Op Gupta

Chlamydophila pneumoniae infection and cardiovascular disease

Atherosclerosis is a multifactorial vascular inflammatory process; however, the inciting cause for inflammation remains unclear. Two decades ago, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) infection was proposed as a putative etiologic agent. We performed a PubMed search using the keywords Chlamydia and atherosclerosis in a Boolean query to identify published studies on C. pneumoniae and its role in atherogenesis, and to understand research interest in this topic. We found 1,652 published articles on this topic between 1991 and 2011. We analyzed relevant published studies and found various serological, molecular, and animal modeling studies in the early period. Encouraged by positive results from these studies, more than a dozen antibiotic clinical-trials were subsequently conducted, which did not find clinical benefits of anti-Chlamydophila drug therapy. While many researchers believe that the organism is still important, negative clinical trials had a similar impact on overall research interest. With many novel mechanisms identified for atherogenesis, there is a need for newer paradigms in Chlamydophila-atherosclerosis research.

Hypokalemia induced rhabdomyolysis.

An 18-year-old unmarried girl presented with a history of pain in the abdomen and nonbilious vomiting of 4-day duration. This was followed by painful muscle cramps and progressive proximal muscle weakness involving all four limbs. She had no history of diarrhea, diuretic intake, fever, arthralgia, and rash. She had a similar episode of abdominal pain, vomiting, and muscle weakness 2 months prior to this illness which recovered after receiving some IV injections in a private hospital. She had never passed any urine stones. She was normotensive and nondiabetic with a normal thyroid profile. There was no history of drug intake.

A rare case of situs inversus with dextrocardia, lutembacher syndrome, and pericardial effusion.

Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is low as compared to congenital cardiac anomalies in isolated dextrocardia. We describe the first ever case of situs inversus with dextrocardia, Lutembachers syndrome, and pericardial effusion. The pericardial effusion in our case was acquired and was tubercular in etiology.

Recurrent pneumothorax in a young female with pulmonary lymphangiomyomatosis: a case report and overview of literature.

Lymphangiomyomatosis (LAM) is a rare cystic interstitial lung disease that exclusively affects women of child bearing age and is associated with vascular proliferation of smooth muscle cells in the lung. We report a case of young female with pulmonary LAM presenting with recurrent pneumothorax.

Carotid intima-media thickness and apolipoproteins in patients of ischemic stroke in a rural hospital setting­ in central India: A cross-sectional study

Context: Carotid intima-media thickness (CIMT) and apolipoproteins have been found as a risk factor for ischemic stroke Objective: The objective was to study the carotid intima-media thickness, apolipoproteins, and their relation in patients of ischemic stroke in central rural India. Settings and Design: A cross-sectional study was performed in a rural hospital in central India. Materials and Methods: In all patients of ischemic stroke proven by computerized tomography (CT), CIMT, apolipoprotein A-I (ApoA-I), and apolipoprotein B(ApoB) were measured. Statistical Analysis Used: We used Students t-test to compare means, a chi-square test to compare proportions, and a Mann-Whitney test to compare medians. A P value <0.05 was considered significant. Results: The mean age of our study population (N=106) was 61 years. The mean CIMT was 0.83 mm ranging from a minimum of 0.45 mm to a maximum of 1.096 mm. Mean CIMT was significantly higher than expected 0.67 values, which was calculated according to the age of the study population. The association of decreased ApoA-I < 100 mg/dl and increased ApoB > 90 mg/dl with CIMT > 0.7 mm was statistically significant with P<0.001. Conclusions: The CIMT in computerized tomography-proven ischemic stroke was significantly higher than expected for the age of the study population. The relation of decreased ApoA-I and increased ApoB with CIMT > 0.7 mm was also statistically significant.

Effect of short term vitamin E supplementation on lipid peroxidation in acute myocardial infarction.

In view of sufficient body of evidence to substantiate the role of free radical mediated oxidative injury in myocardial infarction (M.I.), the utility of exogenous supplementation with antioxidant substance, vitamin E was studied. Forty patients of acute myocardial infarction were divided into two equal groups, one who received vitamin E and the other who did not. Plasma MDA levels showed a reduction in patients of M.I. who received vitamin E as well as in those who did not, however, the decrease was significantly more in the vitamin E treated subgroup.

A comparative study of the C-reactive protein and the ST-score (ECG) as prognostic indicators in acute myocardial infarction in a rural resource-constrained hospital setting in central India: A cross-sectional study

Context: The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events. Aims: The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India. Settings and Design: Cross sectional study, rural hospital in central India. Material and Methods: In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission. Statistical analysis used: We used Students t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals. Results: STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively. Conclusions: STS on admission is independent predictor while hs- CRP is not in resource constrained settings.

Feasibility of measles vaccine: Experience with live attenuated virus vaccine in and around Sevagram

Abstract301 susceptible children between 9 months to 59 months of age from villages around Sevagram were immunised against measles with the live attenuated Schwartz strain. Ouster approach was adopted. 95 percent coverage was achieved. Follow up for next 15 days by village health worker revealed mild reactions to measles vaccine in 70(23.25%) Upper respiratory cattarh with or without fever was the commonest finding. Measle like rash was a rare finding (only two children). Acute allergic edema of the vaccinated limb within 12 hof vaccination and rapid response to antihistaminics was an interesting observation in one child. By and large, duration of postvaccinal illness confined to 3–4 days.Thus, considering 95 percent coverage with the single dose vaccine and mild nature of reactions, it is felt that measles vaccine can easily be accepted in rural India.