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   Table of Contents - Current issue
January-March 2020
Volume 10 | Issue 1
Page Nos. 1-42

Online since Monday, April 20, 2020

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Myocardial infarction in people living with HIV/AIDS p. 1
Shailesh Singh, Katyayni Singh
The advancements in the field of antiretroviral therapy and prevention, diagnosis and treatment of deadly opportunistic infections in HIV has led to prolongation of life of these patients. As these patients now have a higher life expectancy and since they are dying less of infectious diseases, a rise in cardiovascular and metabolic diseases has been seen in these patients. More and more patients have been found to be suffering from acute coronary syndrome, peripheral vascular disease, and stroke.
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Association between anthropometric measurements and lipid profile in newly detected hypertensive patients at a tertiary hospital in Bangladesh p. 6
Jishu Deb Nath, Rajat Sanker Roy Biswas
Introduction: Hypertension (HTN) is an important public health problem worldwide and causing global disease burden contributing as cardiovascular diseases, cerebrovascular disease (stroke), and end-stage renal disease and marked disability. Objectives: The objective was to investigate the correlation between anthropometric indices and dyslipidemia relating to newly diagnosed HTN and compare with normotensive individuals. Materials and Methods: A cross-sectional comparative study of 131 patients splitting two groups comprising 65 hypertensive patients as case and 66 normotensive patients as control underwent in a tertiary hospital. Different anthropometric indices and fasting lipid profile were evaluated between two groups with the help of SPSS software. Results: Among 131 patients, the mean ± standard deviation (SD) of systolic blood pressure (SBP) was 155.9 ± 9.18 in case group and 124.6 ± 22.06 in control group (P < 0.5) and diastolic pressure was 96.70 ± 6.10 in case group and 78.45 ± 6.98 in control group (P < 0.05). The mean ± SD body mass index was 24.23 ± 3.3 in case group and 22.13 ± 2.92 in control group (P < 0.05). Serum triglyceride was 251.13 ± 85.9 in case group and 256.5 ± 73.5 in control group (P < 0.05). Total cholesterol (TC) and low-density lipoprotein (LDL) were 230.2 ± 44.53 and 150.78 ± 32.9 in case group and 166.27 ± 30.45 and 98.9 ± 20.15 in control group (P < 0.05). Strong-positive correlation was found between high SBP and LDL (r = 0.517), high diastolic blood pressure (DBP) and LDL (r = 0.560), and high DBP and TC (r = 0.514). Conclusion: Anthropometric measures and lipid profile are the important tools should be emphasized early to diagnose HTN.
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Biochemical markers for detection of intracardiac thrombosis p. 10
Hala Gouda Abomandour, Baher Nabil Nashy, Ahmed Shaker
Aims: Intracardiac thrombus is known as the common cause of cardiogenic cerebral ischemia and a useful clinical marker of thrombogenesis. This study aimed to predict the presence of intracardiac thrombosis by noninvasive method using NT-pro-brain natriuretic peptide (BNP) and D-dimer evidenced by trans-esophageal echocardiography (TEE). Methods: A total of 200 patients were included and referred to TEE for the detection of intracardiac thrombi. Measurement of NT-Pro-BNP and D-dimer was done 2 h before the TEE examination. The patients were divided into two groups namely Group A with intracardiac thrombus and Group B without intracardiac thrombus. Results: There was an increased prevalence of intracardiac thrombus in diabetic hypertensive patients and transient ischemic attack patients. Intracardiac thrombus had significantly higher levels of Pro-BNP and D-dimer (P < 0.001). Using the receiver operating characteristic curve, the value of D-Dimer level >788 ng/ml and NT-Pro-BNP >683 ng/ml predicted the presence of intracardiac thrombus. Conclusion: High value of NT-Pro-BNP and D-dimer level can predict the presence of intracardiac thrombosis and its decreased value can predict the absence of thrombosis in patients with suspected intracardiac thrombi.
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PTCA in anomalous RCA arising from left sinus of valsalva - A case series p. 16
Veena Nanjappa, KS Sadanand, CN Manjunath
Background: Anomalous origin of the right coronary artery (AORCA) from the left sinus of Valsalva (LSOV) accounts for 6%–27% of all coronary anomalies. Systematic planning and selection of appropriate catheters are pertinent for successful results. On many occasions, it is not possible to selectively cannulate the vessel despite the use of multiple catheters or modified curves in them. Situation worsens in acute coronary syndrome scenario where valuable time is lost just trying to delineate the diseased coronary anatomy. Aims and Objectives: to study the guide catheter selection in cases of (Anomalous RCA) AORCA arising from left sinus of valsalva (LSOV). Materials and Methods: We encountered six cases of AORCA from left sinus of valsalva with significant coronary lesions in one year. Results: Three cases were done through transfemoral access and in three others cases the access was switched from transfemoral to right radial access. In two of these cases we adopted a double length coronary wire for performing the percutaneous transluminal coronary angioplasty (PTCA) as compared to the regular technique. Conclusion: In order for PTCA to be successful in anomalous coronary arteries, optimal guide catheter seating and catheter back up should be achieved, both of which may require modification in either the technique or change in access or alteration in the guiding catheter employed. While performing primary PCI, the operators and the ancillary staff need to be aware of this anomaly and be prepared. Exchanging guide catheter on coronary double length wire though cumbersome can ensure successful outcome. Change to right radial approach may confer an additional advantage of cannulating the vessel as the catheter gets support from the contralateral aortic wall.
