Quantitative analysis of heart type fatty acid binding protein in early detection of acute coronary syndrome

Background: Coronary heart disease is a major cause of mortality, morbidity and disability in developed countries. Even though coronary heart disease mortality rates worldwide have reduced over the past five decades, coronary heart disease is the major cause of death in one-third of people more than 35 years of age.Many risk factors and biomarkers have been studied in the past and research is on in detecting the acute coronary syndrome at the earliest so that reperfusion therapy can be undertaken as early as possible to save the life of patients. Heart-type fatty acid binding protein is a newer modality of investigation developed for the above purpose.Methods: Single centre cross-sectional observational study was conducted from 1 September 2017 to May 2019 with an aim to study novel cardiac biomarker h-FABP in patients with acute coronary syndrome and compare sensitivity and specificity of the same with that of troponin -T in the early detection of acute coronary events after fulfilling inclusion and exclusion criteria .The data of 80 patients were collected after getting informed consent. The clinical, demographic and investigations were performed as per the hospital protocol and such patients were recorded in the proforma. The additional test heart-type fatty acid binding protein is performed in the triage by collecting patient’s serum and by using point of care analysis machine. Statistical analysis was performed using SPSS version 20.0 and results were obtainedResults: Out of 80 patients selected males were 35 and female are 45. Chest pain was present in 58 people, dyspnoea was in 28, sweating in 40 people, 35 had anterior wall MI, 30 had Inferior wall MI and 15 had global hypokinesia. Median values of h-FABP values were 82 ng/dl, 53.2 ng/dl, 35.3 ng/dl at 0-6 hours, 6-12 hours, and 12-24 hours respectively after the onset of symptoms with a significant p< 0.001. There were major differences between median values between different time groups of symptoms onset. Median troponin T values were 0.061 ng/ml, 0.350 ng/ml, 1.56 ng/ml after 0-6 hours, 6-12 hours and 12-24 hours of onset of symptoms respectively. There was no correlation between h-FABP and troponin-T values.Conclusions: h-FABP rises early in coronary events in first 6 hrs of onset of symptoms of ACS serum levels of h-FABP decreases as time progresses in 24 hours. In comparison troponin-t levels continue to rise as time progresses. h-FABP serum levels can be used as novel marker for early detection of ACS

Post COVID-19 Guillain Barre syndrome with syndrome of inappropriate secretion of antidiuretic hormone

Guillain Barre syndrome (GBS) is a rare but potentially fatal immune mediated disorder of peripheral nerves and nerve roots usually triggered by infections characterized by ascending paralysis with or without sensory symptoms, hyporeflexia to areflexia. Usually preceded by gastrointestinal or respiratory infection. Post COVID-19 neurological manifestation include GBS, transverse myelitis etc., occur at varying incidence rates at various places. Here we report a 42-year-old lady who had COVID-19 recovered presented with quadriparesis with absent deep tendon reflexes with electro-diagnostically proven AMSAN variety of GBS treated successfully with IVIg. Patient was having hyponatremia which was diagnosed to be due to SIADH and was successfully treated with fluid restriction and tolvaptan. This case is being reported due to combination of COVID-19, COVID vaccination shortly before GBS and hyponatremia due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH) which is quite rare combination

ACENOCOUMAROL OR WARFARIN: WHICH IS THE CLINICIAN'S ALLY?

ABSTRACTWarfarin and acenocoumarol are commonly prescribed oral anticoagulant drugs that are used in the prevention and treatment of thromboembolicdisorders across the world. Although both these drugs act by a similar mechanism, there are significant differences between them, especially in termsof their half-lives, and more importantly, in their variability in response pharmacogenetically. This case report highlights an instance wherein warfarinproved to provide a much more stable anticoagulant cover, as compared to that provided by acenocoumarol.Keywords: Thrombosis, Bleeding, Antiphospholipid antibody syndrome, Anticoagulant, International normalized ratio

A RARE INSTANCE OF DIASTASE/PEPSIN–INDUCED HYPERSENSITIVITY REACTION

Diastase/Pepsin combination supplements are very commonly prescribed in clinical practice, mainly in the adult population. The chief indication for such use is indigestion or dyspepsia, wherein concomitant medication with proton pump inhibitors and antiemetics is also advised. Hypersensitivity reactions, though theoretically plausible with the use of digestive enzymes, there are no cases reported in the medical literature, to the best of our knowledge. This is one such case of hypersensitivity secondary to the administration of digestive enzymes in an adult Indian male. Keywords: Digestive enzymes, Rash, Maculopapular, Allerg

Comparison between intravenous dexmedetomidine and local lignocaine infiltration to attenuate the haemodynamic response to skull pin head holder application during craniotomy

Background and Aims: Skull pin application is intensely painful and can be accompanied by detrimental haemodynamic changes. We compared intravenous (IV) dexmedetomidine with local infiltration of lignocaine at pin application sites to attenuate haemodynamic changes associated with pin application. Methods: Fifty-two patients undergoing craniotomy were randomised to either group dexmedetomidine (received 1 μg/kg dexmedetomidine over 10 min starting at induction of anaesthesia) or group lignocaine (received 3 ml of 2% lignocaine infiltration at pin application sites before pin application). Anaesthetic protocol was standardised. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the following time intervals, pre-induction baseline, pre-infiltration, post-infiltration, pre-pin application and post-pin application at 1, 2, 3, 4, 5, 10 and 15 min. Statistical analysis was done using independent samples t-test, Fisher exact test and Chi-square test. Results: HR and MAP were comparable between the groups at all the study intervals. The incidence of adverse haemodynamic effects attributable to pin application (tachycardia and/or hypertension) was comparable between the groups (2 patients in group dexmedetomidine and 5 in group lignocaine). However, the incidence of hypotension and/or bradycardia was significantly greater in the dexmedetomidine group (19 patients in group dexmedetomidine and 5 patients in group lignocaine; P = 0.0007). Conclusion: IV dexmedetomidine 1 mcg/kg over 10 min is comparable to local infiltration of 2% lignocaine at pin application sites to attenuate the haemodynamic response associated with skull pin application. However, use of dexmedetomidine is associated with significantly higher incidence of hypotension and bradycardia