Disparity in coronary artery dimensions in diabetic and non-diabetic population undergoing quantitative coronary angiography in South India: a 2-year prospective analysis

Diabetic subjects have higher prevalence as well as increased risk for coronary artery disease than non-diabetic counterparts. The study was aimed to seek the disparity of vessel diameters among diabetic and non-diabetic patients undergoing quantitative coronary angiography (QCA). The objectives were to compare coronary artery measurements (CAM) between diabetic and non-diabetic patients and also to find the respective segment of coronary artery affected greatest among diabetics by QCA. A cross sectional study was conducted in four cities of India after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study. Among total sample population, non-flow limiting coronaries were seen in 1100(27.5%) cases [167 in NFL diabetic and 933 in NFL non-diabetic group]. We had 2890 (72.2%) patients with diseased coronaries. Ten segments of the coronary arteries were taken for diameter measurements namely, LMCA, LAD (O, P), DIAG, LCx (O, P), OM, RCA (O, P), RAM. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m2BSA). For all arterial segments both indexed and non-indexed measurements of diabetic patients with NFL coronaries had significantly (p<0.01) smaller arterial segments except for RCA-o. Reduced dimensions after post balloon dilatations of PCI, diffused lesions can result in increased chances for in-stent restenosis among diabetics leading to poor outcome following PCI.

Carotid intima-media thickness and epicardial fat thickness predict precoronary artery disease status in psoriasis

BACKGROUND

Carotid intima-media thickness test is a surrogate marker of subclinical atherosclerosis. Epicardial fat thickness is an early marker of coronary artery disease. Several studies have noted that psoriasis patients have an increased risk of coronary artery disease. In the present study, we attempted to see any variation in carotid intima-media thickness and epicardial fat thickness in psoriasis patients when compared to controls.

AIMS

1) To determine the carotid intima-media thickness and epicardial fat thickness in psoriatic patients and healthy controls. 2) To evaluate the association between carotid intima-media thickness and epicardial fat thickness in psoriasis patients.

METHODS

A hospital-based study with 100 subjects (50 with psoriasis and 50 healthy controls) was conducted in the Dermatology Outpatient Department of Justice KS Hegde Charitable Hospital, a unit of KS Hegde Medical Academy affiliated to NITTE (Deemed to be University) Mangaluru. A detailed history and examination including body mass index, psoriasis area and severity index were done. Carotid ultrasound was done to measure carotid intima-media thickness and transthoracic echocardiography was done to assess epicardial fat thickness in both cases and controls. Independent sample t-test, Pearson rank correlation (r) coefficient were used for statistical analysis. P-value <0.05 was considered statistically significant. IBM Statistical Package for the Social Sciences version 22 Armonk, NY: IBM Corp was used for statistical analysis.

RESULTS

Mean carotid intima-media thickness in the right carotid ([0.51 ± 0.1mm vs 0.47 ± 0.1 mm] [P = 0.038]) and left carotid ([0.53 ± 0.12 mm vs 0.48 ± 0.1 mm] [P = 0.041]) were significantly increased in psoriasis patients than in controls. Mean epicardial fat thickness was significantly increased ([1.76 ± 0.66 mm vs. 1.49 ± 0.47 mm] ([P = 0.020]) in patients with psoriasis when compared with the controls. Epicardial fat thickness was positively correlated with carotid intima-media thickness in patients with psoriasis.

LIMITATIONS

The cross-sectional design of the study, smoking among study subjects, inter and intraobserver variability of measurement of epicardial fat thickness and carotid intima-media thickness.

CONCLUSION

Carotid intima-media thickness and epicardial fat thickness were increased in psoriasis patients when compared with healthy controls. Epicardial fat thickness was positively correlated with carotid intima-media thickness in cases.

Pitfalls in comparison of coronary artery measurements of Indian population with different geographical area studies

Introduction

Coronary artery disease (CAD) is the most common cause of morbidity and mortality especially in the developing countries. Coronary artery measurements (CAM) are the most important factor affecting the procedure and outcome of coronary angioplasty (PCI) as well as coronary by-pass operations (CABG). In this study, we aimed to establish a database for the normal CAM as well as for gender difference among the Indian population using quantitative coronary angiography (QCA) with an objective of assessing normal coronary vessel morphology of patients with normal coronaries.

