Novel lipid biomarkers and associated gene polymorphism in young ST-segment elevation myocardial infarction

Background: There is an increasing prevalence of coronary artery disease (CAD) in younger individuals. Lipid biomarkers such as lipoprotein-a (Lp-a), Apo A1, Apo B and Paraoxonase-1 (PON1) serve as important risk predictors for development of CAD. There is little evidence regarding the role of lipid biomarkers and their genetic polymorphisms in young (<50 years) ST-segment elevation myocardial infarction (STEMI) patients. Methods: This study included 110 young (18e50 years) STEMI patients and 110 healthy controls. Serum levels of Apo A1, Apo B, Paraoxonase-1 (PON-1) and Lipoprotein-associated phospholipase A2 (Lp-PLA2) were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the Apo A1 (75G/A) and the PON1 (Q192R) genes were evaluated. Results: Serum levels of apo B (101.31 ± 27.58 vs 75.31 ± 18.77 mg/dl; p < 0.0001), Lp(a) [87.56 ± 74.28 vs 25.81 ± 24.66 mg/dl, p < 0.0001] and Lp-PLA2 [5.97 ± 1.39 vs 3.49 ± 1.27 ng/mL, p < 0.0001] were significantly higher in patients as compared to controls. Serum levels of Apo A1 [44.76 ± 35.65 vs 95.97 ± 29.89; p < 0.0001] and PON1 [2.63 ± 1.5 vs 3.87 ± 1.47 ng/mL, p < 0.0001] were significantly lower in cases as compared with controls. Additionally, patients with genetic polymorphisms in the Apo A1 (75G/A) and the PON1 (Q192R) gene had an increased risk of STEMI. Conclusion: Lipid biomarkers such as Apo A1, Apo B and PON1 and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals.

Matrix metalloproteinases and their gene polymorphism in young ST-segment elevation myocardial infarction

Background: Genetic polymorphism in MMPs are associated with multiple adverse CV events. There is little evidence regarding role of MMPs and their genetic polymorphisms in young (<50 years) STsegment elevation myocardial infarction (STEMI) patients. Methods: This study included 100 young (18e50 years) STEMI patients and 100 healthy controls. Serum levels of MMP-3, MMP-9 and TIMP were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the MMP-9 gene (_x0001_1562 C/T and R279Q) & MMP-3 gene (5A/6A-1612) was evaluated. All these patients were followed up for one year and major adverse cardiac events (MACE) were determined. Results: Serum levels of MMP-3 (128.16 ± 115.81 vs 102.3 ± 57.28 ng/mL; P ¼ 0.04), MMP-9 (469.63 ± 238.4 vs 188.88 ± 94.08 pg/mL; P < 0.0001) and TIMP (5.84 ± 1.93 vs 2.28 ± 1.42 ng/mL; P < 0.0001) were significantly higher in patients as compared to controls. Additionally, patients with genetic polymorphisms in the MMP genes (5A/5A, 6A/6A and the AG genotypes) had an increased risk of STEMI. Patients with MACE had significantly higher levels of MMP-9 (581.73 ± 260.93 vs 438.01 ± 223.38 pg/mL; P ¼ 0.012). A cutoff value of 375.5 pg/mL of MMP-9 was best able to discriminate patients with STEMI and MACE with sensitivity of 77.3% and specificity of 57%. Conclusion: Novel biomarkers such as MMP-3, MMP-9 and TIMP and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals. Higher MMP-9 levels in STEMI patients with MACE suggests its potential role in predicting cardiac remodeling and left ventricular dysfunction

Left ventricular function assessment after aortic and renal intervention in Takayasu arteritis by speckle tracking echocardiography: A pilot study

Background: Overt left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown. Methods: This study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention. Results: Six patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p ¼ 0.001), E/ e’ ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p ¼ 0.005) and median NT pro BNP decreased from 1673 pg/ml (970e2401 pg/ml) to 80 pg/ml (40e354 pg/ml) (p ¼ 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80 e898.5 pg/ml) to 34 pg/ml (29e70.8 pg/ml) (p < 0.01), mean GLS improved from 8.80 ± 0.77% to 16.3 ± 0.78% (p < 0.001) and mean E/e’ decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p ¼ 0.005) at 6 months follow up. Conclusion: LV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes

Left atrial function by two-dimensional speckle tracking echocardiography in patients with severe rheumatic mitral stenosis and pulmonary hypertension

We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using twodimensional speckle tracking echocardiography (STE). Eighty patients with isolated severe MS in sinus rhythm and 40 controls underwent comprehensive echocardiography including STE derived LA strain [reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct)]. The mean MVA was 0.93 ± 0.21 cm2 . The mean values of LASr (14.73 ± 8.59%), LAScd (±7.61 ± 4.47%) and LASct (±7.16 ± 5.15%) in patients were significantly lower (p < 0.001) vs. controls 44.11 ± 10.44%, ±32.45 ± 7.63%, -11.85 ± 6.77% respectively and showed decreasing trend with increasing MS severity and higher NYHA class. In conclusion, LA dysfunction is prevalent in severe MS irrespective of NYHA functional class.

