Combined ST Elevation in a Case of Acute Myocardial Infarction: How to Identify the Infarct-related Artery?

Combined ST elevation in anterior and inferior ECG leads in acute myocardial infarction is not a rarity. It is both interesting and challenging to indentify the infarct related culprit artery. We report the case of a middle aged male with acute myocardial infarction whose admission ECG shows ST elevation in lead II, III, aVF as well as from V1-V3. 90% of such cases are due to single vessel occlusion - majority due to proximal RCA occlusion and the remaining due to mid to distal LAD occlusion. ECG features to differentiate between these two vascular occlusions are discussed. In this case at hand, lead III ST elevation of 2.5 mm and V2/V3≥ 1 indicates proximal RCA as the IRA and the same has been confirmed by pre-discharge coronary angiogram .

AS, DISH or something else?

A 68-year-old farmer presented with progressively worsening pain in multiple joints associated with stiffening for 9 months. Locomotor examination revealed grossly restricted movement of the axial skeleton. There were no neurological deficits. Radiological evaluation demonstrated diffuse bone densification and extraspinal calcification with bony ankylosis reminiscent of ankylosing spondylitis. Laboratory tests subsequently yielded the true diagnosis. The patient was counselled accordingly and started on appropriate therapy.

Rhabdomyolysis with acute kidney injury in a case of hanging.

Although well-known as a complication of other hypoxic conditions such as near drowning, status asthmaticus and carbon monoxide poisoning, rhabdomyolysis has not been reported in patients with hanging. The authors report a case of partial hanging complicated by rhabdomyolysis and acute kidney injury.

Posterior reversible encephalopathy syndrome in a patient with hepatitis B induced type 1 membranoproliferative glomerulonephritis.

Posterior reversible encephalopathy syndrome (PRES) is a rare complication of nephrotic syndrome and corticosteroid therapy. Here, we discuss an 18 year old man with type 1 membranoproliferative glomerulonephritis (MPGN) secondary to hepatitis B infection who developed posterior leukoencephalopathy while on therapy with lamivudine and prednisone. He developed seizures and vision loss. He also had hypertension, but no sudden elevation was recorded at any time. Magnetic resonance imaging revealed patchy areas of altered signal intensity involving cortical gray and subcortical white matter in the bilateral frontoparietal regions, occipital cortices, temporal cortices and cerebellar hemispheres, and hyperintensity on T2W and FLAIR sequences. Tapering of prednisone and controlling hypertension resulted in clinical improvement within a few days, and in a month MRI was normal. Diagnosing PRES requires a high index of suspicion when treating similarly susceptible patients. PRES as a complication during the treatment of MPGN secondary to hepatitis B has, to our knowledge, never been reported previously in the literature.

An unusual cause for fever of unknown origin in a patient with a prosthetic valve.

A case of Wegener granulomatosis as a cause for fever of unknown origin (FUO) and secondary involvement of endocardium in association with mitral valve prosthesis is presented. Although the patient was referred as a case of unresolving pneumonia, her unresponsiveness to broad spectrum antibiotics including infective endocarditis treatment prompted investigation for a non-infectious aetiology for her FUO, leading to a diagnosis of Wegener granulomatosis.

Amelioration of diabetic dyslipidemia by macrocyclic binuclear oxovanadium complex on streptozotocin induced diabetic rats.

Diabetic dyslipidemia, the main causative factor for the progression of vascular complications in diabetes, is caused due to hyperglycemia and excess mobilisation of fatty acids. Recently we have reported on a novel macrocyclic binuclear oxovanadium (MBOV) complex synthesized by us with significant hypoglycemic efficacy and without any apparent toxicity on streptozotocin induced diabetic rats. In the present study, streptozotocin induced diabetic rats were treated with the vanadium complex (5 mg/kg body weight/day) for a period of 30 days and at the end of the treatment period the status of the lipid profile in the plasma, liver and kidney was evaluated. Also the fatty acid composition of liver and kidney were analysed by gas chromatography. The increased levels of lipid contents in plasma and tissues observed in diabetic rats were reverted back to near normal levels by the administration of the vanadium complex. Also the decreased levels of HDL cholesterol and increased levels of LDL cholesterol in plasma of diabetic rats were restored to near normal levels by the treatment with the vanadium complex. The altered fatty acid composition in liver and kidney were restored by the treatment. The results enhance the claim for the macrocyclic binuclear oxovanadium complex as a potent anti-diabetogenic drug.

Effect of Eugenia Jambolana seed kernel on antioxidant defense system in streptozotocin-induced diabetes in rats.

