Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both ge... more Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both genders, however, the importance of CAD in females is underappreciated. Aims and Objectives: This study is aimed at investigating the gender-based differences in presentation, evaluation, and outcome of CADs in a northern state of India. Materials and Methods: This is a prospective study conducted over a period of 3 years. All the patients with CAD (acute coronary syndrome or chronic stable angina) enrolled in the study were evaluated for clinical profile, angiographic profile, and the outcome. Results: A total of 3660 patients were enrolled in this study. There were 56.2% of males and 43.8% of females. Smoking as risk factor was noted in 69.6% of males and 7.9% of females, hypertension in 52.9% of males versus 65.4% of females, diabetes in 42.5% of males versus 60.7% of females, and obesity in 46.2% of males versus 57.3% of females. Male versus female mean body mass index was 24.7 versus 27.4, low-density lipoprotein 112.8 versus 123.7, high-sensitivity C-reactive protein 1.5 versus 2.9, and Lp(a) 274.9 versus 442.1, respectively. On coronary angiographic evaluation, male versus female single-vessel involvement was seen in 54.1% versus 58.8% of patients, double-vessel disease in 31.6% versus 27.6%, left main disease in 1.7% versus 3.6%, and spontaneous coronary artery dissection in 0.9% versus 1.5% patients, respectively. The overall mortality in males was 4.03% and 5.11% in females. Conclusion: Despite its atypical presentation, CAD has the worst outcome in women than men. Greater awareness of these gender-based differences will significantly improve the management and outcome of CAD in women.
Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the ser... more Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the serious presentations of the atherosclerotic disease spectrum. PAD due to atherosclerotic disease can lead to significant morbidity and mortality with significant medical and economic burden. Aim: To study the prevalence of PAD in patients presenting with ACS in the Hill population of Northern India. Materials and Methods: Patients presenting with ACS, with acute chest pain, Electrocardiogram (ECG) changes and elevated troponins were enrolled in the study. The presence of PAD was assessed with MESI Ankle Branchial Measuring Device (MESI ABPI MD® Slovenia EU) system which uses plethysmographic sensors with an inbuilt software that automatically calculates ABI with accuracy. Patients with ABI <0.91 were further evaluated by Computed Tomography (CT) Angiography of lower limb vessels. Results: A total of 288 patients were included in the study. There were 238 (82.6%) males and 50 (17.4%) fem...
Objectives: To study the magnitude of chronic liver disorders in children attending the only tert... more Objectives: To study the magnitude of chronic liver disorders in children attending the only tertiary care hospital. To study the spectrum of chronic liver disorders in children. Study design: Prospective observational study Material and methods: The study included prospective (July 2007 to Dec.2008) analysis of all children < 18 yrs with chronic liver disorders. A total of 94 children with confirmed diagnosis of chronic liver disease were included in the study. The diagnosis of all liver diseases was based on established clinical and diagnostic criteria. Severity of chronic liver disease was defined using Child grading. Results: Mean age of patients was 10.4 ± 4 yrs with a range of 1-18 yrs. Jaundice(75%), ascites (64%),encephalopathy (29%) were presenting symptoms in chronic liver disease patients indicating decompensation at presentation .Features of portal hypertension were seen in 65%.Etiology was found to be HBV in 18%, Wilsons disease in 16% ,HCV in 6.4%, autoimmune in 5.3...
The present case study demonstrates the alcoholic with niacin deficiency. Niacin deficiency can o... more The present case study demonstrates the alcoholic with niacin deficiency. Niacin deficiency can occur through genetic disorders, malabsorptive conditions, and interaction with certain medications. Alcohol use disorder is associated with increased malnutrition and can impair the conversion of tryptophan to niacin. A 45 year old male truck driver by occupation chronic alcoholic, normotensive, non-diabetic, with hyper pigmented dermatological lesions on dorsum of hands, neck, scalp labeled as psoriasis with topical treatment was brought to emergency casualty with fever for 15 days. Patient was managed as a case of febrile neutropenia without much improvement and his striking dermatological lesions and history of alcoholism warranted his management as pellagra.
