Paraplegic neurodeficit management post endovascular graft: a rare case of aortic dissection.

Acute aortic dissection is a catastrophic episode that usually presents as a sudden, painful, ripping sensation in the chest or back. It is associated with neurologic sequelae in as many as one-third of patients. We report a case of aortic dissection, presenting as acute paraplegia. A 50-year-old patient presented to us with chief complaints of paraplegia and back pain. On examination, strength was 5/5 in both upper extremities and 0/5 in both lower extremities. Deep tendon reflexes were absent in her legs. CT angiogram of aorta Aortic Dissection Stanford type B / De-Bakey type -III. Patient was treated with endovascular graft for aortic dissection, paraplegia recovered completely.

MTHFR C677T polymorphism among Meiteis of Manipur (India).

BACKGROUND: The enzyme MTHFR catalyses the irreversible conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, which serves as a methyl donor in the reaction converting homocysteine to methionine. Mutation at MTHFR gene (C677T) has been implicated in the pathogenesis of common complex diseases such as thrombosis, hypertension, stroke, myocardial infarction, and recurrent pregnancy loss across world populations. OBJECTIVE: We wanted to explore C677T mutation among Meiteis of Manipur to generate baseline data and to gain information that could be used in disease prevention programs. METHODS: A total of 1142 (625 males and 517 females) unrelated individuals aged 35 to 75 years were involved in the study. 1098 samples could be genotyped for MTHFR C677T polymorphism. RESULTS: MTHFR C677T was found to be polymorphic in the Meitei population studied. Around 30% of individuals are carrying the mutant allele either in heterozygous or homozygous condition with T allele frequency of .16. CONCLUSION: Among study participants, those with T allele frequency of .16 may be predisposed to complex diseases, if their active lifestyles are shifted to sedentary lifestyles. Relatively lower frequency of T allele among individuals of younger age (though not significant) is indicative of selective disadvantage of this allele in the recent years.

Differences in conventional cardiovascular risk factors in two ethnic groups in India.

BACKGROUND: Studies have been carried out at national and international levels to assess ethnic variations in the prevalence of cardiovascular diseases and their risk factors. However, ethnic variations in the contribution of various risk factors to complex diseases have been scarcely studied. OBJECTIVES: Our study examined such variations in two ethnic groups in India, namely, Meiteis of Manipur (northeast India) and Aggarwals of Delhi (north India). METHODS: Through random sampling, we selected 635 participants from the Meitei community and 181 Aggarwals from the Aggarwal Dharmarth Hospital, Delhi. Patients with coronary artery disease (CAD) and hypertension were identified based on their recent medical diagnostic history. Anthropometric parameters such as height, weight, waist and hip circumferences along with physiological parameters (blood pressures, both systolic and diastolic) and biochemical parameter (lipid profile) were measured for all study participants. Patient parameters were available from the medical reports recorded when patients were first diagnosed. RESULTS: Among CAD individuals, the Aggarwals showed higher mean values of weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TC), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) but had lower high density lipoprotein (HDL) levels than the Meiteis. The same trend for weight, BMI and lipid parameters could be seen among hypertensive individuals. In step-wise regression analysis, SBP, LDL and TG were found to significantly contribute to the risk for CAD in the Aggarwals; whereas in the Meiteis, SBP, VLDL, HDL, TC and LDL were found to significantly contribute to the risk for CAD. In hypertensive Aggarwal participants, SBP, DBP and waist-to-hip ratio were significant contributors for hypertension; whereas SBP, DBP, and height contributed significantly to risk for hypertension among the Meiteis. CONCLUSION: We found marked differences in conventional risk factors between the two ethnic groups. In India, as found elsewhere, the presence of substructuring of groups and hence, genetic isolation is high. More research is needed within this context to unveil the conventional risk factors for complex diseases.

Left ventricular pseudoaneurysm with infective pericarditis: a rare cause of intractable hemoptysis.

A 52-year-old man with diabetes presented with recurrent, massive hemoptysis following pericardiectomy for pyopericardium secondary to Streptococcus viridans infection. Chest radiograph and bronchoscopic examinations revealed no bronchial cause. Computed tomography of the chest and echocardiography showed a pseudoaneurysm of the left ventricle. Surgical exploration confirmed that the pseudoaneurysm communicated with the left lung parenchyma and was the cause of recurrent intractable hemoptysis.

Inappropriate shock delivery by implantable cardioverter defibrillator due to electrical interference with washing machine.

We report a patient with hypertrophic cardiomyopathy who received an inappropriate implantable cardioverter defibrillator shock due to electrical interference from a washing machine. This electrical interference was detected as an episode of ventricular fibrillation with delivery of shock without warning symptoms.

Utilization of Telefax System for Early Detection, Interpretation and Management of Acute ST-Elevation Myocardial Infarction: An Initial Experience from Rural Punjab Telecardiology Rapid Access Project.

OBJECTIVES: The aim of this study was to assess the feasibility, safety and efficacy of telecardiology-guided initiation of therapy and management of acute coronary syndrome at primary care hospitals before the transfer of the patient to a tertiary care center. METHODS: This study covered 25 of 41 patients diagnosed with acute coronary syndrome at the Kharar Civil Hospital over a period of 15 months. These 25 patients (group A) had ST-elevation myocardial infarction. The remaining 16, with non- ST-elevation acute coronary syndrome, were excluded from the study. The group A patients were thrombolyzed at the Kharar Civil Hospital under telecardiology guidance (transmission of the electrocardiograms by fax to the coronary care unit of the PGIMER, where they were analyzed by a cardiologist). The patients were later sent to the PGIMER for further treatment. The group A patients were compared with two control groups (B and C) of 25 patients each with similar problems. The group B patients were referred for thrombolysis to the emergency ward of the PGIMER from local hospitals (situated at a distance of about 15 km), after acute myocardial infarction had been confirmed by electrocardiograms. The group C patients had come directly to the PGIMER emergency ward for thrombolysis. The patients in all groups were evaluated in terms of door-to-needle time saved, improvement in left ventricular systolic function and adverse events during hospitalization, as well as at three months' follow-up. RESULTS: For patients in group A, the mean door-to-needle time was 67.08 +/- 18.21 minutes. It was 121.8 +/- 48.71 minutes for those in group B and 22.68 +/- 9.24 minutes for those in group C. Thus, the differences among the groups were significant (p < 0.0001). Complications were rare and none occurred during transfer from the Kharar Civil Hospital to the PGIMER. The ejection fraction of all the patients showed an improvement between the time of admission and at three months' follow-up (p < 0.0001). CONCLUSIONS: Utilizing telecardiology advances, district hospital physicians, in collaboration with cardiologists at the tertiary center, can provide adequate standard diagnosis at the pre-coronary care unit level and also provide adequate therapy for acute myocardial infarction. Early administration of streptokinase in the civil hospital brought about a significant reduction in door-to-needle time and considerable improvement in left ventricular function.