Increased oxidative stress has been suggested to be involved in the pathogenesis and progression of diabetic tissue damage. The aim of this study was to investigate the effect of ethanolic extract of Eugenia jambolana seed kernel on antioxidant defense systems of plasma and pancreas in streptozotocin-induced diabetes in rats. The levels of glucose, vitamin-C, vitamin-E, ceruloplasmin, reduced glutathione and lipidperoxides were estimated in plasma of control and experimental groups of rats. The levels of lipidperoxides, reduced glutathione and activities of superoxide dismutase, catalase and glutathione peroxidase were assayed in pancreatic tissue of control and experimental groups of rats. A significant increase in the levels of plasma glucose, vitamin-E, ceruloplasmin, lipid peroxides and a concomitant decrease in the levels of vitamin-C, reduced glutathione were observed in diabetic rats. The activities of pancreatic antioxidant enzymes were altered in diabetic rats. These alterations were reverted back to near normal level after the treatment with Eugenia jambolana seed kernel and glibenclamide. Histopathological studies also revealed that the protective effect of Eugenia jambolana seed kernel on pancreatic beta-cells. The present study shows that Eugenia jambolana seed kernel decreased oxidative stress in diabetic rats, which inturn may be due to its hypoglycemic property.

Protective effect of macrocyclic binuclear oxovanadium complex on oxidative stress in pancreas of streptozotocin induced diabetic rats.

Chronic hyperglycemia in diabetes is a major causative factor of free radical generation which further leads to many secondary diabetic complications via the damage to cellular proteins, membrane lipids, nucleic acids and eventually to cell death. Recently we have reported on the hypoglycemic efficacy of a new macrocyclic binuclear oxovanadium complex and its non-toxic nature. This study focuses on the effect of the above complex in ameliorating oxidative stress in the pancreas of diabetic rats. Streptozotocin induced diabetic rats were treated orally with the vanadium complex (5 mg/kg/body weight) for 30 days and the level of pancreatic antioxidants and lipid peroxides were determined. Treatment with the macrocyclic binuclear oxovanadium complex decreased the lipid peroxides and the antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase to near control levels. Histological examinations also revealed the protective effect of the complex on pancreatic beta cells. The results demonstrate the protective effect of the macrocyclic binuclear oxovanadium complex on the pancreatic antioxidant status.

Protective effect of Eugenia jambolana seed kernel on tissue antioxidants in streptozotocin-induced diabetic rats.

Oxidative stress plays an important role in chronic complications of diabetes. In the present study the antioxidant effect of oral administration of ethanolic extract of Eugenia jambolana seed kernel on tissue antioxidant enzymes and lipid peroxidation in liver and kidney of streptozotocin-induced diabetic rats was evaluated. Administration of seed kernel to diabetic rats significantly decreased the levels of blood glucose, glycosylated hemoglobin and increased body weight gain, plasma insulin and hemoglobin. The diabetic rats showed the low activities of superoxide dismutase, catalase, glutathione peroxidase and reduced glutathione content in liver and kidney, which were restored to near normal levels by treatment with the seed kernel extract. The increased levels of lipid peroxidation and hydroperoxides in diabetic rats were reverted back to near normal levels after the treatment with seed kernel extract. Diabetic rats treated with seed kernel extract restored almost normal architecture of liver and kidney and were confirmed by histopathological examination. The present study reveals the efficacy of Eugenia jambolana seed kernel in the amelioration of diabetes, which may be attributed to its hypoglycemic property along with its antioxidant potential. The antioxidant effect of Eugenia jambolana seed kernel was also compared with glibenclamide, a standard hypoglycemic drug.

Effect of macrocyclic binuclear oxovanadium complex on tissue defense system in streptozotocin-induced diabetic rats.

BACKGROUND: Oxidative stress plays an important role in chronic complications of diabetes mellitus and hence the regulation of free radicals is essential in the treatment of diabetes. The protective effect of a new macrocyclic binuclear oxovanadium complex on antioxidant defense systems of liver and kidney was examined in streptozotocin-induced experimental diabetes in rats. METHODS: The levels of lipid peroxides, glutathione and the activities of superoxide dismutase, catalase, glutathione peroxidase and glutathione-S-transferase were assayed according to standard procedures in the liver and kidney of control and experimental groups of rats. RESULTS: A significant decrease (p < 0.05) was observed in both the glutathione content and in the activities of antioxidant enzymes such as superoxide dismutase, catalase, glutathione peroxidase and a concomitant increase in the level of lipid peroxides in diabetic rats. The observed alterations in the antioxidant status of tissues reverted back to near normal levels after the oral administration of macrocyclic vanadium complex at a dose of 5 mg/kg body weight/rat/day for a period of 30 days. CONCLUSION: The normoglycemic efficacy of the vanadium complex alleviates oxidative stress in streptozotocin-induced diabetes in rats.