ultrasound waves to deliver anti-inflammatory drugs to the painful site. The heel pain subsided in all the cases and did not recur for a period of one year till last reviewed indicating the definite role of phonophoresis in heel pain.

Acute ST elevation myocardial infarction in a patient with caged ball mitral valve prosthesis: a case report.

One of the complications of prosthetic valve thrombosis (PVT) is systemic thromboembolism. We are reporting the occurrence of coronary artery embolism presenting as acute ST elevation myocardial infarction, 15 years after mitral valve replacement in a 30 year old female, with no clinical evidence of PVT.

Transesophageal Doppler echocardiographic study of pulmonary venous flow pattern in severe mitral stenosis and the changes following balloon mitral valvuloplasty.

The studies of pulmonary venous flow-pattern in mitral stenosis (MS) have given conflicting data about the type of abnormality. This study was undertaken to assess the pulmonary venous flow-pattern in severe MS and to study the changes occurring after balloon mitral valvuloplasty (BMV). There were 51 patients of MS with sinus rhythm with the mean age of 32.5+/-9.35 years, 18 males and 33 females. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed before and after BMV. Pulmonary venous flow was recorded by TEE from left upper pulmonary vein (PV). Peak velocities (V) and velocity time integrals (VTI) of systolic wave (S), diastolic wave (D), and atrial reversal wave (A) were measured. The S(v)/D(v) and S(VTI)/D(VTI) were calculated. Mitral valve area (MVA) increased from 0.81+/-0.18 cm(2) to 2.02+/-0.46 cm(2), left atrium (LA) mean decreased from 28.55+/-6.68 mmHg to 13.88+/-4.89 mmHg, and cardiac output increased from 3.1+/-0.86 L/min to 3.7+/-1.02 L/min. The S, D, and A velocities increased from 33.84+/-13.55 cm/s, 37.24+/-11.55 cm/s, and 20.53+/-6.7 cm/s to 59.86+/-18.25 cm/s, 48.43+/- 12.55 cm/s, and 24. 94+/-9.14 cm/s, respectively. The VTIs of S, D, and A waves increased from 4.88+/-2.24 cm, 6+/-2.45 cm, and 2+/-0.88 cm to 10.46+/-4.23 cm, 8.82+/-3.61 cm, and 2.34+/-1.29 cm, respectively. MS leads to reduction in pulmonary flow velocities during all the phases. Successful BMV resulted in improvement of all these velocities, with improvement in systolic fraction being the maximum. These improved flows after BMV appear to be secondary to reduction in LA pressure and improved cardiac output.

Balloon mitral valvuloplasty: our experience with a modified technique of crossing the mitral valve in difficult cases.

The efficacy and safety of percutaneous transvenous mitral commissurotomy performed by the Inoue technique is well known. In cases with critical mitral stenosis and when there is abnormal bulge of the interatrial septum, the usual direct method of crossing the mitral valve may not be successful. In such cases alternative over-the-wire techniques to cross the mitral valve have been advocated by various authors. In this report of 32 cases, we present our experience with the modified and simplified version of over-the-wire technique of crossing the mitral valve in technically difficult cases. This technique involves direct positioning of a pigtail Inoue wire into the left ventricle through the Mullin sheath followed by introduction of an Inoue catheter over the wire. The mitral valve could be crossed in 30 cases (93.75%). There were no major complications attributable to this technique. Frequent ventricular premature beats (100%) and episodes of nonsustained ventricular tachycardia (90%) were seen in most of the cases. We conclude that our modification of the over-the-wire technique is safe, effective, and does not require any additional accessories. Using this technique, percutaneous transvenous mitral commissurotomy could be performed, even in difficult cases wherein the conventional method of crossing the mitral valve has failed.