Clinical profile, treatment and outcome of Kawasaki disease: A single-center experience from a tertiary care referral center of Assam, north-east India.

AIM: This is a retrospective study to report our experience with a cohort of 73 patients with Kawasaki disease (KD) over 2.5 years. METHOD: The study was conducted in the Department of Pediatrics. Data were retrieved from medical records of Pediatric Rheumatology and Immunodeficiency Clinic collected from April 2017 to October 2019 and analyzed. RESULTS: Male-to-female ratio in our cohort was 2:1. The median age at diagnosis of KD was 3 years (IQR, 4.25). Fever was present in all patients. Oral mucosal changes are the second most common symptom (N = 64, 87%) followed by extremity changes (N = 58, 79%), and rash (N = 56, 76%). Nineteen (26%) children had cardiovascular complications like coronary artery abnormalities (N = 15, 20%), cardiac tamponade (N = 2, 2%), and shock (N = 1, 1%). The effusion in the patients with cardiac tamponade contained inflammatory cells and plenty of red blood cells. Sixty-eight (93%) patients with KD had received treatment with IVIg. Patients in our cohort had completed a mean follow-up of 13.6 ± 9.4 months. No fatality or any long term adverse effects were observed on follow-up. CONCLUSION: Kawasaki disease is a common rheumatological disorder in children at our center with diverse clinical presentations. The disease needs to be considered as a differential diagnosis in an acute febrile illness in children persisting up to 5 days.

Glycated Hemoglobin (HbA1c) Correlation with Severity of Coronary Artery Disease in Non-diabetic Patients - A Hospital based Study from North-Eastern India.

INTRODUCTION: Glycated Hemoglobin (HbA1c) levels are predictive of cardiovascular disease and mortality in patients with diabetes mellitus, however, association of HbA1c with Coronary Artery Disease (CAD) in non-diabetics is inconsistent. AIM: To evaluate the correlation between HbA1c level and severity of CAD in non-diabetic patients using SYNTAX score in a cohort of proven CAD on angiography at Gauhati Medical College, Guwahati, Assam, India, which is a major tertiary care hospital of North-Eastern India. MATERIALS AND METHODS: We prospectively collected data of non-diabetic patients with proven CAD on angiography from June 2014 to June 2015. Patients were divided into four groups (interquartiles) according to HbA1c levels, less than 4.8%, 4.8% to 5.1%, 5.1% to 5.6%, and 5.6% to 6.5%. Severity of CAD was assessed using SYNTAX score and the number of coronary vessels diseased. We compared different quartiles of HbA1c with regard to SYNTAX score and number of diseased vessels. RESULTS: A total of 346 patients were included in the study. Mean age was 58.1±10.4 years. Of the total 91.9% (318) were males, 44.8% (155) were hypertensives, 29.2% (101) were smokers and 34.7% (120) were dyslipidemic. We found that CAD severity by SYNTAX score as well as number of vessels involved was significantly different among quartiles (p-values <0.001 and <0.001 respectively). Increase in HbA1c level was strongly correlated with disease severity and higher SYNTAX score. A significant increase was noted in the mean number of diseased vessels (p-value <0.001) as HbA1c level increases. Age, gender, hypertension and dyslipidemia did not show significant difference among quartiles however smoking was found to be an independent predictor of severity of CAD by SYNTAX score (p <0.05). CONCLUSION: From this clinical study, we can conclude that a significant correlation exists between HbA1c and severity of CAD by SYNTAX score as well as number of vessels involved in non- diabetes.

Spectrum of acute coronary syndrome in North Eastern India - A study from a major center.

AIM: Spectrum of acute coronary syndrome (ACS) has not been reported from North Eastern India. The present study was undertaken to study the clinical spectrum of ACS. METHODS: We prospectively collected data of 704 ACS patients from February 2011 to August 2012 in Gauhati Medical College, a tertiary care center. We evaluated data on clinical characteristic, treatment, and outcome in ACS patients. RESULTS: Of the 704 ACS patients, 72.4% presented with STEMI and 27.6% presented with NSTEMI/UA. Mean age of presentation was 56.5 years. Mean time to presentation was 11.42h and was higher in NSTEMI/UA than STEMI (12.86h vs. 9.98h, p<0.001). Treatment for STEMI did not differ much from NSTEMI/UA with ≥90% of patients in both groups receiving antiplatelets, statin, and anticoagulants. 39% of STEMI received thrombolytic therapy and percutaneous coronary intervention (PCI) rates were higher in STEMI. The 30-day mortality was found to be 10.22%, with STEMI having higher mortality than NSTEM/UA (11.76% vs. 6.18%, p=0.03). CONCLUSION: These data represent the first reported study on spectrum of ACS in North Eastern India and has noted few key differences from the national registry CREATE, with greater percentage of STEMI patients, greater delay in seeking treatment, greater 30-day mortality, and lesser percentage of patients receiving reperfusion therapy.