Serum ferritin-a novel risk factor in acute myocardial infarction.

BACKGROUND: A possible association between body iron status and risk of coronary heart disease (CHD) has been found to be controversial from the data obtained from various studies. OBJECTIVES: To study the relationship of serum ferritin with acute myocardial infarction (AMI) in univariate and multivariate analysis and to assess the relationship of high serum ferritin with established conventional risk factors. METHODS: Hospital based case-control study of 75 cases of AMI, and 75 age and equal number of age, and gender-matched controls without having AMI in the age group of 30-70 years. RESULTS: Median serum ferritin levels were significantly higher in cases (220 µg/L) than controls (155 µg/L) (P ≤ 0.0001. In univariate analysis in addition to ferritin > 200 µg/L (odds ratio [OR] 6.71, 95% confidence interval [CI] = 3.22-12.89, P<0.05), diabetes (OR=7.68, 95% CI=2.95-19.13, P<0.05), hypertension (HTN) (OR=2.36, 95% CI=1.02-5.14, P<0.05) high-density lipoprotein (HDL) < 35 mg/dL (OR = 11.9, 95% CI = 2.66-52.57, P<0.05) and smoking (OR=2.17, 95% CI = 1.12-3.87, P< 0.05) were found to be significantly associated with AMI. After controlling for all conventional risk factors, in multiple logistic regression analysis, high ferritin was significantly associated with AMI. (adjusted OR=5.72, 95% CI=2.16-15.17, P < 0.001). Serum ferritin was significantly higher in diabetics than non-diabetics (P < 0.01). CONCLUSION: High serum ferritin is strongly and independently associated with AMI.

Association of impaired cognitive functions with cardiovascular risk factors in elderly Indian population.

BACKGROUND: The prevalence of dementia is projected to rise dramatically in future with increasing life expectancy. Though dementia itself is not treatable in majority of cases, modification of co-morbid medical conditions may influence onset and rate of decline of cognitive functions. OBJECTIVE: To determine the prevalence of dementia in elderly by assessing cognitive function and to assess the association of cardiovascular risk factors with cognitive functions. STUDY DESIGN: Cross sectional analytical study. PARTICIPANTS: 400 consecutive elderly subjects > 65 years attending Geriatric OPD, Dept. of Medicine, Indira Gandhi Government Medical College, Nagpur, were recruited and assessed for cognitive functions by applying Mini Mental Status examination Score (MMSE). Relationships between cardiovascular risk factors and impaired cognitive score were determined. RESULTS: Prevalence of impaired cognitive function (MMSE Score < 25) was 33.25% (133 cases), while that of dementia (MMSE < 23) was 3.25 % (13 cases) in this elderly population. Impaired cognitive function was higher in those with low education and low socioeconomic status, (p = < 0.001). Increasing age, Female gender, alcohol intake and high cholesterol were found to be independently associated with impaired cognitive score in multiple logistic regression (p = < 0.001). Hypertension, diabetes mellitus, smoking and obesity were not associated with impaired cognitive score. CONCLUSION: Prevalence of cognitive impairment rises significantly as the age advances and is associated with alcohol intake and high cholesterol.

Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India.

BACKGROUND & OBJECTIVE: In India a chikungunya fever outbreak started in December 2005 when the country experienced more than 13 lakhs of chikungunya infected cases. We undertook this study to study detailed clinical profile of chikungunya fever in both indoor and outdoor patients in a tertiary care hospital in Nagpur, Maharashtra in 2006. METHODS: Suspected cases of chikungunya fever (n=405) during the period of July to September 2006, having clinical triad of fever, arthralgia and/or rashes were included in the study. Clinical profile was studied in all the cases. Of the 405 samples collected, 166 were tested for serum CHIK IgM antibodies. RESULTS: Of the 166 samples tested for CHIKV IgM antibodies, 87 (52.4%) were positive (confirmed cases). Male: female ratio was 2.3:1. Fever and arthralgia were present in all cases. Rash was present in 27 (31%) confirmed and 38 (12%) suspected cases. Lymphadenopathy was present in 12 (13.8 %) confirmed and 4 of suspected cases. Chronic polyarthritis was seen in 22 (25.3%) confirmed and 75 (23.6%) suspected cases. Neurological manifestations were observed in 08 (9%) confirmed and 10 (3.14%) suspected cases. Mortality was 7 (2.2%) in 318 suspected cases and 3 (3.4%) in 87 confirmed cases. INTERPRETATION & CONCLUSION: Our findings showed that about half of the serum samples for CHIKV IgM antibody tested positive from cases suspected to have chikungunya fever. Fever, joint pain and headache were major symptoms. Certain rare manifestations like lymphodenopathy, oral ulcers and encephalitis were also seen. Mortality in confirmed cases was about 3.4 per cent.

Clinical profile of acute myocardial infarction in elderly (prospective study).

BACKGROUND: Heart disease is the leading cause of hospitalization and death in elderly patients. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instances and the manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. OBJECTIVE: The purpose of this study is to describe the risk factors, clinical features, outcomes in AMI in Elderly (>60 years) and to compare the same with the young subjects (<60 years) and to study the various complications in 30 days follow up. STUDY DESIGN: Prospective observational cross- sectional analytical study. SETTING: ICCU Department of Medicine, Indira Gandhi Government Medical College, Nagpur. PARTICIPANTS: 120 cases of AMI were categorized in two groups:--(a) Group I--age < 60 years, (b) Group II--age >60 years. Subjects were analyzed for baseline clinical history, complications, and risk factors of AMI. A detailed clinical examination and relevant investigations were done. The various complications at the time of admission were recorded. 07 days in hospital follow up and 30 days follow up after discharge from hospital was done for various complications. RESULTS: The male and female ratio was 3:1 in group I and 1.37:1 in-group II Atypical chest pain, sweating, dyspnoea and giddiness were observed predominantly in the elderly group with AMI than younger group, and less no. Of elderly subjects arrived at hospital within 6 hours of chest pain as compared to young subjects. (30/64 i.e. 46.8% vs. 40/56 i.e. 71.4%, p = < 0.05). Thrombolytic therapy and beta-blockers were under used in elderly (group II) (35.8% & 7.8% cases) as compared to( 60.8% and 60.8% cases) in(group I) respectively. Poor LVEF <55% (31 i.e. 63.2% cases) and presence of ventricular aneurysm in 2 cases were observed in-group II (>60 years). The incidence of major complications like congestive cardiac failure, arrhythmias, AV block were significantly higher in the elderly group (70.2%, 57.8%, 28.6%) as compared to (46.5%, 37.5%, 7.1%) respectively in younger group. Mortality, CCF, post AMI angina were the common complications observed in group (II), during one month follow up after AMI, whereas interventions like CABG/ PTCA were commonly performed in group I (<60 y). Mortality was significantly high in elderly group (II) than young (gr I) with AMI, 25 (39%) vs. 7 (12.5%) (p = 0.019). CONCLUSION: We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication and mortality rate.