Materials and methods

Four thousand angiograms from patients of Indian origin were studied prospectively after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study.

Results

Ten segments from right and left coronary arteries were taken for diameter measurements. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m² BSA). Among, 4000 patients, 933(23.3%) [M:F-521:412] had normal coronaries and 3067 (76.7%) were diseased.

Discussion and conclusion

The dimensions of the coronary artery segments of Indians were smaller (in BSA indexed and non-indexed data), compared to studies from other continents which can be due to their smaller BSA.

Endovascular Intervention for Central Venous Stenosis in Hemodialysis Patients: A Single-center Experience

Central venous stenosis (CVS) refers to a significant stenosis of a large intrathoracic vein, such as the subclavian, brachiocephalic, or the superior vena cava (hemodialysis, HD). Percutaneous transluminal angioplasty (PTA) with or without stent placement has been the recommended as the preferred approach to CVS. A total of 10 consecutive HD patients with documented CVS over a 2-year time period from April 2017-April 2019 underwent percutaneous angioplasty and stent insertions under sedation. The procedure was performed by the interventional cardiologist in the institute. One patient underwent only PTA, whereas nine (90%) had PTA with primary stent insertion. Primary patency was 90% at 3 months, 80% at 6 months while at 12 months, it was 70% and remained at 70% at 24 months. We did not find any association between age, gender, diabetic status, dialysis vintage, or previous catheter infection with procedural patency. Central venous stenosis can be treated successfully with percutaneous angioplasty and primary stenting. Despite advances, prevention of CVS should be the primary approach.

Molecular analysis shows the presence of periodontal bacterial DNA in atherosclerotic plaques from patients with coronary artery disease

Links between periodontitis and atherosclerosis can be predicted based on inflammatory mechanisms initiated by bacteria associated with periodontal lesions, which then influence the initiation or propagation of the atherosclerotic lesion. This study aimed to detect the presence of three periodontal pathogens, in atheromatous plaques of patients with coronary artery disease. Subgingival and atherosclerotic plaque samples were obtained from 80 patients scheduled for CABG or angioplasty. A nested PCR was done for the detection of the pathogens in the plaque samples. Porphyromonas gingivalis, Tanarella forsythia, and Treponema denticola were detected in 10%, 12.5%, and 1.3% of the atherosclerotic plaque samples respectively. It was also observed that patients whose atherosclerotic plaques tested positive for one or more of the pathogens had chronic periodontitis.

Gender-associated dimensional differences among normal to non-flow limiting coronary artery dimensions

Aim and objectives

To study gender-specific differences in coronary artery diameters among subjects with normal to non-flow limiting disease (NFLD) coronary arteries (up to 0 - 20% of stenosis) and to assess the possible association of body-mass index (BMI) with coronary dimensions, among the west coastal population of Karnataka and Kerala.

Materials and Methods

A prospective cohort study was conducted for a period of one year. Two thousand angiograms samples were collected and assessed from two study centers (one from each state), after obtaining the ethical clearance. Patients with past history of myocardial infarction and those with recanalized normal looking coronary arteries and those who had diabetes for more than five years were excluded. Ten segments of coronary arteries- left main coronary artery, ostial and proximal segments of left anterior descending artery and its first diagonal branch, ostial and proximal segments of left circumflex coronary artery and its obtuse marginal branch, ramus intermedius and the ostial and proximal segments of the right coronary artery- were included in diameter measurement. BMI values of the patients were calculated.

Results

Out of 2000 patients included in the study, 454 (22.7%; mean age 53.4 ± 14.2 years) had normal to NFLD coronaries of which 253 (55.7%) were males and 201 (44.3%) were females. As compared to women, men had larger diameters of coronary arteries for eight segments, except the obtuse marginal branch and the proximal right coronary artery. A weak, yet statistically significant, negative correlation existed between BMI and coronary artery diameters in total cohort, indicating that an increase in BMI was associated with a decrease in artery diameters. No such association was seen when men and women were assessed separately.

