Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study.

OBJECTIVE: India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population. METHODS: A total of 18 918 individuals (aged 42.6 ±â€Š11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively. RESULTS: On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds. CONCLUSION: There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.

Primary aspergillosis of the larynx: a case report.

Aspergillosis of larynx is very rare. Only a few cases have been reported in medical literature. Larynx is generally involved secondarily by aspergillosis. Only rarely the larynx happens to be the primary site of involvement. The lesions may be confined to the vocal folds or may involve various other sites of the larynx. There is, invariably, certain risk factors which may predispose for fungal infection like immune deficiency condition, use of inhaled or systemic steroids, long and continuous use of antibiotics etc. These lesions may mimic malignancy or a premalignant condition. Awareness of this entity is essential as the management depends on accurate diagnosis. These lesions invariably respond well to antifungal therapy with elimination of risk factors. Here we have reported a case of primary aspergillosis of the larynx without involvement of other part of the airway and without any generalized immune deficit in a 35 year old woman.

Ophthalmological Manifestations of ENT Diseases: An Overview.

A total number of 62 cases of ophthalmological manifestations caused by various ENT diseases, mostly paranasal tumour extensions, nasopharyngeal tumour and furunculosis of nose were analysed in a retrospective study in relation to their age, sex, clinical, radiological and HP profile. CT scan was considered as the most dependable investigating tool. Different modalities of medical and surgical treatment have been adopted according to location and nature of the disease. A close cooperation is needed between otolaryngologist and ophthalmologist to overcome this challenge.

Submitral aneurysm of the left ventricle.

Submitral aneurysm is a rare cardiac pathology of uncertain origin with varied clinical manifestations. Recent studies have revealed a congenital basis of this pathology, although genetic link has been suspected because of the racial predilection. The other suggested aetiologies are infection and inflammation. The case reported here is that of a young female with a large submitral aneurysm presenting in a state of cardiogenic shock. In addition, the presence of raised inflammatory parameters indicates that the cause of origin of this aneurysm is related to inflammation.

Use of intratympanic steroid as a primary treatment for sudden sensorineural hearing loss.

Dramatic nature of sudden sensorineural hearing loss sets it apart from most of the conditions, which the otologists face in their practice. It has a reported incidence of 5-20/1,00,000 of population with involvement of both sexes in any age group. Exact aetiology of the disease is not known and most of the cases are idiopathic. Treatment policy differs from centre to centre. This prospective study with intratympanic steroid injection as a primary treatment with or without oral corticosteried therapy results 64% success rate with average hearing gain of 25 dB.

Covered stent to treat saphenous venous graft perforation--a case report.

This case report shows the immediate and long-term clinical result of percutaneous coronary intervention in a patient with total occlusion of saphenous venous graft. The case also highlights the management of venous graft perforation during percutaneous intervention using a covered stent.

Auricular trauma and its management.

Forty cases of external ear trauma have been studied during a period of three years from Jan '2001 to December 2004. It was observed that accidental trauma to the auricle may result in laceration, partial or complete loss of auricle. Injury of the tympanic membrane, temporal bone or facio maxillary region may be associated with auricular trauma. All wounds of auricle carry a risk of infection leading to perichondritis. Principles of successful treatment are conservation of tissue and prevention of infection.

Concurrent coronary, bilateral iliac and left renal artery direct stenting.

We describe a patient who underwent percutaneous coronary intervention combined with bilateral iliac and left renal artery angioplasty during the same sitting. Stenting of the coronary and peripheral arteries was performed employing the "direct stenting" technique. No complications occurred. The patient was discharged 2 days after the intervention and remains asymptomatic, leading a fully active life during 1 year of follow-up. To our knowledge, unstaged coronary stenting combined with direct stenting of the renal and both common iliac arteries has not been reported previously in India.

Dual left anterior descending coronary artery: surgical revascularization in 4 patients.

Dual left anterior descending artery (or dual anterior interventricular artery) is a rare coronary anomaly. It is important to know the anatomic variants of this anomaly in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty. We report the cases of 4 patients who had anatomic variants of dual left anterior descending coronary artery. These patients had developed coronary artery disease in the long or the short left anterior descending artery, or in both. The long left anterior descending artery was diseased in 1 patient, and the short left anterior descending artery was diseased in another In the 3rd and 4th patients, both the long and the short arteries were atherosclerotic and had developed severe stenosis. All 4 patients underwent successful myocardial revascularization. There was no electrocardiographic evidence of perioperative myocardial infarction. All patients were asymptomatic during the follow-up period, which ranged from 3 months to 1.5 years. Angiographers and surgeons alike must be aware of the variants of dual left anterior descending coronary artery, so that the diseased vessels can be correctly identified even if 1 of the dual arteries is 100% occluded.

Combined brachial and femoral approach to balloon angioplasty in coarctation of aorta.

Transfemoral balloon angioplasty of native aortic coarctation was initially not feasible in two patients, because of inability to cannulate the femoral artery percutaneously in one, and to cross the coarctation in the other. The percutaneous brachial approach helped overcome both these problems, after which utilization of intravascular snares allowed successful transfemoral completion of angioplasty.

Transjugular approach to transseptal balloon mitral valvuloplasty.

The feasibility of a transjugular approach to septal puncture and Inoue-balloon mitral valvuloplasty (BMV) was studied in 20 patients with severe mitral stenosis and varying degrees of anatomic atrial distortion. Left atrial entry by transjugular septal puncture was achieved without difficulty and BMV completed in all patients. In all of 16 patients who had high septal punctures, crossing the mitral valve with the Inoue-balloon was consistently simple and quick. In one patient, septal dilation after very high septal puncture led to a tear extending to the atrial free wall, resulting in cardiac tamponade requiring surgery. Another patient developed severe mitral regurgitation after BMV and required mitral valve replacement. Excellent results were obtained in 16 patients. The transjugular approach simplifies BMV procedure significantly in patients with distorted atrial anatomy and allows rapid patient mobilization. Its safety and efficacy need to be established in larger studies.

Transseptal approach to aortography and carotid artery stenting in pulseless disease.

We report on a patient with pulseless disease (Takayasu's arteritis) in whom access to the central circulation by extremity arterial cannulation was not possible due to absent pulses in all four limbs. The transseptal approach was used for aortography, bilateral selective carotid angiography, and successful elective stent deployment in the right common carotid artery.

Serum troponin-T in acute myocardial infarction.

This study was carried out to assess the utility of serum troponin-T estimation in the diagnosis of acute myocardial infarction (AMI). One hundred and twenty two consecutive patients presenting with Q wave myocardial infarction were included in the study. In patients with AMI, serum troponin-T level was significantly elevated (4.21 +/- 3.49 ng/ml) on the first day of AMI (normal = 0.1 ng/ml). The elevated serum levels were detected even on the second (4.82 +/- 3.01 ng/ml) and the 3rd day (5.83 +/- 3.83 ng/ml) of AMI. Our results thus indicate that serum troponin-T is elevated twenty eight folds on the first day of AMI and the levels remain elevated as long as the third day. Hence, troponin-T can be used as sensitive biochemical marker of AMI, both in the immediate as well as in the early phase of myocardial infarction.