Effect of congenital ptosis on corneal topography and total aberrometry and comparison of these variables between ptotic and normal fellow eyes.

PURPOSE: To analyze the effect of congenital ptosis on corneal topography and total aberrometry and to compare these variables between ptotic and normal fellow eyes. METHODS: The study included 32 eyes of 16 patients with unilateral congenital blepharoptosis. A Shack-Hartmann wavefront sensor was employed to assess Zernike coefficients and root-mean-square. Computerized corneal topography, Orbscan and aberrometry were measured in the healthy and ptotic eyes. Data were analyzed using SPSS version 16. P<0.05 was considered significant. RESULTS: The mean patient age was 21.31±6.3 years. The mean margin to light reflex distance-1 (MRD-1) was 0.6±1.44mm in the ptotic eyes. Among topography variables, surface regularity index (SRI), cylinder power, irregular astigmatism index (IAI), and flat meridian keratometry were significantly different between ptotic and non-ptotic fellow eyes (P<0.05). Some Orbscan parameters, including simulated keratometry, maximum and minimum corneal power, and astigmatism power were significantly different between ptotic and normal fellow eyes (P<0.05). There was no statistically significant difference in total aberrometry variables between paired eyes. However, in a comparison between ptotic eyes with over 1 diopter astigmatism vs. less than 1 D, high-order Zernike modes without spherical aberration at 6mm (HOW/O Z400 6mm) were significantly different between the 2 groups (P=0.02). CONCLUSION: Unilateral congenital ptosis significantly affects corneal topography and aberrometry, especially in eyes with astigmatism≥1 D. Such differences need to be considered before keratorefractive surgery (KRS).

Psoriasis and coronary heart disease-not as severe as predicted.

BACKGROUND: Psoriasis is a systemic disorder involved in several disease processes, including cancer, metabolic syndrome and cardiovascular disease (CVD). Previous studies showed that psoriasis is most likely an independent risk factor for CVD, yet the extent of its impact on CVD and the extent of coronary artery disease (CAD) remains unclear. We investigated the correlation of psoriasis to the severity of CAD in age and gender-matched patients with CAD with and without psoriasis. METHODS: This is a retrospective, case-control study of 59 patients with psoriasis who underwent coronary angiography were matched using a computer software to 59 patients without psoriasis according to age, gender, smoking status, hyperlipidemia, hypertension and diabetes. CAD severity was defined according to number of affected vessels (single vs. multiple) and location of lesions (proximal vs. distal). RESULTS: CAD severity was significantly higher in the control group compared to the psoriasis group (P = 0.038). Among patients with psoriasis, 20.3% were disease free or with low severity (42.4%), while only 37.3% had severe CAD. Among patients without psoriasis, the majority had severe CAD (57.6%), followed by low severity (30.5%) or disease free (11.9%). We did not find an association of prior treatment with anti-inflammatory medications and the severity of CAD. CONCLUSIONS: Our results show that although psoriasis may be a risk factor for CAD, psoriatic patients have a less severe CAD compared to the general population. The use of anti-inflammatory medications does not explain this finding.

Frequency of Multivessel Severe Coronary Artery Disease in Patients With Non-ST Segment Elevation Myocardial Infarction Having Markedly Raised Cardiac Troponin T.

Introduction Non-ST segment elevation myocardial infarction (NSTEMI) is becoming more common than ST segment elevation myocardial infarction (STEMI) and data regarding presence of underlying multivessel coronary artery disease (MVCAD) in these patients is consistent in locoregional population that leads to lethal delays in proper management. Therefore, in the current study, we aimed to evaluate the frequency of MVCAD in NSTEMI with markedly raised troponin T levels. This will help to identify patients that should be labeled as high risk and must be referred for coronary revascularization on priority basis, so that clinical outcomes can be improved in these patients. Methods This cross-sectional research study was carried out at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan over a period of one year. A total of 326 patients with history of chest discomfort within past 48 hours of presentation or angina equivalent symptoms and cardiac troponin T more than 500 ng/l were included in the study. Coronary angiography was done within 72 hours of same hospital admission. The outcome variable i.e. MVCAD was determined. Results Mean age of patients was 50.74 ± 7.75 years with range of 30 to 60 years. MVCAD was found in 107 (32.82%) patients, whilst there was no MVCAD in 219 (67.18%) patients. Moreover, no significant association of MVCAD was noted with age or smoking. Conclusion We found presence of MVCAD in a considerable number of patients presenting with NSTEMI. The key to detect the underlying presence of MVCAD in these patients is lifted troponin T levels. Therefore, we conclude that any patient with elevated troponin T levels, even in the absence of ST segment elevation, should undergo cardiac catheterization to detect presence of MVCAD as this subset of patients can benefit from early revascularization including coronary artery bypass graft (CABG) surgery.