Conclusions

The present study indicates that men have higher caliber for coronary arteries compared to women. The study also indicates that when BMI increases there is a relative decrease in the coronary artery diameter.

Using Atomic Force Microscopy to Predict Tumor Specificity of ICAM1 Antibody-Directed Nanomedicines

Atomic force microscopy (AFM) is a powerful tool to detect in vitro antibody-antigen interactions. To date, however, AFM-measured antibody-antigen interactions have yet to be exploited to predict in vivo tumor specificity of antibody-directed nanomedicines. In this study, we have utilized AFM to directly measure the biomechanical interaction between live triple negative breast cancer (TNBC) cells and an antibody against ICAM1, a recently identified TNBC target. For the first time, we provide proof-of-principle evidence that in vitro TNBC cell-ICAM1 antibody binding force measured by AFM on live cells more precisely correlates with in vivo tumor accumulation and therapeutic efficacy of ICAM1 antibody-directed liposomes than ICAM1 gene and surface protein overexpression levels. These studies demonstrate that live cell-antibody binding force measurements may be used as a novel in vitro metric for predicting the in vivo tumor recognition of antibody-directed nanomedicines.

Percutaneous Stenting for Unprotected Left Main Chronic Total Occlusion

PCI of a left main coronary artery chronic total occlusion followed by PCI of the right coronary artery was performed in a patient refusing CABG surgery.

Bibliometric studies of research collaboration: A review

Scientific research is becoming an increasingly collaborative endeavour. The nature and magnitude of collaboration vary from one discipline to another, and depend upon such factors as the nature of the research problem, the research environ ment, and demographic factors. Earlier studies have shown a high degree of correlation between collaboration and research productivity, and between collaboration and financial support for research. The extent of collaboration cannot be easily determined by traditional methods of survey and observation. Bibliometric methods offer a convenient and non-reactive tool for studying collaboration in research. In this paper, several types of collaboration have been identified, and earlier research on collaboration has been reviewed. Further research is needed to refine the methods of defining and assessing collaboration and its impact on the organization of research and communica tion in science.

"Dry" and "wet" beriberi mimicking critical illness polyneuropathy

Three cases with manifestations of right heart failure, shock, metabolic acidosis, and renal failure in varying combination were admitted with paraparesis. Nerve conduction study suggested predominantly motor and mainly axonal type of neuropathy. Rapid reversal of shock, acidosis, and multi-organ dysfunction with timely infusion of thiamine was followed by the complete neurological recovery.

Effect of insecticides alone and in combination with fungicides on nitrification and phosphatase activity in two groundnut (Arachis hypogeae L.) soils

The effect of selected pesticides, monocrotophos, chlorpyrifos alone and in combination with mancozeb and carbendazim, respectively, was tested on nitrification and phosphatase activity in two groundnut (Arachis hypogeae L.) soils. The oxidation of ammonical nitrogen was significantly enhanced under the impact of selected pesticides alone and in combinations at 2.5 kg ha(-1) in black soil, and furthermore, increase in concentration of pesticides decreased the rate of nitrification, whereas in the case of red soil, the nitrification was increased up to 5.0 kg ha(-1) after 4 weeks, and then decline phase was started gradually from 6 to 8 weeks of incubation. The activity of phosphatase was increased in soils, which received the monocrotophos alone and in combination with mancozeb up to 2.5 and 5.0 kg ha(-1), whereas the application of chlorpyrifos singly and in combination with carbendazim at 2.5 kg ha(-1) profoundly increased the phosphatase activity after 20 days of incubation, in both soils. But higher concentrations of pesticides were either innocuous or inhibitory to the phosphatase activity.