Technological Innovation in Pharmaceutical Research Vol. 8, 2021
Background: The goal of this prospective, randomised, double-blind research was to see how adding... more Background: The goal of this prospective, randomised, double-blind research was to see how adding magnesium or dexmedetomidine to epidural bupivacaine in upper abdomen procedures affected the outcome. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing upper abdominal procedures were randomly assigned to either magnesium sulphate (Group M) or dexmedetomidine (Group D) as well as epidural bupivacaine for surgical anaesthesia. All of the trial participants were given an epidural anaesthetic with 8 ml of 0.5 percent bupivacaine and either 50 mg MgSO4 (Group M) or 1 g/kg dexmedetomidine (Group D). Duration of analgesia, total rescue analgesic requirement, hemodynamic parameters and any adverse events were monitored. Results: Analgesia in the postoperative phase was better in Group BD, as was the need for rescue analgesics. Sedation was more common in Group BD. Conclusion: Dexmeditomidine prolongs the duration of analgesia and produ...
Case Report Catheter-based interventions have become the preferred choice of treatment for most o... more Case Report Catheter-based interventions have become the preferred choice of treatment for most of the cardiac ailments world over. Guiding catheters act as conduits for delivering different sophisticated hardware to the target lesion. Malfunction of these conduits can adversely affect the outcome of an interventional procedure. A 60 years old male presented with a history of 4 hours of chest pain. ECG was suggestive of an inferior wall myocardial infarction. Left sided angiogram with JL 4 diagnostic catheter revealed normal coronaries. Right coronary artery had a proximal lesion. After predilatation of the lesion, difficulty was encountered in advancing stent due to development of kinks in the guiding catheter. These kinks were treated with serial dilatation with semi-compliant balloons (Guidoplasty). Following this Guidoplasty, the stent and post dilatation balloon could be advanced and the procedure completed successfully. We conclude that careful balloon dilatation of the guidin...
Highlights on Medicine and Medical Science Vol. 5, 2021
In the cath lab, transcutaneous or transvenous pacing of the right ventricle is performed as a ro... more In the cath lab, transcutaneous or transvenous pacing of the right ventricle is performed as a routine practise for patients with symptomatic bradycardia or complete heart block. Temporary transcutaneous or transvenous pacing is commonly the first intervention taught to cardiologists and intensivist, as it is one of the most important lifesaving interventions in cardiology. However, more and more patients are received with multiple comorbidities, critical condition, and difficult vascular access. The goal of this study is to report a patient who had challenging venous access, tricuspid regurgitation, and a displaced right ventricular pacemaker temporary lead who was handled with emergent nonconventional left ventricular pacing while having coronary angiography.
Cardiac pseudoaneurysm formation following isolated pericardial effusion is one of the rare compl... more Cardiac pseudoaneurysm formation following isolated pericardial effusion is one of the rare complications with only few case reports published so far in the literature. A 3½ years old male child present with fever and purulent polyarthritis causing staphylococcus aureus septicemia, which finally complicated into purulent pericardial effusion followed by left ventricular pseudo-aneurysm formation. Despite aggressive management, the patient had a downhill course of illness and finally resulted in death. Staphylococcal infection, especially in children can lead to metastatic infection of heart with fatal outcomes.
Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboem... more Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively. Results A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD...
Background Acute coronary syndrome (ACS) indicates the serious clinical manifestation of coronary... more Background Acute coronary syndrome (ACS) indicates the serious clinical manifestation of coronary artery disease (CAD) and is closely associated with cardiovascular prognosis in patients with ACS. This study was aimed to study the prevalence of type 2 diabetes mellitus (T2DM) and the relation of HbA1c with the severity of CAD in patients presenting as non-diabetic ACS. Diabetic status of the patients was assessed with fasting blood sugar (FBS) and HbA1c levels, and coronary artery disease burden was assessed by coronary angiography. Results Out of 208 patients, 85.1% were males, and 14.9% were females; 73.56% cases were hypertensive. 80.77% of cases had STEMI, 17.79% had NSTEMI, and 1.44% had unstable angina. Out of 168 STEMI patients, 64.3% were thrombolysed, 21.42% presented late, 2.38% had contraindications to thrombolysis, and 11.9% underwent primary PCI. FBS in diabetic range was found in 44.23% of cases, impaired FBS in 36.54%, and 19.23% of patients had FBS in non-diabetic ra...
Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised t... more Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised the management of this disease and the choice and safety of vascular access site has significantly contributed to the outcome of the overall procedure. Aim: To assess upper extremity dysfunction in patients undergoing Transradial Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Materials and Methods: This study involved patients planned for transradial coronary intervention. Patients were assessed for development of upper extremity dysfunction and other local complications post procedure at 24 hours, 2 weeks, 1 month and 6 months. Data analysis was done using SPSS Version 21. Results: A total of 165 patients were enrolled in the study. There were 123 (74.5%) males. Total 156 patients (94.5%) had stable angina as underlying diagnosis, 4 (2.4%) had unstable angina, 2 (1.2%) had Non ST Elevation Myocardial Infarction (NSTEMI), 1 (0.6%) had ST Elevation Myocardial Inf...
International Journal of Contemporary Medical Research [IJCMR], 2020
Introduction: CAPD is one of the renal replacement therapies which is gaining popularity in the d... more Introduction: CAPD is one of the renal replacement therapies which is gaining popularity in the developing world especially India. This study was aimed to study the clinical profile and complication of Complications of Continuous Ambulatory Peritoneal Dialysis (CAPD). Material and Methods: Patients on CAPD at our center were evaluated for their clinical profile, complication and outcome on follow-up. Results: A total of 100 patients were included in the study. There were 66%males and 34% females. Mean age of the patients was 47.95± 6 years. Hypertension was seen as etiology in 36%, Diabetes in 27%, chronic glomerulonephritis in 22%, Analgesic nephropathy in 4%, Obstructive nephropathy in 3% and in 4% cases no obvious cause for CKD could be found. Among the complications pain was seen in 11%, pericatheter leak in 5%, bleeding 7%, intestinal perforation in 2%, hernia in 5%, total obstruction in 4%, exit site infection in 7%, tunnel infection in 2% and total 111 episodes of peritonitis. Technique survival at 1 year and 2 years was 97%and 94% respectively. Patient survival at one and two years was 90% and 78% respectively Conclusion: CAPD presents a viable form of renal replacement therapy. There has been sustained decrease in complication rates and improvement in technique and patient survival with advancement in catheter implantation and complication management
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
International Journal of Research in Medical Sciences, 2020
Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world... more Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and ...
International Journal of Contemporary Medical Research [IJCMR], Mar 1, 2020
Introduction: Penetrating ballistic cardiac injury is usually fatal before victim the gets any me... more Introduction: Penetrating ballistic cardiac injury is usually fatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few cases have been reported in the literature. Case report: We describe a young patient who presented with multiple life threatening pellet injuries involving chest, abdomen, and limbs. Patient had CT and echocardiography documented retained pellets in the heart with pericardial effusion. Patient was managed successfully using conservative approach without any surgical intervention. Conclusion: this case highlights the importance of careful monitoring and conservative approach in such critically ill patients for a better outcome.
Scholars Journal of Medical Case Reports, Jan 25, 2020
Post procedural chest pain after percutaneous coronary intervention is a nerve wrecking symptom f... more Post procedural chest pain after percutaneous coronary intervention is a nerve wrecking symptom for both the interventionist and the patient. Prompt recognition of the underlying condition and management is critical for survival of the patient and success of the procedure. Here we describe an unusual cause of acute severe chest pain with a good prognosis on early recognition, which should be considered as one of the differential diagnosis after a coronary intervention in this scenario.