Left Ventricular Thrombus Formation in Acute Anterior Wall Myocardial Infarction: A Comparison Between Thrombolyzed and Non-Thrombolyzed Patients.

Introduction Left ventricular thrombus (LVT) formation is a prominent complication of acute myocardial infarction (AMI). Accurate and prompt detection of the condition is important as it poses a high risk for thromboembolic events that can be arrested by systemic anticoagulation. The purpose of our study was to evaluate the frequency of LVT formation in thrombolyzed and non-thrombolyzed patients with AMI to ascertain the current magnitude of the problem in the local population. Methods The study was conducted at the Chaudhry Pervaiz Elahi Institute of Cardiology in Multan, Pakistan. A total of 281 patients of either gender aged between 30-65 years with anterior wall myocardial infarction (AWMI; both thrombolyzed and non-thrombolyzed) were included in the study. Once they were enrolled in the study, all the relevant baseline investigations were performed. A detailed history was taken and examinations were done; serial ECG and echocardiography were performed till discharge from the hospital on the third day of hospitalization to record the final outcome of the study, i.e., LVT formation. Results The mean age of the patients was 55.54 ± 7.26 years. Overall, LVT formation was noted in 65 cases (23.1%), of which 11 (16.9%) were thrombolyzed patients and 54 (83.1.1%) were non-thrombolyzed. A significant association of LVT was noted with age, hypertension, family history, and duration of symptoms. Conclusion We found a high frequency of LVT formation among patients with AWMI who have not undergone thrombolytic therapy. It was observed that LVT was notably associated with advanced age, hypertension, and other comorbidities. Early presentation to the hospital and thrombolysis reduce the risk of developing LVT, which in turn can reduce morbidity and mortality in such patients.

Enteroenteric Fistulae in Acute Bowel Ischemia.

Gastrointestinal fistulae are classified as enteroenteric or enterocutaneous. Most gastrointestinal fistulae are formed after surgical procedures for inflammatory bowel disease or malignancy. For spontaneous enteroenteric fistulae, ischemia has been reported as a possible etiology. We report two cases of spontaneous enteroenteric fistulae arising after bowel ischemia; a 38-year male with a 10-day history of severe abdominal pain with fever and vomiting, and a 22-year female with a one-week history of abdominal pain and diarrhea. Arterial and venous thrombi in association with enteroenteric fistulae were identified on computed tomography. These cases point towards acute mesenteric ischemia as a rare cause of spontaneous enteroenteric fistulae. Surgical management of these fistulae can be effective in resolving this complication.

The effect of several uremic parameters on uremic serum inhibition of lymphocyte blastogenesis.

Uremic sera are known to inhibit thymidine incorporation of normal lymphocytes. The nature of the factor(s) responsible for this inhibitory effect has not been completely elucidated. In this study a possible correlation was investigated between a number of uremic blood constituents altered with the progression of the disease and the immunoinhibitory effect of the respective sera. No such correlation was found with the values of hematocrit, urea, creatinine, calcium and phosphorus. On the other hand a significant negative correlation emerged between H+ and Mg2+ ion levels and the inhibition imposed on normal lymphocyte thymidine incorporation. This apparently paradoxical result would indicate that with regard to these two parameters the greater the severity of renal failure the smaller would be the immunoinhibitory effect of the respective serum. The inhibition imposed by uremic serum on immune functions is probably a multifactorial phenomenon, in which H+ and Mg2+ might play a role antagonistic to inhibitory factors.