Lipid clinical trials with special reference to Indian population.

Indians have a pattern of atherogenic dyslipidaemia characterised by not so high LDL-C but elevated small, dense LDL-C, elevated triglyceride levels and low HDL-C levels. In addition, different lipid-lowering drugs exhibit pharmacokinetic variability in Indians, which may have implications on the optimum doses required to achieve the desired LDL-C levels. Currently the management of dyslipidaemia in Indians are based on the landmark trials, which largely included western population. This review focusses on major clinical trials of lipid lowering drugs with special reference to the Indian population.

Conundrum of aortic stenosis in a case of multivalvular rheumatic heart disease: perspicuity is in the details.

A 36-year-old woman presented with dyspnoea on exertion for 5 years. She was evaluated elsewhere and diagnosed to have severe mitral stenosis. She was referred for mitral valve replacement to our centre. Echocardiography revealed a thickened aortic valve with mild aortic regurgitation, with transaortic gradient suggestive of mild aortic stenosis, in addition to severe rheumatic mitral stenosis. Detailed echocardiographic analysis and cardiac catheterisation revealed features suggestive of moderate to severe aortic stenosis. Detailed assessment of aortic valve needs to be done in patients with coexistent mitral stenosis. Each modality for assessment of aortic stenosis has its own limitations and a decision regarding treatment needs to be taken based on combined analysis of all the parameters. Dimensionless velocity index is a relatively less time-consuming, flow independent measure of aortic stenosis. Prompt recognition of this concealed aortic stenosis helps to avoid repeat valve surgery. Subsequently, patient was sent for dual valve replacement.

Autoantibody profile in children with Kawasaki disease on long-term follow-up: A prospective study from North India.

AIM: To study the profile of autoantibodies on long-term follow-up of children with Kawasaki disease (KD). PATIENTS AND METHODS: In this single-center observational cohort study, 50 children who had been diagnosed and treated for KD with a minimum follow-up period of 3 years were enrolled. The organ-specific autoantibodies that were assessed in the study included anti-thyroid microsomal antibody (TMA), anti-parietal cell antibody (PCA) and anti-liver kidney microsomal (LKM) antibody. The organ-nonspecific autoantibodies that were studied included anti-endothelial cell antibody (AECA), anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), anti-mitochondrial antibody (AMA) and anti-smooth muscle antibody (SMA). RESULTS: The sample for assessment of serology was taken at a mean follow-up period of 6.41 years (±1.95 SD) after diagnosis. Autoantibodies were detected in 11/50 (22%) patients. ANA was detected in three patients, TMA was positive in seven and ANCA was positive in one. CONCLUSIONS: These autoantibodies likely develop in children with KD during the acute stage and may persist for many years. There is no concrete evidence to suggest that these children are at increased risk of developing an autoimmune disease in the future. However, there is some justification for prolonged surveillance for development of autoimmune manifestations.

Systemic cryptococcosis in an immune-competent child.

Crytococcus neoformans is an encapsulated yeast that frequently affects immune-compromised patients, although increasingly being detected in the immune-competent host as well. We report a case of disseminated cryptococcosis in a young child in whom no immune deficiency was yet identified. A 4-year-old child presented with high-grade fever, intermittent abdominal pain and generalized skin eruptions for the past two months. He had pallor, firm lymphadenopathy, skin lesions with scarring and firm hepatosplenomegaly. Magnetic resonance imaging of brain and bone-marrow aspiration were normal. Fine-needle-aspiration-cytology of cervical lymph nodes demonstrated Cryptococcus. Serum latex-agglutination test showed a positive titer (1:256). Cryptococcus culture was sterile. The patient received intravenous liposomal amphotericin-B and oral flucytosine for 8 weeks followed by oral fluconazole. Disseminated cryptococcosis with involvement of reticuloendothelial and dermatological systems is rare. Early diagnosis and timely management of associated complications would be life saving.