Journal of Cardiovascular Disease Research, Nov 3, 2017
Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atri... more Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (V max : maximal LA volume, V min : minimal LA volume, and V p : LA volume at the onset of P-wave) were measured by modified Simpson's method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in V max (p < 0.001), V min (p < 0.001), and V p (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.
Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir vall... more Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir valley. This study was designed to document various clinical features and to sequence exons 11 and 12 of plakophilin 2 (PKP2) gene in these patients. ACM patients who attended cardiology outpatient department of our institute from January 2014 to April 2015 were included in the study. Their records were reviewed. Controls were randomly selected, who had no history or family history of cardiac illness and had a normal cardiac examination. A blood sample was also taken from both the groups for sequencing of exon 11 and 12 of PKP2 gene. ACM patients were followed up until July 2016. Eleven ACM patients and seven controls were included in the study. Most common mode of presentation was ventricular tachycardia (VT). Two patients had left ventricular (LV) systolic dysfunction. One patient had a splice site mutation in exon 12 of PKP2 gene and one patient died during follow-up. One of the controls ...
This study was conducted to compare the safety and efficacy of microwire assisted technique with ... more This study was conducted to compare the safety and efficacy of microwire assisted technique with contrast venography guided axillary venipuncture in patients undergoing cardiovascular implantable electronic device (CIED) implantation.
Case Report IntroductIon Among the cardia rhythm disturbances bradyarrythmias are more commonly e... more Case Report IntroductIon Among the cardia rhythm disturbances bradyarrythmias are more commonly encountered and have life threatening presentations. Prompt treatment of the condition has a rewarding out come in these patients. Transcutaneous or transvenous pacing of the right ventricle is performed as a routine practice for patients received with symptomatic bradycardia or complete heart block with relative ease in cath lab. However, more and more patients are received with multiple comorbidities, critical condition, and difficult vascular access. In this article, we describe a patient with difficult venous access with tricuspid regurgitation and displaced the right ventricular pacemaker temporary lead undergoing coronary angiography who was managed with emergent nonconventional left ventricular pacing.
Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both ge... more Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both genders, however, the importance of CAD in females is underappreciated. Aims and Objectives: This study is aimed at investigating the gender-based differences in presentation, evaluation, and outcome of CADs in a northern state of India. Materials and Methods: This is a prospective study conducted over a period of 3 years. All the patients with CAD (acute coronary syndrome or chronic stable angina) enrolled in the study were evaluated for clinical profile, angiographic profile, and the outcome. Results: A total of 3660 patients were enrolled in this study. There were 56.2% of males and 43.8% of females. Smoking as risk factor was noted in 69.6% of males and 7.9% of females, hypertension in 52.9% of males versus 65.4% of females, diabetes in 42.5% of males versus 60.7% of females, and obesity in 46.2% of males versus 57.3% of females. Male versus female mean body mass index was 24.7 versus 27.4, low-density lipoprotein 112.8 versus 123.7, high-sensitivity C-reactive protein 1.5 versus 2.9, and Lp(a) 274.9 versus 442.1, respectively. On coronary angiographic evaluation, male versus female single-vessel involvement was seen in 54.1% versus 58.8% of patients, double-vessel disease in 31.6% versus 27.6%, left main disease in 1.7% versus 3.6%, and spontaneous coronary artery dissection in 0.9% versus 1.5% patients, respectively. The overall mortality in males was 4.03% and 5.11% in females. Conclusion: Despite its atypical presentation, CAD has the worst outcome in women than men. Greater awareness of these gender-based differences will significantly improve the management and outcome of CAD in women.
Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the ser... more Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the serious presentations of the atherosclerotic disease spectrum. PAD due to atherosclerotic disease can lead to significant morbidity and mortality with significant medical and economic burden. Aim: To study the prevalence of PAD in patients presenting with ACS in the Hill population of Northern India. Materials and Methods: Patients presenting with ACS, with acute chest pain, Electrocardiogram (ECG) changes and elevated troponins were enrolled in the study. The presence of PAD was assessed with MESI Ankle Branchial Measuring Device (MESI ABPI MD® Slovenia EU) system which uses plethysmographic sensors with an inbuilt software that automatically calculates ABI with accuracy. Patients with ABI <0.91 were further evaluated by Computed Tomography (CT) Angiography of lower limb vessels. Results: A total of 288 patients were included in the study. There were 238 (82.6%) males and 50 (17.4%) fem...