Magnitude of shift of tumor position as a function of moderated deep inspiration breath-hold: An analysis of pooled data of lung patients with active breath control in image-guided radiotherapy

The purpose of this study was to evaluate the reproducibility and magnitude of shift of tumor position by using active breathing control and iView-GT for patients with lung cancer with moderate deep-inspiration breath-hold (mDIBH) technique. Eight patients with 10 lung tumors were studied. CT scans were performed in the breath-holding phase. Moderate deep-inspiration breath-hold under spirometer-based monitoring system was used. Few important bony anatomic details were delineated by the radiation oncologist. To evaluate the interbreath-hold reproducibility of the tumor position, we compared the digital reconstruction radiographs (DRRs) from planning system with the DRRs from the iView-GT in the machine room. We measured the shift in x, y, and z directions. The reproducibility was defined as the difference between the bony landmarks from the DRR of the planning system and those from the DRR of the iView-GT. The maximum shift of the tumor position was 3.2 mm, 3.0 mm, and 2.9 mm in the longitudinal, lateral, and vertical directions. In conclusion, the moderated deep-inspiration breath-hold method using a spirometer is feasible, with relatively good reproducibility of the tumor position for image-guided radiotherapy in lung cancers.

Valvular heart disease: diagnosis and management

Valvular heart disease is a leading cause of morbidity and mortality in India. Advances in both surgical and percutaneous techniques and a better understanding of timing for intervention accounts for the current increased rates of survival. Echocardiography remains the gold standard for diagnosis and periodic assessment of patients with valvular heart disease. Generally, patients with stenotic valvular lesions can be monitored clinically until symptoms appear and most can now benefit from percutaneous techniques. In contrast, patients with regurgitant valvular lesions require careful echocardiographic monitoring for left ventricular function and may require surgery even if no symptoms are present. Percutaneous therapy of valvular regurgitant lesions is yet to evolve fully.

EMPIRE (Escorts Multiple ProNova Implantation Registry) Study: Evaluating the ProNova SES in De Novo Coronary Artery Lesions

BACKGROUND

The main limitation of percutaneous coronary intervention (PCI) with bare metal stents was the increased incidence of instant restenosis. The introduction of drug-eluting stents has decreased the rate of restenosis. Various DESs, using different drugs and stent designs, are now being used in interventional cardiology worldwide. The EMPIRE study was conducted to evaluate the safety and efficacy of the slow-release sirolimus-eluting ProNova stent in de novo coronary artery lesions in patients with single- or multi-vessel disease. METHODS AND RESULTS- A total of 300 patients, enrolled in a single-centre registry, were successfully implanted with ProNova, a sirolimus-eluting stent (SES). They were followed up clinically, first at 30 days and then six months after the procedure for parameters like death, target vessel failure, documented myocardial infarction (MI) and restenosis. Assessment of binary restenosis was done angiographically at six months. The primary success rate of stent implantation was 100%, the percentage of acute major adverse cardiac events (MACE) being 0% and 2% at 30 days and six months, respectively. Angiographic restenosis was documented in 12.6% of the patients enrolled in the study.

CONCLUSION

The ProNova stent was found to be safe and effective in this trial.

Interaction of flunarizine with sodium valproate or ethosuximide in gamahydroxybutyrate induced absence seizures in rats

Sodium valproate(VPA), ethosuximide(ESM), 200 mg/kg ip and flunarizine (FLU) 5 or 10 mg/kg ip were first administered independently to rats in order to study their effects on behavioural and EEG aspects of spike and wave discharges (SWDs) induced by y- hydroxybutyrate (GHB,100 mg/kg ip). GHB treated rats show behavioural changes and concomitant repetitive EEG episodes of 7 to 9 Hz SWDs, mimicking human absence seizures (AS), and can be used as a pharmacological model. The number and duration of SWDs were calculated for 1 hr from the EEG and were parameters for drug evaluation. VPA and ESM at 200 mg/kg, significantly reduced SWD number and duration/hr, while FLU showed significant reduction only at 10 but not at 5 mg/kg. Combination of FLU, 10 mg/kg with either VPA or ESM showed significant reduction of SWD number and duration, suggesting an additive effect of the anti-absence agents with the calcium channel blocker, FLU, on experimental absence seizures in rats.

