Ponniah Thirumalaikolundusubramanian

Lipid and lipoprotein profiles among middle aged male smokers: a study from southern India

ObjectivesThe objectives were to investigate into the relationship between lipid profile including Apolipoprotein-A1 (Apo-A1) and Apolipoprotein-B (Apo-B) and smokers and to relate them with smoking pack years.Materials and MethodsA total of 274 active male smokers without any other illnesses and age matched male healthy control subjects (78) with similar socio-cultural background were assessed for clinical details, dietary habits, physical activities, smoking and alcohol consumption. Standard methods were adopted to check the lipid levels. The data were analyzed statistically.ResultsTheir ages ranged from 40 to 59 years, systolic BP from 110 to 130 mmHg, and diastolic BP from 76 to 88 mmHg. All of them had similar pattern of diet (vegetarianism with occasional meat). None was on any medication influences lipid level. Their physical activity was moderate. Number of pack years varied from 10 to 14 (mild), 15 to 19 (moderate) and 20 and above (heavy) among 69, 90 and 115 cases, whose mean ages were 43, 44 and 49 respectively. The mean (+SD) values in mg/dl of total cholesterol (TC), Triglyceride (TGL), Apo-B, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and Apo-A1 in mg/dl among mild/ moderate/ heavy smokers and control subjects were 198 (30.6)/ 224 (27.2)/ 240 (24.3) and 160 (20.4); 164(42.6)/ 199 (39.5)/ 223(41.7) and 124 (31.6); 119 (24.9)/ 121 (27)/ 127 (28.3) and 116 (21.4); 94 (19.7)/ 104 (21.8)/ 120 (20.5) and 82 (17.6); 42 (5.9)/ 39 (3.1)/ 35(4.4) and 48 (5.3); and 120 (17)/ 119 (21)/ 115 (25) and 126 (19), respectively. In smokers, there was a rise in TC, TGL, LDL, Apo-B and fall in HDL and Apo-A; these changes were significant (P < 0.05).ConclusionNumber of pack years was directly proportional to abnormal lipid profile. It is also concluded that changes in Apo-A1 and Apo-B were more significant when compared to HDL and LDL cholesterol among smokers. In the view of double risk for smokers (smoking and altered lipid profile) efforts may be made to introduce smoking cessation program.

Hypothesis of snake and insect venoms against Human Immunodeficiency Virus: a review

BackgroundSnake and insect venoms have been demonstrated to have beneficial effects in the treatment of certain diseases including drug resistant human immunodeficiency virus (HIV) infection. We evaluated and hypothesized the probable mechanisms of venoms against HIV.MethodsPrevious literatures published over a period of 30 years (1979-2009) were searched using the key words snake venom, insect venom, mechanisms and HIV. Mechanisms were identified and discussed.Results & ConclusionWith reference to mechanisms of action, properties and components of snake venom such as sequence homology and enzymes (protease or L- amino acid oxidase) may have an effect on membrane protein and/or act against HIV at multiple levels or cells carrying HIV virus resulting in enhanced effect of anti-retroviral therapy (ART). This may cause a decrease in viral load and improvement in clinical as well as immunological status. Insect venom and human Phospholipase A2 (PLA2) have potential anti-viral activity through inhibition of virion entry into the cells. However, all these require further evaluation in order to establish its role against HIV as an independent one or as a supplement.

Electrocardiographic changes in spontaneous pneumothorax

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Cardiac Tamponade in Russell Viper (Daboia russelii) Bite: Case Report with Brief Review

BACKGROUND Coagulopathy after snake bite is well known; however, cardiac tamponade as a manifestation of coagulopathy is rare. OBJECTIVE To report a case of pericardial hemorrhage with cardiac tamponade after Russell viper bite. CASE REPORT A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical and laboratory follow-up of this case confirmed the clinical diagnosis of toxin-induced disseminated intravascular coagulation. Interestingly, pericardial hemorrhage with large pericardial effusion was evident clinically as well as on electrocardiogram and echocardiogram, as an initial presentation without any other bleeding manifestations. The patient developed cardiac arrest and was revived with cardiopulmonary resuscitation. Emergency pericardiocentesis was carried out. He was given fresh frozen plasma in addition to snake antivenin along with symptomatic management. On the third day of hospitalization, the patients clinical and laboratory profile returned to normal and he was discharged on the fifth day. CONCLUSION Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage. Practitioners and physicians should suspect and search for pericardial effusion in snake bite victims who develop breathlessness, and treat it vigorously in addition to antivenin therapy.

