Efficacy and safety of a combination therapy of atorvastatin and krill oil versus atorvastatin and niacin in dyslipidemia: a randomized, open, and comparator study

Background: Atherosclerotic cardiovascular disease is a major health problem, with CAD being the leading cause of mortality. Epidemiologic data strongly associate high CAD risk to elevated total and LDL cholesterol and low levels of HDL cholesterol. Combination therapy is often required to achieve multiple lipid treatment goals, and ≥50% reduction in low-density lipoprotein. Niacin/statin combination therapy may promote the cost-effective achievement of OLVs in several at-risk patient populations. Krill oil is extracted from Antarctic krill, Euphausia superba, a zooplankton crustacean rich in phospholipids. Krill oil significantly reduces total cholesterol, LDL, and triglycerides, and increase HDL levels and has been found to be effective in the management of hyperlipidemia and long-term regulation of blood lipids. The aim of this study is to compare the Efficacy and Safety of a combination therapy of statin and krill oil versus Statin and Niacin in dyslipidemia.Methods: 30 eligible patients were randomized in a 12 week, open-label, comparative (2-arm, 1:1), prospective study into 2 arms, the first receiving atorvastatin 10mg od and krill oil 500mg bid and the second receiving atorvastatin 10mg od and niacin 375mg od. The primary endpoint of the study was a comparative assessment of change in lipid profile (LDL, TG, HDL) from baseline and after 12 weeks. The secondary endpoint involved recording all the adverse effects during the study.Results: Analysis of the baseline and post 12 week lipid levels by non-parametric unpaired ‘t’ test (Mann-Whitney test) showed a statistically significant change in two of the lipid levels (i.e. LDL – p=0.0037 in favour of statin and niacin and HDL – p=0.0003 in favour of statin and niacin). However the triglyceride levels showed no significant change in the two groups (p=0.2452).Conclusions: In our study the conventional combination therapy of statin and niacin is found to be more efficacious than the newer statin and krill oil combination in lowering LDL levels and increasing HDL levels in dyslipidemic patients. A further study with a higher sample size could confirm the findings of this study

Serum Cortisol Level as a Predictor of In-Hospital Mortality in Patients Undergoing Primary Percutaneous Intervention for ST Segment Elevation Myocardial Infarction

Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial infarction. Serum cortisol is one such laboratory marker. There are only few studies done in the recent past which prove that cortisol is a prognostic marker in STEMI.Methods: We studied a total of 168 patients who presented with STEMI and underwent primary percutaneous intervention (PPCI) within 12 hours of symptom onset between April 2016 and November 2016.Results: The average age of study population was 61 ± 0.12 years. Males were predominant (n = 132, 78.57%). 155 patients survived, whereas 13 patients died in the hospital. Mean syntax score was 16.65 ±5. 33 among patients who died, whereas it was 13.11 ± 5.62 among survivors (P = 0.03). Mean cortisol was significantly higher among the patients who died (46.13 ± 14.61 mcg/dl) than the survivors (31.16 ± 13.16 mcg/dl) (P = 0.003). The ROC AUC for in-hospital mortality was 0.77 (95% confidence interval [CI], 0.645–0.897). An optimal cut-point identified from the ROC curve was a random serum cortisol concentration of 33.66 mcg/dl, with corresponding sensitivity and specificity of 69.2 % and 64 %, respectively. At a cut-point of 29.55 mcg/dl, sensitivity and specificity were 84.6 and 50 %, respectively.Conclusion: This study showed that serum cortisol level is a strong predictor of mortality in patients undergoing PPCI for STEMI. Levels more than 33.66 mcg/dl can predict mortality with a sensitivity of almost 70 percent and specificity of 64 percent

Successful patent ductus arteriosus device closure in a patient with massive pulmonary embolism

AbstractPatent ductus arteriosus, an essential vasculature structure during fetal life that becomes abnormal after 3 months of age, may be silent. However, the incidence of silent patent ductus arteriosus is as high as 1 in 500 patients. Existence of patent ductus arteriosus leads to left-to-right shunt. The development of pulmonary embolism in left-to-right shunt is rare. We present a case of a 33-year-old male patient who was incidentally diagnosed to have large patent ductus arteriosus along with the left-to-right shunt while being treated for pulmonary embolism. The patient was treated electively with device closure of patent ductus arteriosus.<Learning objective: Pulmonary embolism in left-to-right shunt (although there is a large patent ductus arteriosus) cannot be overlooked. Device closure of large patent ductus arteriosus is possible in patients with massive pulmonary embolism.