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Predicting preventive strategies of acute myocardial infarction in young patients in Egypt: An observational analytical study in the form of cross-sectional study p. 22
Islam Elsayed Shehata, Basel Hatem, Mohamed Wafaei Aboul Enein, Ahmed Saeid Eldamanhory
Background: In the developing countries, coronary artery disease commonly occurred in younger people and is the main cause of mortality worldwide. Aim: This study aims to identify risk factors and characteristics of acute myocardial infarction (AMI) in young patients. To clarify the risk factors for AMI in young patients and the prevention for it, is very important problem worldwide. Patients and Methods: 650 ST-elevation myocardial infarction (STEMI) patients were included in our study. History taking, clinical examination, electrocardiography, echocardiography, and cardiac enzymes and coronary angiography were done to all patients; demographic data and risk factors including mental stress measured by the Standard Stress Scale, left ventricular (LV) dimensions, LV systolic and diastolic function, and angiographic characteristics were measured. We excluded patients with familial dyslipidemia and Type I diabetes. We classified the patients into two groups according to age: Group I – young – 142 patients <45 years and Group II – old – 508 patients >45 years. Statistical Analysis: Variables were expressed as the mean ± standard deviation. Percentage was used for categorical variables. t-test was used for comparison. Then, the significant univariate predictors were assessed by multivariate linear regression analysis to find the independent predictors for unfavorable outcome. Data analyses were performed with SPSS (version 21.0, Chicago Inc., Chicago, Illinois, USA). Results: Young patients were 142 (21.8%); males were majority between both groups. Smoking (56.3%), addiction (17.6%), mental stress (79.6%), and family history (4.2%) were significantly associated with young age group. Spontaneous coronary dissection (SCAD) (6.3%) and coronary spasm (10.5%) are relatively common cause of young AMI patients. SCAD and spasm has its specific risk factors such as young female and smoking, respectively. Anterior STEMI occurred in 59.1% of young patients and was the most common followed by Inferior STEMI in 31%. 14.8% of young patients presented late after 12 h of onset of symptoms. The multivariate logistic regression for independent predictors of unfavorable outcome showed that hypertension, Type II diabetes mellitus, Killip class, and multiple-vessel disease were significant predictors of unfavorable outcome. Conclusion: The prevalence of STEMI in young patients is increasing due to sedentary and stressful lifestyle and bad habits as smoking and addiction. Young patients have unique risk factor profile. STEMI in young occurred most often in males. Smoking is the most common risk factor. Anterior STEMI is the most common followed by inferior STEMI.
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Characterization of Iron deficiency in patients with chronic heart failure: A prospective, multicentric, observational study from India p. 30
Dharmendra Jain, Bhupen N Desai, Rajeev Kumar Rathi, Chandra Shekhar, Prasant Kumar Sahoo, Nitin Burkule, Sitanshu Sekhar Mohanty, Sohan Kumar Sharma, Gursaran Kaur Sidhu, Uttam Kumar Halder, M Jayarajah
Objective: The objective of the study is to assess the characteristics of iron deficiency (ID) in Indian patients with chronic heart failure (CHF). Materials and Methods: This was a prospective observational study involving in patients visiting the outpatient department and admitted to hospitals with a clinical diagnosis of CHF falling within the New York Heart Association (NYHA) classification (I–IV). ID was diagnosed based on hemoglobin (Hb), serum ferritin levels, serum iron, total iron-binding capacity, and transferrin saturation (TSAT) percentage. Absolute ID was diagnosed as ferritin level <100 μg/L. Functional ID was diagnosed as normal serum ferritin (serum ferritin, 100–299 μg/L) in combination with TSAT (>20%). Anemia was defined as Hb <13 g/dL for men and <12 g/dL for women, based on the definition by the World Health Organization. Results: A total of 584 patients (men, 311 [53.25%]; women, 259 [44.35%]) with a mean age of 56.68 ± 14.53 years were evaluated. Absolute ID was noted in 314 (53.8%) patients. Female patients had a higher prevalence of absolute ID than male patients (51.3% vs. 46.5%; P < 0.0001). Patients with ID tended to be younger and predominantly belonged to NYHA Class II. The prevalence of anemia was higher in patients with ID than those without ID [167 (57.6%) vs. 123 (42.4%); P=0.0602]. The functional ID was present in 34 (6.34%) of patients, with a higher prevalence in female patients. Conclusion: More than half of the study population had ID. Female sex, younger age, and NYHA Class II of heart failure were some of the parameters that were associated with the presence of ID.
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Transbrachial approach for successful recanalization and stenting of celiac artery p. 37
CM Nagesh, VA Sathwik Raj, TR Raghu, CN Manjunath
Mesenteric ischemia is an infrequent condition that presents either acutely or chronically. Endovascular treatment of mesenteric artery stenosis or short-segment occlusion by balloon dilation or stenting represents a less invasive therapeutic alternative to open surgical intervention, particularly in patients with comorbidities. We describe a case of ostio proximal celiac artery occlusion that was treated using balloon-expandable stent through the left brachial approach.
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Aggressive emergency interventional management in a case of intraoperative massive pulmonary embolism p. 40
Shishir K Roul, Shubhranshu Kumar, Muni Venkatesa Reddy, Saurabh Ajit Deshpande
Acute pulmonary embolism (PE) is commonly associated with trauma-related orthopedic procedures (63% or even higher). Massive PE in this setting requires meticulous treatment decisions to reduce bleeding risk. We hereby present such a case where we successfully used a combination of fibrinolysis and catheter-directed fragmentation and multidisciplinary approach for intraoperative massive PE.
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