Vincristine (Vinca-alkaloid) as a sclerosing agent for malignant pleural effusions

Vincristine, extracted from Vinca rosea Linn., is an effective antineoplastic chemotherapeutic drug used in oncology practice. This drug has never been used as a sclerosing agent for the treatment of malignant pleural effusion for reasons unknown. A study was conducted to examine the use of Vinca-Alkaloid as a sclerosing agent (pleurodesis) for the palliative treatment of malignant pleural effusions. The study included 15 patients, all diagnosed to have cytology-proven malignant pleural effusions. Intercostal tube drainage followed by chemical sclerotherapy with 2 mg vincristine was performed on all patients and a high success rate was noted. Twelve procedures out of 15 (12/15) achieved complete resolution of pleural fluid with a success rate of 80%. In two procedures the pleural effusion was reduced and then recurred but did not require re-aspiration. One procedure failed and repeated pleural aspiration was required. In this study, with adequate pleural drainage and the proper technique, vincristine was found to be an effective sclerosing agent for malignant pleural effusion. Further randomized trials are necessary in order to establish the role of this drug.

Achalasia secondary to malignant mesothelioma of the pleura

A patient with malignant mesothelioma of the pleura presented with radiological, endoscopic, and manometric features of achalasia. This is the third such patient who had achalasia along with pleural mesothelioma.

Erosion of Marlex band and silastic ring into the stomach after gastroplasty: endoscopic recognition and management

We report three patients who developed erosion of a Marlex band or a silastic ring that was used to reinforce the stoma after vertical stapled gastroplasty. The patients were symptomatic and the diagnosis was made by endoscopy. After endoscopic removal of the foreign body, symptoms resolved in two patients. To our knowledge, this is the first report of successful removal, by endoscopy, of an eroding mesh or a ring.

Vaccine distribution: an operations research study

The implementation of an immunization program in rural areas is affected by lacunae in the vaccine distribution system. A study conducted in India identified the extent to which irregular supply of vaccines has affected the immunization program. This study also identified other problem areas, such as a faulty cold chain and the need for an improved monitoring and control system and for better supervision. A model was designed to represent the immunization program and was used to assess the performance of the system under different supply conditions and operational policies. The study identified a number of improvements that could be made in the vaccine distribution system.

Glycogen utilization in tissues of toad, Bufo melanostictus under electropolarity treatment

Electropolarity treatment (0.8V/DC/Cm) was given to the gastrocnemius muscle of B. melanostictus every day for 5 min for 5 days. The glycogen content and aldolase activity levels increased and phosphorylase 'a' activity levels decreased on cathode treatment in muscle, liver and brain while an opposed trend was observed on anode treatment. The heart showed contrasting pattern under both cathode and anode electropolarity treatments.

Barium granuloma of the sigmoid colon

Barium granuloma (BG) is an unusual complication of barium enema that occurs due to the intravasation of barium into the colonic wall as a result of mucosal injury from an enema tip, overinflation of the rectal balloon, or intrinsic disease such as ulcerative colitis. We report a case of BG from a barium enema performed within 24 h after a proctoscopic biopsy. It was detected 5 years later when the patient developed persistent low back pain.

Upper gastrointestinal hemorrhage from ischemia of an interposed jejunal segment in the esophagus

We report a patient who presented with hematemesis due to ischemic injury to the jejunal segment which had been interposed following distal esophagectomy for a benign esophageal stricture. The complications of this surgery are reviewed.

Relation of Campylobacter pyloridis to gastritis and peptic ulcer

Biopsy specimens from the gastric antral mucosa of 50 patients with upper gastrointestinal complaints were studied by light and electron microscopy and culture. Of 46 assessable specimens, seven were histologically normal, and 39 showed evidence of gastritis. Twenty-seven of the specimens with evidence of gastritis (69%) contained spiral bacteria, whereas only one of the normal specimens (14%) contained these bacteria (P = .02). Of 17 patients found to have gastric ulcers, 10 (59% [P greater than .10] ) also had spiral bacteria. The bacteria could be seen scattered over the surface of the epithelial cells and just under the layer of mucus but were rarely found inside the epithelial cells. Curved or spiral gramnegative bacilli were isolated from 10 of the specimens on chocolate agar incubated at 37 C under microaerophilic conditions. The bacteria resembled the organism recently named Campylobacter pyloridis by other investigators.

