Cholenhally Nanjappa Manjunath

C-Peptide and its Correlation to Parameters of Insulin Resistance in the Metabolic Syndrome

The progress of metabolic syndrome (MetS) continues with the onset of type-2 diabetes mellitus (Type-2 DM) along with linkage to other disorders such as neurodegenerative, especially Alzheimers disease (AD), via oxidative stress and low grade systemic inflammatory process. Type-2 DM and AD are health disorders of priority research. The treatment for an individual suffering with Type- 2 DM and/or AD requires monitoring by clinicians. The aim of this study was to investigate the role of C-peptide and its correlation to insulin resistance, body mass index (BMI), β cell function, insulin sensitivity, lipid profile and hemoglobin A1c (HbA1c). The study was designed to include 96 Type-2 DM individuals from India. 58.3% males and 41.7% females were selected and fasting blood samples were collected for estimation of fasting C-peptide, fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c and lipid profile. Analysis was done on Hitachi912 and Elecsys 2010 using Roche reagents and standard controls. Anthropometries to calculate BMI and β cell function, insulin sensitivity, and insulin resistance were obtained. The statistical tool ANOVA, followed by calculation of p-value and r � value were applied for investigating correlation of C-peptide levels to those of high density lipoprotein-C (HDL-C), low density lipoprotein-C (LDL-C), triglycerides (TGL), HbA1c, β cell function, insulin sensitivity and insulin resistance. Highly significant positive correlations were observed in different quantiles of C-peptide levels to the studied parameters of MetS, BMI and % β cell function. Lower HDL-C level was found to be significantly related to higher C-peptide levels. Similarly, TGL and C-peptide levels displayed a significant positive correlation. A significant negative correlation was observed between C-peptide quantiles and % sensitivity. Thus, insulin resistance showed a positive correlation until the fourth quantile. No significant correlation was observed between C-peptide and HbA1c levels. This study demonstrates that assessment of C-peptide levels is a useful tool to monitor the progress of MetS among patients suffering from Type-2 DM and AD, as these disorders are intertwined to each other by common metabolic pathways. Assessment of C-peptide levels, along with HDL-C levels, in patients can be used to monitor insulin resistance.

Prognostic Significance of a Multimarker Strategy of Biomarkers in Acute Heart Failure

BACKGROUND Heart failure (HF) is a growing public health problem. Patients often present to emergency department (ED) with acute onset dyspnea where a rapid triage is required to avoid misdiagnosis and to institute appropriate therapy. An objective risk-stratification in the ED is warranted to identify patients at high risk of adverse outcomes, so that more intensive therapy and vigilant follow-up after discharge are instituted. METHODS AND RESULTS Fifty two consecutive acute HF (AHF) patients in NYHA class III/IV were enrolled for the present study. N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hsTropT), high-sensitivity C-reactive protein (hsCRP) and Uric acid (UA) were evaluated at admission; a second sample for NT-proBNP and hsTropT was obtained 48h later. The end-point of the study, a composite of cardiovascular death, rehospitalisation for worsening HF symptoms and refractory HF was reached in 32.7% of patients during a median follow-up of 4.8mnth. Although, hsTropT (>0.014ng/ml), hsCRP (>0.5mg/dl) and UA (>5.6mg/dl for females and >7 mg/dl for males) were elevated in the vast majority of patients (92.3%, 75% and 63.5% respectively), baseline and changing patterns of NT-proBNP following treatment were the only predictors of adverse outcomes on follow-up. A significant correlation between hsTropT, hsCRP and UA was observed suggesting a link between inflammation, myocyte injury and oxidative stress in AHF. CONCLUSION Baseline and changing patterns of NT-proBNP predicted adverse outcomes on follow-up suggesting that a strategy of serial measurement of NT-proBNP could prove invaluable in early risk stratification. Further research is needed to understand the link between inflammation, myocyte injury and oxidative stress in AHF which could provide potential therapeutic targets.

Cardiac lipoma at unusual location -- mimicking atrial myxoma.

Cardiac lipomas are one of the rare primary benign neoplasms composed of mature fat cells. The tumor originates mostly in the subendocardium and subepicardium but very rarely within the myocardium. Clinically, this tumor is asymptomatic and found incidentally in the vast majority of cases. We report a 26‐year‐old female presenting with atypical chest pain. Transthoracic echocardiogram showed a mass in relation to interatrial septum suggestive of atrial myxoma, but was confirmed to be cardiac lipoma on magnetic resonance imaging. Owing to the asymptomatic character and the benign nature of the tumor, a decision for conservative management was made.