Ventricular fibrillation after exposure to air freshener—death just a breath away

A case of ventricular fibrillation due to butane toxicity after unintentional inhalation of air freshener is reported for its rarity and to create awareness among practitioners and the public. A 25-year-old woman collapsed in the supermarket after unintended exposure to air freshener sprayed into her nostrils. Her husband started cardiopulmonary resuscitation immediately, and she was brought to the hospital. She had coarse ventricular fibrillation. Defibrillation with 360 J was given, and the rhythm reverted to normal sinus rhythm after the third shock. Epinephrine was not administered, and she was treated with esmolol infusion for ventricular ectopy. The patient recovered completely without any sequelae and was discharged on the fifth hospital day. On thin layer chromatography, the chemical content of the spray was identified to be isobutane. Avoiding epinephrine and administering β-adrenergic blockers may protect the catecholamine-sensitized heart early during resuscitation in butane exposure cases.

Role of Hounsfield units to distinguish pseudo-subarachnoid hemorrhage.

The importance of recognizing pseudo-subarachnoid hemorrhage (PSAH) in a case of massive valproic acid overdose was well brought by Min et al. 1 The cerebral edema in valproic acid overdose is due to the disruption of osmotic gradient which usually occurs 48 – 72 hours after the drug over dosage, despite decreasing serum levels of valproic acid 2 .However, the appearance of PSAH within the basal cisterns, in conjunction with diffuse cerebral edema, has received limited attention in medical literature. We would like to highlight the usefulness of Hounsfi eld units to differentiate PSAH from subarachnoid hemorrhage (SAH) with reference to the report published. 1

Propofol's derivative: A potential drug for erectile dysfunction?

Propofol, an intravenous anesthetic agent induces priapism in humans. We hypothesize the probable central nervous system and local mechanisms through which a similar molecule can be used as a therapy in erectile dysfunction. Previous literatures published over a period of 35 years (1976-2010) were searched using the key words, mechanisms were identified and discussed. In the central nervous system, propofol has an inhibitory effect on serotonin receptors and on gamma-aminobutyric acid A (GABA-A) receptors as well as a facilitatory action on N-methyl-D-aspartate (NMDA) mediated calcium response and agonistic action on dopaminergic D2 receptors, which might contribute towards maintaining erections. While in the penile tissue, propofols action may be due to increased synthesis of nitric oxide (NO), the principal mediator of penile erection. In addition, it may also have inhibitory effect on thromboxane A2, a potent vasoconstrictor and stimulatory action on penile adenosine triphosphate (ATP) dependent potassium (K-ATP) channels, a potent vasodilator. In view of the above mechanisms, use of propofol or similar molecule in erectile dysfunction needs to be ascertained and evaluated.

Cardiovascular Complications in Ciguatera Fish Poisoning: A Wake-up Call.

Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity. Although cardiovascular symptoms are rare with ciguatoxin, we report two cases with bradycardia and hypotension. Fatality and long-term sequelae are not uncommon with ciguatoxin poisoning and educating the general population is essential.

Significance of the Intima-Media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population

Background: Ultrasound detected intima-media thickness (IMT) of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease (CAD) in asymptomatic individuals. Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population. Patients and Methods: A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test. At plaque-free regions, the carotid IMT was evaluated by B-mode ultrasonography and thoracic aorta IMT was evaluated by trans-esophageal echocardiography (TEE). The significance of difference in means between two groups was analyzed using one-way ANOVA F-test and the significance of difference in proportions by Chi-square test. Multiple comparisons were done by Bonferroni t test. The correlation between IMT and severity of CAD was assessed by Spearmans method. Results: There were 38 males and 2 females among cases with age 51.7 ± 8.3 years, and 28 males and 2 females among control subjects with age 52.2 ± 7.1 years. Increased carotid IMT was noted among 24 cases and 2 control subjects, and the association was significant for CAD [P < 0.001, Chi-square = 20.89, odds ratio (OR) = 21.00, and 95% confidence interval (CI) = 4.78-89.59]. Similarly, 19 cases and one control subject had abnormal IMT with positive correlation for CAD (P < 0.001, Chi-square = 16.39, OR = 28.24, and 95% CI = 4.06-163.21). There was no association between IMT and diabetes, hypertension, or smoking; however, IMT was significantly associated with age and dyslipidemia. Also, there was no correlation between extent of IMT and severity of CAD. Conclusions: IMT of the carotid and thoracic aorta is strongly associated with risk of CAD in a South Indian population, and may be used as a non-invasive screening tool for coronary atherosclerosis in resource-limited settings. The presence of dyslipidemia influenced IMT and may be used as a tool to follow patients on hypolipidemic drugs.

Acute ST-segment elevation myocardial infarction from a centipede bite

Acute myocardial infarction (AMI) following a centipede bite has been very rarely reported. Here, we describe a 22 year-old man who had ST-segment elevation AMI after a centipede bite. He presented with typical chest pain, electro and echocardiographic abnormalities, and elevated cardiac enzymes with normal coronary angiography. The probable mechanisms were described. Practitioners treating centipede bites shall not consider it lightly, as centipede envenomation may produce a variety of systemic and local manifestations in susceptible individuals.