Nirlep Gajiwala

Small-for-gestational-age versus appropriate-for-gestational-age: Comparison of cord blood lipid profile & insulin levels in term newborns (SAGA-ACT study).

Background & objectives: The genesis of atherosclerotic lesions, a major cardiovascular risk factor starts in the early stage of life. If the premature development of cardiovascular risk factors can be anticipated during childhood, cardiovascular events can be prevented effectively by taking appropriate measures. This study was carried out to assess the role of in utero malnutrition in cardiovascular disease development by comparing cord blood lipid profiles and serum insulin levels between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) term newborns. Methods: Consecutive full-term infants who were born between June 20 and August 19, 2013, at the Obstetric Unit of a Hospital at Secunderabad, India, were enrolled in this study. Participating newborns were divided into SGA group (n = 51; test group) and AGA group (n = 52; control group) based on their gestational age and body weight. Cord blood lipid profile and insulin levels were compared between these two groups. Results: As compared to the newborns in AGA group, SGA group of newborns had significantly (P<0.01) higher levels of cholesterol, triglyceride and low-density lipoprotein. No difference was observed between the groups for high-density lipoprotein and insulin levels. Mild and moderate anaemia was observed among mothers of both groups, while severe anaemia was seen in mothers of SGA group only. Interpretation & conclusions: SGA newborns exhibited elevated lipid profiles as compared to AGA newborns. Hence, SGA newborns should be closely monitored for cardiovascular morbidities during childhood, adolescence and early adult life.

To air is human, to liberate is divine!

Coronary artery air embolization is a rare complication of cardiac catheterization that leads to catastrophic consequences within seconds after an introduction of air bubbles in the coronary circulation. Rapid and aggressive management is essential to ensure the best chance of recovery in such cases. Here, we report an unusual occurrence of large air embolization during elective percutaneous transluminal coronary angioplasty in a 41-year-old male patient. The patient experienced sudden severe retrosternal chest pain, followed by loss of consciousness, hypotension, flattening of aortic pressure curve, and severe bradycardia. Immediate attempts were made to remove the air embolus by performing continuous saline flush through a guiding catheter and using other supportive resuscitation measures. The attempts were successful, which ultimately resulted in relieving patient′s symptoms and offering an uneventful recovery.

A Challenging Case of Bifurcation Lesion in Left Anterior Descending Artery: Managed Successfully with Everolimus-Eluting Bioresorbable Vascular Scaffold and Kissing Balloon Technique under Optical Coherence Tomography Guidance

A 54-year-old Indian male patient was presented to our hospital with the complaints of chest pain since 1-day prior to admission. He was diagnosed, elsewhere, with anterior-wall myocardial infarction and was treated with tenecteplase. Subsequently, he was referred to us for the management of postinfarction angina. He was a known case of hypertension and had no family history of coronary artery disease. Echocardiogram demonstrated hypokinesia of anterolateral wall with normal left ventricular function. Angiography revealed a single vessel disease-99% stenosis in the mid-segment of left anterior descending (LAD) coronary artery with significant narrowing at the proximal site of diagonal 1 (D1) branch. An optical coherence tomography-guided percutaneous coronary intervention to the LAD-D1 bifurcation lesion was performed successfully using ABSORB bioresorbable vascular scaffold (Abbott Vascular, USA) and kissing balloon angioplasty. No postprocedural complication was observed and the patient was discharged the next day. Clinical evaluation at 1-year follow-up was satisfactory.

Non-identical yet similar: presentation of coronary artery disease in dizygotic twins

There is a considerable debate regarding the role of genetic and the environmental factors in the pathogenesis of coronary artery disease (CAD). Since twin pairs are exposed to similar prenatal and postnatal environmental factors, a particular role of genetic vs. environmental factors can be evaluated by investigating the twins. We report a case of a dizygotic twin-pair who presented with simultaneous development of coronary insufficiency, and underwent coronary angiography and stent implantation on the same day. There were striking similarities and differences in certain characteristics between the presenting twins. We believe that the occurrence of CAD might be predetermined genetically, while the location of CAD lesion and its severity might be subjected to the modification of environmental factors among dizygotic twins. Considering the high risk of CAD-related fatal events in monozygotic and dizygotic twins, we recommend aggressive medical surveillance for a twin individual, whose co-twin has reported a cardiac event.

Gelfoam embolization - a preoperative requisite in patients with juvenile nasopharyngeal angiofibroma: report of three patients.

We present a case series of three patients who were admitted in the ENT department with the complaints of nasal congestion, nasal bleeding and vertigo. Evaluation of these patients revealed juvenile nasopharyngeal angiofibroma. Patients were advised to undergo excision surgery. We performed preoperative gelfoam embolization in each of these patients to reduce the complications of intraoperative bleeding. All surgeries went well and the blood supply to the area was found to be reinitiated within 5–6 days postoperatively. Here, we highlight the importance of preoperative gelfoam embolization for uneventful surgical excision of juvenile nasopharyngeal angiofibroma. Case Study Porwal et al.; BJMMR, 6(7): 730-734, 2015; Article no.BJMMR.2015.250 731