Lipid Association of India 2023 update on cardiovascular risk assessment and lipid management in Indian patients: Consensus statement IV.

OBJECTIVE: In 2016, the Lipid Association of India (LAI) developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for prevention of atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of various risk factors and subclinical atherosclerosis in prediction of ASCVD risk necessitated updating the risk algorithm and treatment goals. METHODS: The LAI core committee held twenty-one meetings and webinars from June 2022 to July 2023 with experts across India and critically reviewed the latest evidence regarding the strategies for ASCVD risk prediction and the benefits and modalities for intensive lipid lowering. Based on the expert consensus and extensive review of published data, consensus statement IV was commissioned. RESULTS: The young age of onset and a more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands early institution of aggressive preventive measures to protect the young population prior to development of ASCVD events. Wide availability and low cost of statins in India enable implementation of effective LDL-C lowering therapy in individuals at high risk of ASCVD. Subjects with any evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions. CONCLUSIONS: This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The intent of these updated recommendations is to modernize management of dyslipidemia in Indian patients with the goal of reducing the epidemic of ASCVD among Indians in Asia and worldwide.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement.

;Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19.

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Cardiological Society of India: Document on acute MI care during COVID-19.

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.

Ultrasound-based carotid stenosis measurement and risk stratification in diabetic cohort: a deep learning paradigm.

BACKGROUND: Stroke is in the top three leading causes of death worldwide. Non-invasive monitoring of stroke can be accomplished via stenosis measurements. The current conventional image-based methods for these measurements are not accurate and reliable. They do not incorporate shape and intelligent learning component in their design. METHODS: In this study, we propose a deep learning (DL)-based methodology for accurate measurement of stenosis in common carotid artery (CCA) ultrasound (US) scans using a class of AtheroEdge system from AtheroPoint, USA. Three radiologists manually traced the lumen-intima (LI) for the near and the far walls, respectively, which served as a gold standard (GS) for training the DL-based model. Three DL-based systems were developed based on three types of GS. RESULTS: IRB approved (Toho University, Japan) 407 US scans from 204 patients were collected. The risk was characterized into three classes: low, moderate, and high-risk. The area-under-curve (AUC) corresponding to three DL systems using receiver operating characteristic (ROC) analysis computed were: 0.90, 0.94 and 0.86, respectively. CONCLUSIONS: Novel DL-based strategy showed reliable, accurate and stable stenosis severity index (SSI) measurements.

A rare case of ruptured subclavian artery aneurysm treated successfully with covered stent.

Subclavian artery aneurysms are uncommon. Presentation with complication of rupture is extremely rare. We report a patient presenting as hemothorax and shock because of ruptured right subclavian artery aneurysm. This was successfully treated with placement of a covered stent with good clinical outcome.

Carcinoembryonic antigen: an invaluable marker for advanced breast cancer.

Serial serum Carcinoembryonic antigen (CEA) levels were measured in 150 individuals (50 patients with breast cancer, 50 benign breast diseases and 50 other controls). These levels were correlated with clinicopathological parameters and follow-up information. Serum CEA levels were independent of the primary tumor status, their histology, lymphoreticular response and the patients' characteristics as well as the age, sex and the menstrual status. However, the nodal status, number of involved nodes and the grade of the tumors had significant influence on the level of serum CEA. Breast cancer patients especially those with metastasis had significantly higher serum CEA levels as compared to the controls and those with localised disease, irrespective of the site of metastasis. These levels were lowered appreciably by the disease regression and were raised or stable during the disease progression. Receiver operating characteristic (ROC) curve showed metastasis to be more frequent in patients with pretreatment serum CEA levels above 25 ng/ml and persistent post treatment CEA levels above 15 ng/ml. Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and serial serum CEA levels provided an average lead time of about 3.9 months before the clinical appearance of metastasis.

Prediction of gall stone composition by ultrasound: implications for non-surgical therapy.

Oral cholecystography is the basic radiodiagnostic procedure required to assess chemical composition of gallstones as well as functional status of gall bladder prior to non-surgical management of gallstones. However, the value of ultrasound in non-surgical management of gallstones is yet to be proved. In this study we attempt to establish sonographic criteria which will predict the composition of gallstones prior to their non-surgical treatment. For this purpose the ultrasonographic characteristics of 233 patients with gallstone disease and functioning gall bladders were studied and an effort was made to correlate cholesterol and calcium content of different types of stones (as estimated by X-Ray powder diffraction study and atomic absorption spectrophotometry) with their ultrasonographic characteristics. Sonographic criteria for the presence of cholesterol stones were those which were floating and gallstones producing acoustic shadowing without internal echoes from within the stone. In detecting findings which would predict the presence of cholesterol stones on ultrasound, ultrasound had a sensitivity of 72.90% and a specificity of 100%. The predictive values of positive findings and negative findings were 100% and 93.4%, respectively. The demonstration of typical features of cholesterol stones on ultrasound obviates the need for oral cholecystography.

Situs inversus with cholelithiasis.

Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.

Giant hydronephrosis masquerading as massive ascites.

A case of unilateral giant hydronephrosis containing about 20 litres of old haemorrhagic fluid, clinically simulating massive ascites, is reported. The role of preceding abdominal trauma in the pathogenesis and the rapidity of the disease process is discussed.

Prenatal recognition of central nervous system complications of alloimmune thrombocytopenia.

The radiological findings associated with alloimmune thrombocytopenia have not been well described. We present two such cases diagnosed in utero by ultrasound and discuss the radiographic findings of intracranial hemorrhage and hydrocephalus secondary to alloimmune thrombocytopenia. An awareness of this entity and its early diagnosis and intervention may greatly reduce the morbidity and mortality associated with alloimmune thrombocytopenia.

Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy in breast lumps: a comparative evaluation.

Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy were performed in 86 patients with breast lump and the results of these techniques were finally compared with the incisional or excisional biopsy in all the patients. Fine needle aspiration cytology had the sensitivity of 96.8% and specificity of 100%, the imprint cytology had the sensitivity of 98.4% and specificity of 100%. While the tru-cut needle biopsy had the sensitivity and specificity of 100% though in this technique 15 of 86 (17.4%) specimens were rejected as insufficient for any diagnosis.

Preoperative chemotherapy for fungating breast cancer.

Thirty cases of fungating breast cancer (stages III and IV) were treated preoperatively by combination chemotherapy using cyclophosphamide (Endoxan), methotrexate, 5-fluorouracil, and prednisone. Mastectomy was performed after 2 cycles of preoperative chemotherapy followed by 6 more cycles postoperatively. Of 30 patients, 25 (83.3%) were made operable and had better disease-free survival. Preoperative chemotherapy has an advantage as regards improvement in quality and longevity without much toxicity, and provides a better palliation.