Metabolic Diseases and Associated Complications in Patients with Psoriasis.

BACKGROUND: Psoriasis patients are at increased risk of developing metabolic diseases. Proinflammatory cytokines such as IFN-γ, IL-17, IL-23, and TNF-α,IGF that are increased in psoriasis play an important role in the development of diabetes mellitus(DM), hypertension, dyslipidemia, obesity, insulin resistance and their complications. AIMS: To study prevalence of insulin resistance (IR) using HOMA-IR index in psoriasis patients and its association with severity of psoriasis. To study prevalence of metabolic diseases, macro and microvascular complications of these diseases in psoriasis. MATERIALS AND METHODS: A hospital based case control study was conducted involving 102 psoriasis patients and 102 age and sex matched controls. All patients were analysed for the presence of metabolic diseases and their complications. RESULTS: Mean age of cases was 38.41±16.37 years. Majority of cases(58.8%) as well as controls (55.9%) were males. Prevalence of hypertension, prediabetes, DM, raised TG, low HDL, MetS and IR was 46.1%, 28.4%, 27.5%, 42.2%, 31.4%, 31.4% and 48% respectively in cases as compared to 26.5%, 13.7%, 11.8%, 24.3%, 16.7%, 10.8% and 26.5% respectively in controls. However there was no significant difference in obesity (29.4% vs 21.6%, p=0.2024) and LDL among the cases and controls(14.7 %vs 10.8%,p= 0.4). Prevalence of all the metabolic disorders except LDL was significantly higher in cases as compared to that in controls. Prominent complications noted were retinopathy, neuropathy and CVD. With increased psoriasis severity insulin resistance increased. CONCLUSION: There is a positive correlation of psoriasis with IR and it is associated with increased risk of metabolic diseases and their complications.

Familial hypercholesterolemia supravalvular aortic stenosis and extensive atherosclerosis.

Familial hypercholesterolemia is an autosomally dominant disorder caused by various mutations in low-density lipoprotein receptor genes. This can lead to premature coronary atherosclerosis and cardiac-related death. The symptoms are more severe in the homozygous type of the disease. Premature malignant atherogenesis leading to aortic root abnormalities causing supravalvular aortic stenosis is rare. Our case demonstrates the diagnostic imaging findings of the phenotype of patients who have severe elevated LDL with familial hypercolesterolemia.

Clinical Profile with Angiographic Correlation in Naïve Acute Coronary Syndrome.

INTRODUCTION: Despite cardiovascular diseases having grown to epidemic proportions, there are few studies from India pertaining to Acute Coronary Syndrome (ACS), more so from the region of Purvanchal which is less developed with more poverty. Our study is first of its kind in this region of patients presenting for the first time with ACS. AIM: The present study was undertaken to study the clinical and angiographic characteristics of ACS patients of Purvanchal. MATERIALS AND METHODS: This was a prospective cohort study of 100 patients admitted with ACS. Patients were excluded if they had prior cardiac pathology like valvular heart disease, cardiomyopathy, pericardial disease, cor pulmonale, ischaemic heart disease or cardiac revascularisation. Patients who did not undergo angiography were excluded. Patients were divided into ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI). Presentation delays as well as clinical characteristics analysed in each group were age, gender, presence or absence of diabetes mellitus, hypertension, dyslipidaemia, smoking, Body Mass Index (BMI), family history, duration of chest pain, and treatment received. RESULTS: Mean age of patients was 58.9 years with 27% below 50 years. Of the total 75% were males. Patients with STEMI were 65%. Median time to reach hospital was 24 hours with only 27% patients reaching hospital within 6 hours. Among patients with STEMI only 43% received fibrinolytic therapy. 23% patients had diabetes, 21% were hypertensive, 16% were smokers, family history of cardiovascular disease present in 11% and 21% had body mass index more than 30. Mean LDL was 115mg/dl and HDL 39mg/dl with 54% of patients having at least one risk factor. Factors favouring triple vessel involvement were female sex, higher age, smoking, presence of diabetes and NSTEMI. CONCLUSION: Indians develop ACS at earlier age. Precious time is lost before seeking treatment. There is a need for aggressive risk factor modification which along with health awareness will be the key to prevent premature cases of ACS and limit morbidity and mortality due to delayed treatment.

Metoprolol vs ivabradine in patients with mitral stenosis in sinus rhythm.

BACKGROUND: Severe mitral stenosis is usually symptomatic and is treated by BMV or surgery, whereas mild to moderate mitral stenosis is usually asymptomatic or mildly symptomatic and managed medically. Patients in the later group may become symptomatic during episodes of exercise and increased heart rate. Beta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to investigate the comparative efficacy of ivabradine versus metoprolol in patients with mitral stenosis in sinus rhythm. METHODS: We studied 97 patients of mitral stenosis in sinus rhythm presented with exertional symptoms. The effectiveness of Metoprolol was compared with ivabradine in alleviating these exertional symptoms in a randomized, open label non crossover study. We also assessed various stress ECG parameters, 24 hour Holter parameters and 2D Echo parameters to objectively compare the effects of ivabradine and metoprolol in these patients. RESULTS: Ivabradine and metoprolol both were effective in controlling exertional symptoms. Significant improvement in objective parameters like TMT (work capacity, baseline heart rate and maximal heart rate) and 2D echocardiography (right ventricular systolic pressure) are seen with both drugs. Ivabradine controls the exertional symptoms significantly more than metoprolol. On head to head comparison there was a significant benefit of working capacity and heart rate at maximal exercise in favour of ivabradine. CONCLUSIONS: Ivabradine should be strongly considered in medical management of mitral stenosis patients where beta blockers are contraindicated such as reactive airway disease. The cost of ivabradine is higher than metoprolol which might possess constraints as most of the rheumatic heat disease patients belong to low socio economic status.