Objectives: To study the magnitude of chronic liver disorders in children attending the only tert... more Objectives: To study the magnitude of chronic liver disorders in children attending the only tertiary care hospital. To study the spectrum of chronic liver disorders in children. Study design: Prospective observational study Material and methods: The study included prospective (July 2007 to Dec.2008) analysis of all children < 18 yrs with chronic liver disorders. A total of 94 children with confirmed diagnosis of chronic liver disease were included in the study. The diagnosis of all liver diseases was based on established clinical and diagnostic criteria. Severity of chronic liver disease was defined using Child grading. Results: Mean age of patients was 10.4 ± 4 yrs with a range of 1-18 yrs. Jaundice(75%), ascites (64%),encephalopathy (29%) were presenting symptoms in chronic liver disease patients indicating decompensation at presentation .Features of portal hypertension were seen in 65%.Etiology was found to be HBV in 18%, Wilsons disease in 16% ,HCV in 6.4%, autoimmune in 5.3...
The present case study demonstrates the alcoholic with niacin deficiency. Niacin deficiency can o... more The present case study demonstrates the alcoholic with niacin deficiency. Niacin deficiency can occur through genetic disorders, malabsorptive conditions, and interaction with certain medications. Alcohol use disorder is associated with increased malnutrition and can impair the conversion of tryptophan to niacin. A 45 year old male truck driver by occupation chronic alcoholic, normotensive, non-diabetic, with hyper pigmented dermatological lesions on dorsum of hands, neck, scalp labeled as psoriasis with topical treatment was brought to emergency casualty with fever for 15 days. Patient was managed as a case of febrile neutropenia without much improvement and his striking dermatological lesions and history of alcoholism warranted his management as pellagra.
Technological Innovation in Pharmaceutical Research Vol. 8, 2021
Background: The goal of this prospective, randomised, double-blind research was to see how adding... more Background: The goal of this prospective, randomised, double-blind research was to see how adding magnesium or dexmedetomidine to epidural bupivacaine in upper abdomen procedures affected the outcome. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing upper abdominal procedures were randomly assigned to either magnesium sulphate (Group M) or dexmedetomidine (Group D) as well as epidural bupivacaine for surgical anaesthesia. All of the trial participants were given an epidural anaesthetic with 8 ml of 0.5 percent bupivacaine and either 50 mg MgSO4 (Group M) or 1 g/kg dexmedetomidine (Group D). Duration of analgesia, total rescue analgesic requirement, hemodynamic parameters and any adverse events were monitored. Results: Analgesia in the postoperative phase was better in Group BD, as was the need for rescue analgesics. Sedation was more common in Group BD. Conclusion: Dexmeditomidine prolongs the duration of analgesia and produ...
Case Report Catheter-based interventions have become the preferred choice of treatment for most o... more Case Report Catheter-based interventions have become the preferred choice of treatment for most of the cardiac ailments world over. Guiding catheters act as conduits for delivering different sophisticated hardware to the target lesion. Malfunction of these conduits can adversely affect the outcome of an interventional procedure. A 60 years old male presented with a history of 4 hours of chest pain. ECG was suggestive of an inferior wall myocardial infarction. Left sided angiogram with JL 4 diagnostic catheter revealed normal coronaries. Right coronary artery had a proximal lesion. After predilatation of the lesion, difficulty was encountered in advancing stent due to development of kinks in the guiding catheter. These kinks were treated with serial dilatation with semi-compliant balloons (Guidoplasty). Following this Guidoplasty, the stent and post dilatation balloon could be advanced and the procedure completed successfully. We conclude that careful balloon dilatation of the guidin...