Tuberculosis: still an enigma. Presenting as mycotic aneurysm of aorta

The term mycotic aneurysm is a misnomer that has nevertheless been generally adopted to describe aneurysms that occur secondary to the infectious destruction of the arterial wall. Mycotic aneurysm secondary to tuberculous infection of the aorta is a rare and life-threatening disease. Both abdominal and thoracic aorta are involved with equal frequency.1 Tuberculous aneurysms are usually a consequence of transmural perforation caused by direct extension to the vessel from a contiguous focus, often lymphadenitis, but also pulmonary,2 digestive or vertebral. Other mechanisms implicated are haematogenous contamination through the vasa vasorum,3 or an autoimmune response to tuberculosis. Clinical features are highly …

Spinal epidural hematoma - A rare and debilitating complication of thrombolytic therapy.

Thrombolytic therapy directed to the achievement of early reperfusion in cases with acute ST elevation myocardial infarction can have significant complications which can be due to bleeding or in the form of allergic reactions. Sometimes these complications can cause mortality or significant and incapacitating morbidity which may at times surpass the risk possessed by the disease itself. We are reporting an interesting case of 63-year-old male, who presented to us with acute anterior wall myocardial infarction and developed acute onset paralysis following intravenous administration of streptokinase and heparin. MRI spine revealed spinal epidural hematoma. Patient was advised urgent surgical evacuation of hematoma, but opted for conservative management. Patient had significant residual neurological deficits at follow-up. In conclusion, spinal epidural hematoma is a rare complication following thrombolysis for acute ST elevation myocardial infarction. Though rare, high index of suspicion is required by physicians, as prompt treatment may lead to complete recovery, which otherwise can lead to debilitating neurological sequel.

Type I aortopulmonary window presenting with very early onset Eisenmenger's syndrome

A 2-year-old child with a history of recurrent chest infection early in infancy presented with clubbing, cyanosis, oxygen saturation of 86% in room air, left parasternal heave, short ejection systolic murmur at left second space and loud pulmonary component of second heart sound suggestive of severe pulmonary hypertension. X-ray revealed cardiomegaly with pulmonary artery dilation and peripheral vasoconstriction (figure 1). Echocardiography revealed biventricular hypertrophy with moderate tricuspid regurgitation and pulmonary artery systolic pressure of 90 mm Hg. A large aortopulmonary (AP) window (1 cm) was demonstrated in the parasternal short axis view with bidirectional shunting (figures 2⇓–4, videos 1⇓–3). Cardiac catheterisation to assess for the reversibility of the …

Thrombolytic therapy in the treatment of acute sub-massive pulmonary embolism: a prospective observational study.

The use of thrombolytic therapy in haemodynamically stable patients with sub-massive pulmonary embolism is still controversial. We conducted this study to observe the safety and efficacy of thrombolytic therapy in acute pulmonary embolism patients with normal blood pressure in a tertiary cardiac centre. In this study, 130 patients with sub-massive pulmonary embolism who had right-ventricular dysfunction were included and treated with thrombolytic therapy. Forty-one percent of patients in our study were within 40 years of age. Eighty-three percent of patients had clinical improvement. Both right-ventricular dysfunction and pulmonary artery systolic pressure were improved significantly following thrombolytic therapy from baseline (49 vs. 28 mmHg; P = 0.01; 95% confidence interval −13 to −56). Only 9% patients had died and two patients had intra-cerebral haemorrhage during this study. Thrombolytic therapy may be helpful in improving clinical course following sub-massive acute pulmonary embolism, especially for those who had low risk of bleeding. Further randomized study with large sample size is needed for final conclusion.

Post angioplasty free wall rupture

Abstract Left ventricular free wall rupture (LVFWR) is an uncommon but mostly fatal complication. Its occurrence in the setting of rescue angioplasty is still rare. We report a case of LVFWR which was not directly related to the procedure and despite early recognition and treatment, was fatal.

Differential intraluminal flow turbulence: a marker of aortic dissection

A 54-year-old hypertensive patient presented with chest and back pain for the last 4 h. Physical examination was normal except for a blood pressure of 180/100 mm Hg in both upper limbs. ECG and a chest x-ray were normal, cardiac biomarkers were negative. A bedside transthoracic echocardiogram (TTE) showed concentric left ventricular hypertrophy with normal left ventricular function, normal valves and no evidence of pericardial effusion. The aortic arch as visualised from suprasternal view was also unremarkable except for a differential intraluminal turbulence on colour Doppler, just distal …