A study on usefulness of flow mediated vasodilatation of brachial artery in assessing the severity of coronary artery disease and its correlation with coronary angiogram.

METHODOLOGY- Patients diagnosed with coronary artery disease within 1 month and have undergone coronary angiogram ;from the period January 2014 to September 2014 in ICCU/ cardiology wards are included in the study. Patients will be subjected to symptom analysis, clinical examination, laboratory investigations and flow mediated vasodilation studies of brachial artery. The final analysis will be made at the end of the study to achieve the fore mentioned goals using appropriate statistical methods. PATIENT SELECTION: INCLUSION CRITERIA 1. All patients who have been diagnosed having coronary artery disease which includes chronic stable angina, ST elevation MI, non ST elevation MI , unstable angina 2 within the last 1month and have undergone CAG. 2. All patients who have undergone primary/ facilitated PCI within the above mentioned time. 3. Patients between 20 and 60 years of age. EXCLUSION CRITERIA 1. Patients with any form of connective tissue disorder, chronic kidney disease, Chronic liver disease 2. Any patient 60 yrs of age. CONCLUSION OF THIS STUDY Our aim of this study was to determine if there is any correlation between severity of CAD and FMD of the brachial artery , as well as to observe the relationship with various other cardiovascular risk factors . A total of 75 patients were included in the study and following are conclusions from the statistical analysis. The subjects were divided into 4 four study groups as described above and subsequently analysed. The association between the study group and factors like age , gender , diet ,alcohol intake ,duration of hypertension was found to have no correlation There is a positive correlation between duration of smoking and severity of CAD Presence of diabetes had an meaningful correlation with the study groups and there is a increase in severity of CAD with increase in duration of diabetes BMI was found to have a positive correlation with the study groups and as the BMI of the patient increased more severe was the CAD observed in them Non HDL (LDL) was found to be the better marker for assessing the cardiovascular risk as there was a significant increase in CAD severity with increasing levels of LDL ,however no such positive correlation existed between study groups and HDL Left ventricular ejection fraction measured at the time of admission was significantly lower as the severity of CAD increased There was no positive correlation between brachial artery resting diameter and post occlusive diameter among the various CAD groups Interestingly percentage of increase in flow mediated vasodilatation correlated well with the severity of CAD , in which the more severe CAD patients had significantly lower percentage increase in FMD 3 There is also a meaningful correlation between % increase in FMD and modified GENSINI SCORE.As the severity of CAD as assessed by modified GENISINI score increased significantly lower was the % increase in FMD. Hence we conclude that apart from assessing the traditional cardiovascular risk factors , it is also important to assess the endothelial function of the patient by methods like FMD. It is very clear the physiological alteration(endothelial dysfunction) in the body due to atherosclerosis, diabetes and other risk factors occur much before the structurally evident changes like plaques. FMD could be used as a tool to determine the endothelial function of the patients very early in the course natural history of CAD . Its use could be widely employed as it is non invasive and very simple procedure . Interestingly even unstable angina patients with normal /non obstructive CAG had endothelial dysfunction and whether this could be the reason for angina is still debatable. Since it a direct reflection of the health status of coronary vessels this could be utilised in screening of even young healthy individuals with family history of CAD . This technique has great scope in the near future mainly because of its non invasive technique in assessing the severity of CAD. It however requires large sample studies to substantiate this and though not yet recommended for routine clinical use, non invasive endothelial function testing has provided valuable insights into vascular changes associated with early atherosclerosis and the potential reversibility of arterial disease

A revision of Indian species of Parurios Girault with a new record of Papuopsia Boucek (Hymenoptera: Pteromalidae) from India

Two new species of Parurios Girault viz. P. bouceki Narendran sp. nov. and P. sringericus Narendran sp. nov. are described from India. The female of P. keralensis Narendran is also described. A key to Indian species of Parurios is provided. The genus Papuopsia is recorded for the first time from India

Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study

This is the final published version. Available from BMJ Publishing via the DOI in this record.All data underlying the findings are fully available without restriction. All relevant data are within the paperObjectives To explore attitudes and barriers to exercise in adults with new-onset type 1 diabetes mellitus (T1DM). Design Qualitative methodology using focus group (n=1), individual face-to-face (n=4) and telephone interviews (n=8). Thematic analysis using the Framework Method. Setting Nineteen UK hospital sites. Participants Fifteen participants in the Exercise for Type 1 Diabetes study. We explored current and past levels of exercise, understanding of exercise and exercise guidelines, barriers to increasing exercise levels and preferences for monitoring of activity in a trial. Results Five main themes were identified: existing attitudes to exercise, feelings about diagnosis, perceptions about exercise consequences, barriers to increasing exercise and confidence in managing blood glucose. An important finding was that around half the participants reported a reduction in activity levels around diagnosis. Although exercise was felt to positively impact on health, some participants were not sure about the benefits or concerned about potential harms such as hypoglycaemia. Some participants reported being advised by healthcare practitioners (HCPs) not to exercise. Conclusions Exercise should be encouraged (not discouraged) from diagnosis, as patients may be more amenable to lifestyle change. Standard advice on exercise and T1DM needs to be made available to HCPs and patients with T1DM to improve patients’ confidence in managing their diabetes around exercise. Trial registration number ISRCTN91388505; ResultsNational Institute for Health Research (NIHR)National Institute for Health Research (NIHR