Highlights on Medicine and Medical Science Vol. 5, 2021
In the cath lab, transcutaneous or transvenous pacing of the right ventricle is performed as a ro... more In the cath lab, transcutaneous or transvenous pacing of the right ventricle is performed as a routine practise for patients with symptomatic bradycardia or complete heart block. Temporary transcutaneous or transvenous pacing is commonly the first intervention taught to cardiologists and intensivist, as it is one of the most important lifesaving interventions in cardiology. However, more and more patients are received with multiple comorbidities, critical condition, and difficult vascular access. The goal of this study is to report a patient who had challenging venous access, tricuspid regurgitation, and a displaced right ventricular pacemaker temporary lead who was handled with emergent nonconventional left ventricular pacing while having coronary angiography.
Cardiac pseudoaneurysm formation following isolated pericardial effusion is one of the rare compl... more Cardiac pseudoaneurysm formation following isolated pericardial effusion is one of the rare complications with only few case reports published so far in the literature. A 3½ years old male child present with fever and purulent polyarthritis causing staphylococcus aureus septicemia, which finally complicated into purulent pericardial effusion followed by left ventricular pseudo-aneurysm formation. Despite aggressive management, the patient had a downhill course of illness and finally resulted in death. Staphylococcal infection, especially in children can lead to metastatic infection of heart with fatal outcomes.
Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboem... more Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively. Results A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD...
Background Acute coronary syndrome (ACS) indicates the serious clinical manifestation of coronary... more Background Acute coronary syndrome (ACS) indicates the serious clinical manifestation of coronary artery disease (CAD) and is closely associated with cardiovascular prognosis in patients with ACS. This study was aimed to study the prevalence of type 2 diabetes mellitus (T2DM) and the relation of HbA1c with the severity of CAD in patients presenting as non-diabetic ACS. Diabetic status of the patients was assessed with fasting blood sugar (FBS) and HbA1c levels, and coronary artery disease burden was assessed by coronary angiography. Results Out of 208 patients, 85.1% were males, and 14.9% were females; 73.56% cases were hypertensive. 80.77% of cases had STEMI, 17.79% had NSTEMI, and 1.44% had unstable angina. Out of 168 STEMI patients, 64.3% were thrombolysed, 21.42% presented late, 2.38% had contraindications to thrombolysis, and 11.9% underwent primary PCI. FBS in diabetic range was found in 44.23% of cases, impaired FBS in 36.54%, and 19.23% of patients had FBS in non-diabetic ra...
Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised t... more Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised the management of this disease and the choice and safety of vascular access site has significantly contributed to the outcome of the overall procedure. Aim: To assess upper extremity dysfunction in patients undergoing Transradial Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Materials and Methods: This study involved patients planned for transradial coronary intervention. Patients were assessed for development of upper extremity dysfunction and other local complications post procedure at 24 hours, 2 weeks, 1 month and 6 months. Data analysis was done using SPSS Version 21. Results: A total of 165 patients were enrolled in the study. There were 123 (74.5%) males. Total 156 patients (94.5%) had stable angina as underlying diagnosis, 4 (2.4%) had unstable angina, 2 (1.2%) had Non ST Elevation Myocardial Infarction (NSTEMI), 1 (0.6%) had ST Elevation Myocardial Inf...