Parotid sialolithiasis with Stenson’s duct stricture: a rare case report

Sialolithiasis is the most common disease that affects the major salivary glands and occurs mainly in the submandibular gland (80-90%), and to a lesser degree in the parotid gland (5-20%). In literature many papers have been published regarding the parotid calculi and their treatment. However, data on salivary duct strictures management is less with variable opinion. We present a case of 45-year-old female with swelling of right parotid for 6 months, USG showed duct calculi with sialadenitis and sialogram showed large duct calculi with high grade strictures. Duct calculi was removed by intra-oral approach and parotidectomy was done as endoscopic management of strictures failed. This was highlighted case as parotid duct calculi along with high grade strictures are rare.

A retrospective study of serious adverse drug reactions and associated risk factors in a tertiary care hospital

Background: Serious adverse drug reactions (ADRs) cause physical, psychological and economic harm to patients and society. This study was undertaken to understand serious ADRs in a tertiary care hospital and risk factors associated with it.Methods: The serious adverse reactions that occurred over a one-year period were assessed. The serious adverse drug reactions, action taken, outcome, predictability, suspect drug, causality, patient demographics and risk factors for the reaction was collected. Chi-square test was applied for observing relationships of predisposing factors for serious ADRs.Results: Out of a total of 984 reported adverse drug reactions, 94 (9.55%) were serious. Hematological disorders (41.05%) were the common serious ADRs followed by electrolyte disturbances (18.94%). Anticancer agents were the suspect drugs for majority of serious ADRs. Serious ADRs contributed to 39 (0.05%) admissions in the hospital. Recovery occurred in 97.87% of the patients. The causality was possible in 91.48% (n=86) and probable in 8.51% (n=8) of the serious adverse drug reactions. Males, patients even with a single concomitant disease and those with more than 2 concomitant medications were at increased risk (p<0.05) for developing serious ADRs.Conclusions: Serious ADRs are a significant problem in health care. Measures should be taken to detect and treat them at the earliest to reduce suffering of the patient.

Comparative Analysis of Indices of the Liver Function Tests in Patients with and without Non- Alcoholic Fatty Liver Disease at a Teaching Hospital in Hapur

Background: Non-Alcoholic fatty liver disease (NAFLD) has become a worldwide health concern with increase in the global incidence of obesity and it is now considered the hepatic component of the metabolic syndrome. Aims and Objective: The study’s aim was to compare the indices of the Liver Function tests in compensated chronic liver disease patients with and without NAFLD. Materials and Methods: A total of 100 consecutive patients with compensated chronic liver disease were recruited into the study. A structured questionnaire was administered to obtain relevant socio-demographic data. NAFLD was diagnosed based on clinical, biochemical, ultrasonographic and in a few histological features. The Adult Treatment Panel III criteria were used to identify patients with the metabolic syndrome. Results: In our study, 100 participants were recruited into study. 40 out of 60 patients (67%) showed grade-1 fatty liver findings and 20 out of 60 patients (33%) showed grade-2 fatty liver. Approximately 19% had fatty liver finding. The mean (SD) age of persons with NAFLD was 45.12 (±8.07) years compared  to 47.49(±11.79) years for persons without NAFLD. The difference was not statistically significant (p=0.2). Body mass index (BMI), central obesity (waist circumference), fasting  blood sugar, blood pressure, total cholesterol and triglycerides were significantly higher in  the NAFLD group (p= <0.05) respectively.  Conclusion: Indices of the deranged Liver functions were more prevalent in persons with NAFLD. It is recommended that patients with NAFLD be screened for metabolic syndrome and appropriate therapy instituted to decrease the risk of both hepatic and cardiovascular complications.

Interpretation: a confounding factor.

With reference to the article “Passive euthanasia in India: a critique”, authored by Ms Rohini Shukla and published online on August 5, 2015, I would like to make a few comments and highlight the following points. First, the author notes that Section 309 IPC has been decriminalised. This is not so since there has neither been any amendment to the IPC, nor has any ordinance been passed regarding the matter.

Giant Fronto-parietal Encephalocele: A rare case report.

Although encephaloceles are common, but giant encephaloceles are rare with only few published short series and are mostly described in occipital location. Giant frontal encephaloceles are very rarely reported with only four published case reports in the world literature and giant encephalocele in fronto-parietal region has not been reported till date. Herein, we report a rare case of giant frontoparietal encephalocele in a six month old girl.

Comparison of the dental arch changes in patients with different malocclusions.

