Epicardial fat thickness: A surrogate marker of coronary artery disease - Assessment by echocardiography.

OBJECTIVE: Epicardial fat is considered as indicator of cardiovascular risk. Several studies have tested the association between epicardial fat thickness (EFT) and coronary artery disease. The aim of our study is to test the hypothesis that echocardiographic EFT is a marker of coronary artery disease. METHODS: One hundred and ten patients (70 males and 40 females with mean age of 51.5±10.6 and 52.6±9.6, respectively) admitted for coronary angiogram underwent assessment of epicardial fat thickness by echocardiography. Routine clinical examination, evaluation of risk factor profile, and anthropometric variables were also done. Epicardial fat thickness was measured on the free wall of right ventricle in parasternal long- and short-axis views at end-systole for 3 cardiac cycles. RESULTS: Mean epicardial fat thickness in angiographically normal patients and acute coronary syndromes were 4.4±1.2 and 6.9±1.9, respectively. Epicardial fat thickness in males and females were not statistically different. Burden of coronary arterial lesions denoted by Gensini score shows linear association with epicardial fat thickness and the severity of the coronary disease. CONCLUSION: Epicardial fat is independently and linearly associated with CAD and its severity.

Detection of class 1 integrons in Salmonella Weltevreden and silent antibiotic resistance genes in some seafood-associated nontyphoidal isolates of Salmonella in south-west coast of India.

AIMS: To study the antibiogram of 40 seafood isolates of Salmonella and use of PCR to detect the presence of integrons and genes coding for antibiotic resistance. METHODS AND RESULTS: In this study, 40 isolates of Salmonella were used for antibiogram analysis. The multidrug-resistant isolates were analyzed for the presence of integron using integron-specific primers. Twenty-five percentage of the isolates were multidrug resistant while 67·50% were resistant to at least two antibiotics. Antibiotic resistance genes catA1 and tetA were present in 57·52 and 60%, respectively. Although widespread presence of genes was observed, only 26·08% of the catA1-carrying isolates exhibited phenotypic resistance against the respective antibiotic. Integrons present in representative isolates of Salmonella Weltevreden and Salmonella Newport were sequenced. The former contained class 1 integron with a single gene dfrA7 in the integron cassette and an adjacent dihydropteroate synthetase gene along with the usual quaternary ammonium compound resistance gene, while the later contained class 1 integron with dhfrA1, OrfC, in the integron cassette and an adjacent dihydropteroate synthetase gene along with the usual quaternary ammonium compound resistance gene. CONCLUSIONS: This study demonstrates the presence of silent antibiotic resistance genes and class I integrons in seafood-associated Salmonella strains. The study also demonstrates the first report of class I integron in Salm. Weltevreden. Detection of catA1 genes in phenotypically sensitive bacteria suggests that these could be reservoirs in the environment. SIGNIFICANCE AND IMPACT OF THE STUDY: The manuscript provides novel results describing the existence of a high rate of antibiotic resistance in the Salmonella populations prevailing in environmental sources as well as an absence of correspondence between the presence of antibiotic resistance genes, and the exhibition of a the corresponding phenotypic trait of resistance against the respective antibiotic compound was observed. In addition, the manuscript reports the presence of the class I integron in Salm. Weltevreden.

Bilateral chylothorax following left-sided radical neck dissection.

Chylothorax is an extremely rare but potentially life-threatening complication of radical neck dissection. Its rarity makes surgeons unfamiliar with its management. We report the case of a bilateral chylothorax occurring after a left radical neck dissection and discuss its management. A multi-disciplinary approach is advocated, involving surgical, respiratory and dietetic input, and this led to a favourable outcome for our patient.

A safer way to aspirate a quinsy.

Quinsies (peritonsillar abscesses) are routinely treated in all ENT departments. This paper outlines a technique for safe aspiration of a quinsy, which minimizes the risk to adjacent structures.

Sensorineural hearing loss associated with psoriatic arthritis.

Autoimmune inner ear disease is a well described entity. We report a case of sudden-onset sensorineural hearing loss in association with psoriatic arthritis, which has not been reported in the literature. The case satisfies the criteria for the presumptive diagnosis of autoimmune hearing loss. A high index of suspicion, with early diagnosis and aggressive treatment with steroids and/or immunosuppressive agents, is essential to prevent irreversible hearing loss. The condition of psoriatic arthritis must be added to the pantheon of autoimmune diseases that can lead to sensorineural hearing loss.