Predictors of acute myocardial infarct size in STEMI patients receiving thrombolytic therapy: A delayed contrast enhanced cardiac MRI study

AbstractIntroductionDelayed contrast enhanced Cardiac MRI has been accepted as a standard tool worldwide for determination of infarcted myocardium and viability. Infarct size as determined by cardiac MRI has important therapeutic and prognostic information.MethodsTwenty six STEMI patients who had received thrombolytic therapy were subjected to cardiac MRI assessment at 5–7 day of admission. Base line variables of the study population were compared with the acute infarct size as determined by the Cardiac MRI.ResultsThe mean acute infarct size in our study population was 27.2 ± 17.4% of LV. We found through univariate analysis that final infarct size was dependent on time to thrombolysis (p = 0.04), Status of Thrombolysis (p = 0.01), smoking status (p = 0.02), location of infarct (p < 0.00001), presence of microvascular obstruction (p = 0.01) and viability status (p = 0.0004). Thus, larger acute infarct size was seen in delayed time to thrombolysis, failed status of thrombolysis, smokers, anterior location of the infarct, presence of microvascular obstruction and non viable myocardial status.ConclusionInfarct size as determined by Cardiac MRI has been shown to carry important therapeutic and prognostic information. We have tried to evaluate predictors of acute infarct on cardiac MRI in STEMI patients during their initial hospital stay. Knowing the predictors of acute infarct size can help in early intervention and provide prognostic information for future cardiac events

A study on phenotypic traits of Candida species isolated from blood stream infections and their in vitro susceptibility to fluconazole

Background & objectives: Fungal infections are increasing very rapidly. Candida is a major pathogen involved and constitutes a part of normal microflora of humans. This organism is a leading agent associated with blood stream infections. The present study involves phenotypic characterization of Candida isolates. The isolates were obtained from National Culture Collection of Pathogenic Fungi at Post Graduate Institute of Medical Education and Research, Chandigarh, India. Keeping in view the rising trend of resistance by the Candida species to various antifungal agents their susceptibility has also been studied. Methods: All the isolates were identified upto species level by studying their phenotypic and biochemical characteristics. Phenotypic traits of Candida isolates studied included: formation of pseudohyphae, chlamydospore production, germ tube production, fermentation and assimilation of various sugars by the different species of Candida. All the isolates were tested for their susceptibility to fluconazole by disc diffusion and micro broth dilution methods. Results: The isolates could be clearly differentiated from each other by their phenotypic traits studied. A total of 51 out of 67 isolates examined (76.11%) were sensitive to fluconazole, 6 were sensitive dose dependent and 10 exhibited resistance to this drug. Among the resistant species C. albicans figured on the top followed by C. tropicalis, C. guillermondii and C. glabrata. However, resistance to fluconazole was not observed by C.parapsilosis isolates. Conclusions: The present study would help in the diagnosis of Candida species from clinical samples and give clue about the susceptibility of different species of Candida to fluconazole which might helpin the management of candidal infections

Prevalence and risk determinants of metabolic syndrome in obese worksite workers in hill city of Himachal Pradesh, India

Objective: We report prevalence and risk factors of metabolic syndrome (MS) in the obese workforce of organized sector in hill city of Himachal Pradesh (HP), India. Methods: The cross-sectional survey study of employees of organized sectors in Shimla city of HP, India, was conducted to collect data of demographics, health behavior, psychosocial factors, anthropometry, blood pressure, and blood chemistry to measure blood glucose and lipid profile in fasting state in 3004 employees using validated tools. Out of 3004 subjects screened, data of 418 subjects with body mass index of ≥30 are analyzed to estimate the prevalence of MS and its risk determinants. The association of demographics, health behavior, and psychosocial factors as the risk determinants were analyzed using multivariable logistic regression modeling. Results: MS was prevalent in 57.6% [95% confidence interval (CI): 52.8%–62.3%]. The central obesity (odds ratio: 10.6, 95% CI: 2.32–48.4) and consumption of frequent or daily alcohol (odds ratio: 1.94, 95% CI: 1.05–3.59),and extra salt (odds ratio: 3.34, 95% CI: 1.09–10.2) were independent risk factors for MS. The consumption of tobacco, vegetables, sugar-sweetened drinks, physical inactivity, and psychosocial factors had no significant association with MS in obese population. Conclusions: MS is highly prevalent among obese employees of organized sector. The consumption of alcohol and extra salt were major behavioral risk factors for MS and therefore have important implications in behavioral modifications for prevention of MS among obese employees in organized sectors. Keywords: Obesity, Metabolic syndrome, Risk factors, Psychosocial factor