Aims and Objectives: To evaluate the pre-treatment and post-treatment dental arch changes in both upper and lower arches in orthodontic patients treated with extraction of first premolar teeth. Subjects and Methods: Measurements were made on casts of 50 post treated cases in the age group of 12-30 years for individual tooth measurements, width of the arches (inter-incisal, inter-canine, inter-premolar and inter-molar) arch length (both right and left sides, anterior segment, posterior segment and total arch length for both for the maxillary and mandibular dental casts. Statistical Analysis Used: Kolmogorov-Smirnov test for Normality, Regression Analysis was done as variables were tested and proved to follow normality. Statistical software  Statistical Package for the Social Sciences version 18 (SPSS Inc.; Chicago, Illinois, USA) was used for data analysis. Descriptive statistics and paired t-tests were used to compare the changes in the Class I and Class II div 1 groups. Results: There was a significant increase in the inter-incisor and inter-canine width post-treatment in the Class I and Class II div 1 subjects in the upper arch but no significant change in inter-incisor width in the lower arch in class I subjects. A significant decline in the inter-molar arch width in both the groups were seen. The inter-premolar arch width declined significantly in Class I cases while it increased significantly in Class II div 1 subjects. There was a significant increase in anterior arch length and a significant decrease in posterior arch length in all subjects. Conclusions: The findings of this original clinical research should significantly help the orthodontists in orthodontic treatment planning in patients requiring extractions of premolars.

Quality of Life in Symptomatic HIV Infected Children.

We conducted a case control study to compare the quality of life (QOL) in 40 cases of HIV infected children and 40 demographically matched controls with other chronic ailments at a referral hospital in Northern India. Quality of life among HIV infected children was significantly better in psychosocial (P=0.008), emotional (P=0.001) and school (P=0.039) functioning. Factors including age (P=0.07), gender (P=0.44), socioeconomic status (P=0.99), clinical (P=0.18) and immunological staging (P=-0.91) of HIV infection did not significantly influence QOL scores. Hence, quality of life in HIV infected children of North India was better than those suffering from other childhood chronic illness.

Torsades de pointes in a patient of dilated cardiomyopathy occurring early on oral amiodarone therapy.

Amiodarone induced proarrhythmic effects are rare. We report a case of amiodarone induced torsades de pointes in a young boy aged 16 years occurring early after initiation of oral amiodarone. This case underscores the need of careful electrocardiographic monitoring early during amiodarone therapy to avoid a potentially fatal arrhythmia.

MRKH syndrome: Psychological disturbances and suicide.

The Mayer- Rokitansky-Küster-Hauser (MRKH) syndrome has been known to be associated with psychological abnormalities. However, hardly any case has been reported of suicide by an individual suffering from such syndrome, as per the author‘s knowledge. A 19 year old female was brought to Safdarjung hospital mortuary for post mortem examination. After eliciting a detailed history from the relatives of the deceased, going through the previous investigation reports and after post mortem examination it was confirmed that the deceased was suffering from MRKH syndrome. The mental stress associated with the diseased state resulted in the female committing suicide by ingesting some unknown substance. Emotional support forms the basis of treatment in such cases. Surgical treatment is also employed in some cases so as to help them lead normal sexual life. This paper deals with the pathology and psychological profile of the patient suffering from this syndrome and the therapeutic options that may be considered to ameliorate the stress associated with the disease.

Positional asphyxia: An opinion of exclusion.

The process of normal respiration depends upon three vital components i.e. a patent airway, an intact surface for gas exchange and a normally working ventilatory apparatus. The positional asphyxia has been defined as asphyxia caused due to unusual position of the body which interferes with the breathing and thus pulmonary ventilation. We are reporting a case of an adult female, who under the influence of alcohol positioned herself in such a way which led her to death due to positional asphyxia. The internal and external findings were non-specific. Therefore the exclusion criteria were used to conclude that the death was due to positional asphyxia. The cases of positional asphyxia are difficult to diagnose because of the absence of any specific external findings. The internal findings found in such cases are also non-specific and can be found in any case of an asphyxial death.

Importance of adipocere in determining the cause of death.

Adipocere (term coined by Fourcroy in 1789) also known as corpse wax or grave wax or mortuary wax , derives its name „adipo‟ and „cire‟ meaning the affinity with both fat and wax. It is a late but sure sign of death. It becomes extremely difficult for crime investigators to determine the cause of death in bodies in an advanced stage of decomposition. In such instances, changes like the formation of adipocere and mummification help to preserve certain features and injuries that aid in the determination of identity and in determination of the cause of death of the body. This paper highlights a case in which adipocere was developed and its significance in determining the cause of death. However, decomposition changes like the formation of adipocere, helps to preserve injuries which can aid the forensic experts in opining about the cause of death and hence thereby assisting the law enforcers in administering of justice.

Portopulmonary hypertension in a patient of autoimmune hepatitis.

A 35-year-old women presented with breathlessness and features suggestive of pulmonary hypertension. Further investigations revealed that she had autoimmune hepatitis and both portal and pulmonary hypertension. Pertinent literature is reviewed.