Duration of antiplatelet therapy cessation before coronary artery bypass surgery: Relation with platelet count

AbstractAs of now, no study or data is available to determine the period of discontinuation of antiplatelet therapy and the timing of elective surgery in clopidogrel treated patients. The 2011 ACCF/AHA Guidelines have a Class-I recommendation for withdrawing clopidogrel for 5 days before elective coronary artery bypass grafting. However, 5 days period may not suit all patients as platelet count varies from 150 × 109/L to 450 × 109/L. Based on our retrospective data analysis, we have proposed a hypothesis to determine no of days of discontinuation of antiplatelet therapy while taking in consideration the basal count and life-span of platelets

Violence against doctors in the Indian subcontinent: A rising bane

Incidents of violence against doctors in the Indian subcontinent have increased in the last few years. Most doctors in India, China, Pakistan, Nepal and Sri Lanka are concerned about their safety at work. The problem is worse in government hospitals, which characteristically lack appropriate security protocols. In order to tackle the issue, doctors need to accept the problem, discuss the various causative factors, understand the public sentiment and collaborate with the government to find a solution. Formulation of legal provisions and standards to ensure the safety of health workers is the need of the hour

Jet lag: Heuristics and therapeutics

Jet lag is one of those common medical problems, to which most people don't give a serious thought. However, it is intricately intertwined with our normal circadian rhythm. It is classified as a sleep disorder. There is also a dearth of good scientific literature, not to mention clinical trials on the subject. Slowly but steadily, the scientific community is realizing the various deleterious health effects of jet lag and is devising innovative methods to counter them. This narrative review touches upon the etiopathogenesis, clinical manifestations and therapeutic strategies effective against the nagging problem of jet lag

The dilemma of the “ischemic-looking” electrocardiogram: Pulmonary embolism or acute coronary syndrome?

Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such “ischemic-looking” ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis

Contemporary social network sites: Relevance in anesthesiology teaching, training, and research

Objective: The phenomenal popularity of social networking sites has been used globally by medical professionals to boost professional associations and scientific developments. They have tremendous potential to forge professional liaisons, generate employment,upgrading skills and publicizing scientific achievements. We highlight the role of social networking mediums in influencing teaching, training and research in anaesthesiology. Background: The growth of social networking sites have been prompted by the limitations of previous facilities in terms of ease of data and interface sharing and the amalgamation of audio visual aids on common platforms in the newer facilities. Review: Contemporary social networking sites like Facebook, Twitter, Tumblr,Linkedn etc and their respective features based on anaesthesiology training or practice have been discussed. A host of advantages which these sites confer are also discussed. Likewise the potential pitfalls and drawbacks of these facilities have also been addressed. Conclusion: Social networking sites have immense potential for development of training and research in Anaesthesiology. However responsible and cautious utilization is advocated

Nanomedicine in coronary artery disease

Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10–9 m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization

Coronary subclavian steal syndrome causing myocardial Infarction

Coronary subclavian steal syndrome (CSSS) is a rare complication of the internal mammary artery (IMA) grafting in coronary artery bypass surgery. The technical definition is myocardial ischemia due to the reduced flow of blood, or flow reversal in the IMA graft. This in most cases results from hemodynamically significant proximal subclavian artery stenosis. The clinical presentation is variable and ranges from unstable angina to myocardial infarction, and in some cases, sudden cardiac arrest. CSSS is an entity that is hard to diagnose if one is not actively looking for it. The clinical diagnosis is often complicated, and the prevalence of the disorder is frequently underestimated. In this case presentation, we report a case of myocardial infarction that resulted from significant proximal subclavian artery stenosis. Keywords: Coronary artery disease; coronary subclavial steal; myocardial infarction

Sternal osteomyelitis by Gordonia Bronchialis in an immunocompetent patient after open heart surgery

Gordonia is a catalase-positive, aerobic, nocardioform, Gram-positive staining actinomycete that also shows weak acid-fast staining. Several Gordonia species are commonly found in the soil. The bacterium has been isolated from the saliva of domesticated/wild dogs as well. In hospitalized patients, most commonly it is found in the setting of intravascular catheter-related infections. However, recent reports show that it is being increasingly isolated from sternal wounds, skin/neoplastic specimens and from pleural effusions. Gordonia shares many common characteristics with Rhodococcus and Nocardia. Ergo, it is commonly misrecognized as Nocardia or Rhodococcus. Since this pathogen requires comprehensive morphological and biochemical testing, it is often difficult and cumbersome to isolate the species. Broad-range Polymerase Chain Reaction (PCR) and sequencing with genes like 16S rRNA or hsp65 are used to correctly identify the species. Identification is essential for choosing and narrowing the right antimicrobial agent. Herein, we report our experience with a patient who presented with sternal osteomyelitis after infection with this elusive bug