No reflow phenomenon in CAD patients after percutaneous coronary intervention: A prospective hospital based observational study

The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length≥ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients

Current status of rheumatic heart disease in India

The rheumatic heart disease continues to be an important cause of disease burden in India, affecting the population in their prime and productive phase of the life. The prevalence of rheumatic heart disease is varied in different Indian studies, because of the inclusion of different populations at different point of times and using different screening methods for the diagnosis. The data on incidence and prevalence on a nationally represented sample are lacking. There is a need for establishing a population-based surveillance system in the country for monitoring trends, management practices, and outcomes to formulate informed guidelines for initiating contextual interventions for prevention and control of rheumatic heart disease. Keywords: Prevalence of RHD, Trend of RHD in Indi

Prevalence And Awareness Of Hypertension In A closed Community Of North India Town

Research question: What is the prevalence and awareness of high blood pressure in a closed community of Shimla Town? Objective : To study the prevalence &amp; awareness of hypertension in a closed community of North India Town. Design : Cross sectional study. Setting: 36 Institutions of Shimla town. Participants: 7630 employees (20-60 years) Study Variables: Age, sex, body mass index, physical activity Statistical Analysis: Standard deviation, chi square test Results: Prevalence of hypertension in closed community was founded to be 33.2&#x0025;. The level of awareness in hypertensives was 12.32&#x0025; in less than 35 years of age group; 22.43&#x0025; in 35-49 years age group and rose to 27.09&#x0025; in above 50. Only 307 were taking regular treatment

Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry

Background: The study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF). Methods: Serum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables. Results: Iron deficiency and anemia were prevalent in 58.8% (52.2%–65.1%) and 35.8% (29.8%–42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9–6.5)], history of bleeding [OR 11.7 (95% CI 1.4–101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4–4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40–6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97–0.99)], history of bleeding [OR 13.0 (95% CI 2.3–70.9)], and female gender [OR 2.9 (95% CI 1.5–5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70–0.96) and transferrin saturation (OR 0.98 (95% CI 0.96–0.99)] had a significant inverse association with symptoms of advanced heart failure. Conclusion: Iron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure. Keywords: Nonischemic systolic heart failure, Heart failure with reduced ejection fraction, Iron deficiency, Anemia, Risk factor, Advanced heart failur

Prevalence, risk determinants and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry

Objective: To report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD). Methods: The Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. The association of AF with nature and severity of valvular dysfunction was analyzed, adjusted for age, left atrial (LA) dimension and pulmonary arterial hypertension using multivariable logistic regression model and strength of association was reported as odds ratio (OR) with 95% confidence intervals (C. I.). Results: The study population consisted of young (40.2 ± 14.3 years), predominantly females (72.3%) from rural area (94.1%). Prevalence of AF was 23.9% (95% C. I. 22.1%–25.8%). The independent determinants AF were age (OR 1.04, 95% C.I. 1.03–1.06), LA size (OR 1.10, 95% C.I. 1.08–1.11). The association of AF with age, New York Heart Association functional class, mitral stenosis severity and tricuspid regurgitation was statistically significant and graded. Mitral regurgitation and aortic valve disease had no significant independent association with AF. The prevalence of heart failure, stroke, peripheral embolism and mortality was significantly higher among patients with AF (p < .01). Conclusion: AF is common in RHD patients and is significantly associated with heart failure and systemic thromboembolism. Age, mitral stenosis severity, tricuspid regurgitation and LA size were independently associated with AF. Keywords: Rheumatic heart disease, Atrial fibrillation, Risk factor