A groundbreaking electrocardiographic observation: "Isoelectric Horizontal ST-Segment with Sharp ST-T Angle" a novel sign for acute coronary syndrome.

Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96%, with 33.02%, 15.96%, and (15.04%, 35.96%) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04% of ACS. The presence of IHST was significant among group-3 (p=0.008) as well as the overall ACS cases (p=0.048).

Association between socioeconomic status and influenza-like illness: A study from Western part of India.

OBJECTIVES: Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI). MATERIALS AND METHODS: This observational case-control study was done on 18-70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income <2000 INR) and non-lower SES groups. RESULTS: 810 cases and 830 controls were compared. Many cases were from lower SES, had poor hand hygiene, and were using soil, mud, ash (SMA) for hand cleaning as compared to the control. Among the cases significant numbers were from lower SES (543/810[67%], P < 0.02), many were alcoholics, smokers, had poor hand hygiene, were using SMA for hand cleaning, and had preexisting chronic obstructive pulmonary disease (COPD), while few were having diabetes in the lower SES group as compared to the non-lower SES group. ILI was more common among lower SES class in unadjusted analysis (odds ratio [OR] 1.58, 95% CI 0.89-2.76) and the results were significant even after the adjustment of covariates (OR 1.62, 95% CI, 0.94-2.85). CONCLUSION: Lower SES people were 2.8 times more prone to ILI as compared to the age- and sex-matched control in western part of India.

Posttransplant Lymphoproliferative Disorder in a Patient with Worsening Ascites after Liver Transplantation.

Posttransplant lymphoproliferative disorder (PTLD) is a spectrum of diseases that involves abnormal lymphoid and/or plasmacytic proliferation in patients with solid organ or hematopoietic cell transplantation. It is a condition with a low incidence of 3.5-4.3% in liver transplant (LT) recipients. This case involves a 63-year-old male with history of LT for chronic HCV induced cirrhosis who presented with abdominal distension related to worsening ascites. Cytological ascitic fluid analysis revealed EBV (+) malignant cells without a malignant focal point on imaging. Diagnosis of monomorphic PTLD with primary effusion lymphoma-like morphology and immunophenotype was established. This case highlights the complexity in diagnosis, different diagnostic modalities, and rare clinical presentations of PTLD.