A 2 year retrospective evaluation of mannheim peritonitis index in patients with secondary peritonitis in Hospital Universiti Sains Malaysia (from January 2013 to October 2014)

Topic: A 2 year retrospective evaluation of Mannheim peritonitis index in patients with secondary peritonitis in Hospital Universiti Sains Malaysia (January 2013 - October 2014). Backgound: For decades, peritonitis has presented surgeons a challenge despite newer advances in various facets of medicine. The risk stratification of patients is important to appropriately study the individual risk factors to predict possible outcome in terms of morbidity and mortality. The objective of this study is to evaluate the Mannheim peritonitis index in determining the outcome in patients operated for secondary peritonitis in HUSM. Method: The study population consisted of patients who underwent any form of intra-abdominal operations for secondary peritonitis during the period of study. The total number of patients were 113. The patient’s medical records was traced from the hospital records department after permission was granted from the Hospital Director. The relevant socio demographic, clinical, operative notes and survival status was entered into a proforma form. All the data recorded was entered into SPSS software version 21 and analyzed. Pearson chi-square and independent t-test were used as statistical tests . Significant difference was taken into account if the probability or ‘p’ value is equal or less than 0.05. Results: The mean MPI score was 25.22 (+- 8.03) with the lowest score of 10 and highest score of 43. The threshold MPI score was 26.5 and there was only 1 death which occurred below this score. No deaths occurred below score of 21. The significant predictive factors for mortality was age more than 50 years, gender, organ failure and diffuse generalized peritonitis. Meanwhile, all parameters for MPI affected the MPI scoring except for source of sepsis not from colon. The ROC curve for mortality showed a sensitivity of 94.7% and specificity of 70.2% at a threshold MPI of 26.5. Conclusion: For patients with secondary peritonitis undergoing operation, MPI scoring would be the best for grading severity and prognosis due to its simplicity and cost efficiency. Further increase in its prognostic power is desirable with some physiological data such as from APACHE 2. Application of MPI in the Malaysian population would be appropriate by changing the source of sepsis parameter to a higher score for those who have colonic source instead of non colonic which is the current MPI scoring system

Urine nevirapine as a predictor of antiretroviral adherence

Background & objectives: Incomplete adherence is a major contributor to failure of antiretroviral therapy. Although the available methods to monitor adherence to therapy have proved to be predictive of outcomes, the results are variable. We assessed the feasibility of detecting nevirapine (NVP) in spot urine samples to monitor patient adherence to antiretroviral treatment and to study the urinary excretion of NVP in healthy volunteers after oral administration of a single dose of NVP (200 mg). Methods: Spot urine samples were collected from 50 HIV-infected patients (36 on treatment regimen containing NVP and 14 on drugs other than NVP) and tested for NVP by HPLC in a blinded manner. Sixteen healthy volunteers (9 males and 7 females) were administered a single oral dose of 200 mg NVP and spot urine samples were collected on day ‘0’ before drug administration, and thereafter every 24 h up to 9 days and tested for NVP. Results: All the urine samples collected from patients undergoing treatment with NVP-containing regimens at different time points after drug administration tested positive for NVP. Thirteen out of 14 samples from patients not on NVP yielded a negative result. The drug was detected in the urine of healthy volunteers up to 9 days. The urinary excretion of NVP was prolonged in females than in males. Interpretation & conclusion: In view of its long half-life, NVP gets excreted in urine for a long period of time. Hence, testing spot urine samples for NVP may not be a useful measure to monitor patient adherence to treatment

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis.

AIMS/HYPOTHESIS: Our objectives were to explore whether the phenomenon of HbA1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. METHODS: A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA1c levels over time with random effects on general practices (primary care units) and individuals within practices. RESULTS: 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA1c measurement (-7.0 [95% CI -8.0, -6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA1c. CONCLUSIONS/INTERPRETATION: In individuals with type 1 diabetes, glycaemic control measured by HbA1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA1c tracking level for the next 10 years