ASSOCIATION BETWEEN THE WEIGHT LOSS AND ANXIETY, DEPRESSION AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY: A NEED FOR PRE-DISCHARGED COUNSELING

Objectives: To see the association between weight loss and anxiety, depression after percutaneous transluminal coronary angioplasty (PTCA) for coronary artery disease patients. (1) To see the severity of anxiety and depression 1 month after PTCA, (2) to evaluate the relationship between the weight changes and major adverse cardiac events (MACE) in 1 month follow-up.Methods: A total 1001 patients who underwent PTCA for acute coronary syndrome and coronary heart disease were included. Data were collected at baseline and 1 month after PTCA. A validated Euro 5Q-5D-5L questionnaire was used to assess the level of anxiety and depression. Chi-square test was applied to find out the association between weight loss status and anxiety, depression.Results: There was a significant decrease in mean weight 1 month after coronary angioplasty (64.18±11.022 vs. 61.96±11.17, p&lt;0.001). No association was observed between weight loss status and anxiety, depression in PTCA patients (p=0.5) and there is no significant association between weight changes and MACE 1 month after PTCA (p=0.92).Conclusion: Data show that anxiety and depression were observed in 64.9% of the study population after coronary angioplasty but anxiety and depression are not associated with weight loss after PTCA. Loss of weight may be due to the modified post angioplasty lifestyles such as adherent to Mediterranean diet, physical exercise, cessation of smoking, optimum control of blood pressure, blood sugar, and blood cholesterol along with prescribed medications. Anxiety and depression may turn into chronic stage if not treated wisely could lead to significant MACE. Proper pre-hospital discharge counseling is necessary for all post PTCA patients to sustain their quality of life

Profile of Peripheral Arterial Disease in Type 2 Diabetes Mellitus - A Hospital-based observational study in Coastal Karnataka

Introduction: Ankle Brachial Index (ABI) is one of the common non-invasive diagnostic tools available for diagnosing Peripheral Arterial Disease (PAD). However, it has been observed that for an individual diagnosed with both PAD and Type 2 Diabetes Mellitus (T2DM), ABI tends to give false diagnostic value because of the calcification of the major lower limb arteries. Therefore, the health care professionals are at times misled for the diagnosis of PAD. To overcome this another diagnostic tool Toe Brachial Index (TBI) was suggested to perform. However, there is limited literature on performing both ABI and TBI in the given population in a single study.Aim: The main focus of this study is to report the profile of ABI and TBI along with classical symptoms like claudication pain, palpation of pulse and history of T2DM for the screening and diagnosis of PAD in T2DM.Materials And Methods: In this cross-sectional observational study, a total of 121 participants diagnosed with T2DM were recruited for the study as per the inclusion criteria. Detailed demographic details of the participants were noted. Diagnostic tool including both ABI and TBI were performed for all the participants and the data was analysed.Results: Among 121 participants, only 3 participants had both ABI and TBI positive indicating positive diagnostic test for PAD and 106 participants had both ABI and TBI negative. However, in the remaining 12 participants, 10 showed TBI positive but ABI negative and 2 had ABI positive but TBI negative.Conclusions: Based on our study we have reported the profile of PAD in T2DM individuals, which is found to be 10.75.%. Therefore, it can be concluded that ABI and TBI both should be performed to rule out any complication. This will be beneficial in early screening and detection of neuro ischemic changes in foot and subsequently to prevent amputation

Long-term oxygen therapy in patients with pulmonary artery hypertension

Introduction: Dyspnea associated with pulmonary arterial hypertension (PAH) requires supplemental oxygen to maintain oxygen saturation. Many researches related to oxygen therapy in chronic obstructive pulmonary disease and cor pulmonale are available, but the effect of long-term oxygen therapy (LTOT) has not been explored in PAH patients. Aim: This study aimed to determine the effect of LTOT in patients diagnosed with PAH. Methodology: All adult patients with PAH, primary or secondary to respiratory disease who require LTOT, were included in the study. The following parameters were collected: age, gender, severity of PAH based on echocardiogram, body mass index, comorbidities, type of oxygen therapy device, amount and duration of oxygen usage, mortality, frequency of readmission, oxygenation, and vital sign parameters. Results: This was a retrospective study which included 332 participants diagnosed to have PAH after detailed echocardiogram assessment. Out of these, 32 participants were prescribed LTOT at the time of discharge. At the time of discharge, there was a significant improvement in all the vital signs and oxygenation variables. The increase in oxygenation, hemoglobin, and reduced respiratory rate after LTOT was statistically significant (P < 0.001). During follow-up after 1 year, 26 (81.3%) participants survived, 3 participants (9.4%) expired, and 3 participants (9.4%) were lost to follow-up. Conclusion: The use of oxygen therapy is beneficial in patients with PAH in terms of improvement in oxygenation and reduction in hospital readmission. Survival at 1 year is 81% in patients using LTOT

Moxarella Lacunate Endocarditis

We describe a case of infective endocarditis due to Moraxella lacunata involving the native mitral and aortic valves, complicated by cerebral emboli and resultant hemiparesis. The patient was treated with ceftriaxone and gentamicin and improved. This is the first case reported in medical literature of native multivalvular endocarditis produced by this rare organism

Cardiac metastasis and right ventricular outflow tract obstruction in anaplastic carcinoma of the thyroid

Cardiac metastasis is more frequent than primary tumors, with low absolute incidence reported. Cardiac metastases are common secondary to malignant melanoma, carcinoma of the lung, lymphoma, and carcinoma of the breast. Cardiac metastasis secondary to thyroid carcinoma is very uncommon. Among the thyroid malignancies, anaplastic carcinoma is the most aggressive and metastases to the heart has rarely been described in the literature. We report a case of a 60-year-old female with right ventricular outflow tract obstruction secondary to anaplastic carcinoma of the thyroid. An extensive literature search till date was unfruitful in finding a similar case. Thus, we focus the importance of regular echocardiography screening for all cases of thyroid malignancy, especially anaplastic carcinoma for recognizing cardiac involvement antemortem rather than postmortem