Role of Pulse Oximetry and Ankle Brachial Index in Diagnosis of Lower Limb Artery Disease (LEAD) in Patients with Coronary Artery Disease.

BACKGROUND: Lower extremity arterial disease is common disorder affecting large number of peoples and is frequently asymptomatic. Currently ABI is used as screening test for LEAD, which is time consuming and requires special instrument for measurement. We compare the role of pulse oximetry, ABI and its combination in diagnosis of LEAD. METHODS: Total 224 patients (448 limbs) were enrolled in the study. Complete history, examination was done. Pulse oximetry of all limbs and ABI of both lower limbs were measured. CT angiography and pulse Doppler was done to diagnose LEAD. RESULTS: Pulse oximetry was found to have sensitivity of 60.5%, specificity of 95.9% positive likelihood ratio 14.93 and negative likelihood ratio 0.41. ABI was found to have sensitivity of 69.7%, specificity of 97.3%, positive likelihood ratio 25.8 and negative likelihood ratio 0.32. But when both are combined, sensitivity increases to 84.2%, specificity decreases to 91.9%, positive likelihood ratio decreases to 10.39 and negative likelihood ratio decreases to 0.17. CONCLUSION: Our study suggests that pulse oximetry is simple and non-invasive test that provides quick result which is at least as accurate as ABI and thus is an easy alternative/ additional method for the screening of LEAD. However when used in combination with ABI the sensitivity for the detection of LEAD increases.

Combined deficiency of proteins C and S: ischaemic stroke in young individuals.

In adults of any age, the majority of strokes are ischaemic (caused by a blockage in the blood supply to the brain). Stroke in young individuals poses a major health problem. The WHO defines stroke as an event caused by the interruption of the blood supply to the brain, usually because of rupture of a blood vessel or blockage by a clot. This hampers the supply of oxygen and nutrients, causing damage to the brain tissue. Globally, stroke is the third commonest cause of mortality and the fourth leading cause of disease burden. Ischaemic stroke is the most common cerebrovascular disease, most often due to atherothrombotic diseases and uncommonly by disorders of hypercoagulation. Disorders of coagulation leading to thrombotic disorders are approximately 1% of all ischaemic strokes and 4-8% of strokes in young individuals. Similarly, combined deficiency of proteins C and S can lead to hypercoagulable state and rarely presents as a cerebrovascular accident. We describe here a case of a 25-year-old man who presented with right middle cerebral artery territory infarct due to protein C and S deficiency.