Chronic esophageal ulceration after endoscopic sclerotherapy

Ulceration at the site of injection is a common sequel of endoscopic sclerotherapy. Most postsclerotherapy ulcers heal spontaneously, usually within 3 weeks. We report a patient who developed a large esophageal ulcer after sclerotherapy, which did not heal despite 2 years of aggressive medical therapy. He bled twice from the ulcer. This is the first report in which such an ulcer has been followed sequentially for 2 years and has remained unhealed.

Pyoderma gangrenosum and chronic persistent hepatitis

Pyoderma gangrenosum is a diagnosis of exclusion. A 36-year-old woman was clinically diagnosed as having pyoderma gangrenosum and appropriate exclusion tests were performed. Pyoderma gangrenosum may occur in association with underlying diseases such as leukemia, monoclonal gammopathy, inflammatory bowel disease, arthritis, and chronic active hepatitis. However, these diseases were excluded in this patient who did have chronic persistent hepatitis. To our knowledge, this is the first reported case of chronic persistent hepatitis and pyoderma gangrenosum.

Healing of endoscopic biopsy sites in the human rectum

The time required in man for a rectal ulcer created with endoscopic biopsy forceps to heal is unknown. To answer this question, we created a large ulcer (approximately 8 mm in diameter) and a smaller ulcer (approximately 4 mm in diameter) in four healthy young men and followed the healing of the ulcers by visual examination every 4 days. Complete healing of the large ulcer had not occurred on days 4 and 8, while by day 12, three had healed and by day 16, all four had disappeared. Of the small ulcers, two had healed by day 8, and all had healed by day 12. This study suggests that it takes approximately 8-12 days for an artificially created rectal lesion to heal completely.

Effects of preparation-H on wound healing in the rectum of man

The wound-healing property of Preparation-H, a widely used over-the-counter hemorrhoidal product was investigated in a randomized, controlled, double-blind trial. Artificial ulcers were created in the rectum of 12 healthy male volunteers and the size of these ulcers followed until complete healing by visual examination on days 4, 8, 15, and 22. There were two groups of patients, one using placebo suppositories (placebo group) and another using Preparation-H (Preparation-H group). On day 8, biopsies were obtained from the edge of the ulcer in both groups to assess histological healing. On day 15, all the five subjects in the Preparation-H group had achieved complete healing of their rectal lesion, whereas only three of six subjects in the placebo group had done so. Although the difference in healing does not achieve statistical significance, it may be that with larger numbers of patients, Preparation-H could be shown to increase the rate of wound healing in artificially created rectal ulcers in man.

Granular cell myoblastoma of the esophagus

Granular cell myoblastoma, a rare, but generally benign tumor, is being encountered with increasing frequency in the digestive tract. Seventy-two cases have been described in the esophagus; we report two additional cases. A follow-up, available in 13 patients (including ours), reveals a low likelihood of malignant transformation or recurrence after surgical removal. Guidelines for the management of these tumors are presented.

Ingested foreign material in mentally disturbed patients

Advances in endoscopic technology and its enthusiastic clinical application have resulted in the capability of retrieving most ingested foreign objects from the upper gastrointestinal tract. Although endoscopic removal of foreign bodies is generally safe, it is not always clearly indicated. Foreign bodies in the esophagus usually require prompt intervention. In contrast, objects are frequently retained in the gastric lumen for long periods without adverse consequences. Psychotic or demented patients are a major adult group at risk for foreign body ingestion. Because endoscopy in this group often carries additional risks, and since smooth objects are usually well tolerated in the stomach for long periods, we recommend a conservative approach in this circumstance.