International Journal of Contemporary Medical Research [IJCMR], 2020
Introduction: CAPD is one of the renal replacement therapies which is gaining popularity in the d... more Introduction: CAPD is one of the renal replacement therapies which is gaining popularity in the developing world especially India. This study was aimed to study the clinical profile and complication of Complications of Continuous Ambulatory Peritoneal Dialysis (CAPD). Material and Methods: Patients on CAPD at our center were evaluated for their clinical profile, complication and outcome on follow-up. Results: A total of 100 patients were included in the study. There were 66%males and 34% females. Mean age of the patients was 47.95± 6 years. Hypertension was seen as etiology in 36%, Diabetes in 27%, chronic glomerulonephritis in 22%, Analgesic nephropathy in 4%, Obstructive nephropathy in 3% and in 4% cases no obvious cause for CKD could be found. Among the complications pain was seen in 11%, pericatheter leak in 5%, bleeding 7%, intestinal perforation in 2%, hernia in 5%, total obstruction in 4%, exit site infection in 7%, tunnel infection in 2% and total 111 episodes of peritonitis. Technique survival at 1 year and 2 years was 97%and 94% respectively. Patient survival at one and two years was 90% and 78% respectively Conclusion: CAPD presents a viable form of renal replacement therapy. There has been sustained decrease in complication rates and improvement in technique and patient survival with advancement in catheter implantation and complication management
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
International Journal of Research in Medical Sciences, 2020
Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world... more Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and ...
International Journal of Contemporary Medical Research [IJCMR], Mar 1, 2020
Introduction: Penetrating ballistic cardiac injury is usually fatal before victim the gets any me... more Introduction: Penetrating ballistic cardiac injury is usually fatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few cases have been reported in the literature. Case report: We describe a young patient who presented with multiple life threatening pellet injuries involving chest, abdomen, and limbs. Patient had CT and echocardiography documented retained pellets in the heart with pericardial effusion. Patient was managed successfully using conservative approach without any surgical intervention. Conclusion: this case highlights the importance of careful monitoring and conservative approach in such critically ill patients for a better outcome.
Scholars Journal of Medical Case Reports, Jan 25, 2020
Post procedural chest pain after percutaneous coronary intervention is a nerve wrecking symptom f... more Post procedural chest pain after percutaneous coronary intervention is a nerve wrecking symptom for both the interventionist and the patient. Prompt recognition of the underlying condition and management is critical for survival of the patient and success of the procedure. Here we describe an unusual cause of acute severe chest pain with a good prognosis on early recognition, which should be considered as one of the differential diagnosis after a coronary intervention in this scenario.
Journal of Cardiovascular Disease Research, Nov 3, 2017
Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atri... more Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (V max : maximal LA volume, V min : minimal LA volume, and V p : LA volume at the onset of P-wave) were measured by modified Simpson's method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in V max (p < 0.001), V min (p < 0.001), and V p (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.
Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir vall... more Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir valley. This study was designed to document various clinical features and to sequence exons 11 and 12 of plakophilin 2 (PKP2) gene in these patients. ACM patients who attended cardiology outpatient department of our institute from January 2014 to April 2015 were included in the study. Their records were reviewed. Controls were randomly selected, who had no history or family history of cardiac illness and had a normal cardiac examination. A blood sample was also taken from both the groups for sequencing of exon 11 and 12 of PKP2 gene. ACM patients were followed up until July 2016. Eleven ACM patients and seven controls were included in the study. Most common mode of presentation was ventricular tachycardia (VT). Two patients had left ventricular (LV) systolic dysfunction. One patient had a splice site mutation in exon 12 of PKP2 gene and one patient died during follow-up. One of the controls ...
This study was conducted to compare the safety and efficacy of microwire assisted technique with ... more This study was conducted to compare the safety and efficacy of microwire assisted technique with contrast venography guided axillary venipuncture in patients undergoing cardiovascular implantable electronic device (CIED) implantation.
Case Report IntroductIon Among the cardia rhythm disturbances bradyarrythmias are more commonly e... more Case Report IntroductIon Among the cardia rhythm disturbances bradyarrythmias are more commonly encountered and have life threatening presentations. Prompt treatment of the condition has a rewarding out come in these patients. Transcutaneous or transvenous pacing of the right ventricle is performed as a routine practice for patients received with symptomatic bradycardia or complete heart block with relative ease in cath lab. However, more and more patients are received with multiple comorbidities, critical condition, and difficult vascular access. In this article, we describe a patient with difficult venous access with tricuspid regurgitation and displaced the right ventricular pacemaker temporary lead undergoing coronary angiography who was managed with emergent nonconventional left ventricular pacing.
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