Sachin Sondhi

The profile of amyotrophic lateral sclerosis in natives of Western Himalayas: Hospital-based cohort study

Background: Despite the disabling nature of amyotrophic lateral sclerosis (ALS), there are no contemporary data on clinical characteristics available from rural hilly states from India. Thus, the present study aimed at reporting clinical profile in ALS patients from natives of Western Himalayas. Materials and Methods: A total of 32 patients of ALS were enrolled over a period of 1 year (2013–2014) in the present study. The demographic profile, clinical characteristics, and risk factors were systematically recorded, and these patients were followed for 1 year. Results: The mean age of ALS patients was 53 ± 15.88 (23–90 years). Maximum number of patients of both limb onset and bulbar onset were in the age group of 40–49 years [Figure 1]. Male to female ratio was 1.46. Limb-onset was seen in 23 (72%) and bulbar-onset in 9 (28%) of patients. Bulbar-onset was more common in females as compared to males. Mean duration of symptoms were 19.06 ± 24 months (range 4–120 months). None of the studied risk factor showed statistically significant association with outcome of the disease. No familial association was found. The most common site of weakness was upper limb distal weakness. Definite ALS was seen in 13 (40.6%) patients. Mean ALS functional rating scale (ALSFRS) at presentation is 35.7 ± 7.9. All patients were started on riluzole. Mean ALSFRS at 9-month follow-up was 32.9 ± 7.4. After 1 year of follow up, 5 out of 32 patients died and among them, 4 were of limb onset and 1 was of bulbar onset ALS. Mean age at death in males was 66 ± 16 years and in females was 56.33 ± 24.8 years; mean survival in these patients was 25 months. Conclusion: This present study highlights following findings: (1) Male preponderance is less common in our patients as compared to earlier reports from India. Bulbar onset is more common in elderly (age >60 years) females. (2) As per previous reports from India, when compared to Western population present study supports the fact of the younger age of onset and longer duration of symptoms and slow course of disease in Indian patients.

Prevalence, risk determinants and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry

Objective To report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD). Methods The Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. The association of AF with nature and severity of valvular dysfunction was analyzed, adjusted for age, left atrial (LA) dimension and pulmonary arterial hypertension using multivariable logistic regression model and strength of association was reported as odds ratio (OR) with 95% confidence intervals (C. I.). Results The study population consisted of young (40.2 ± 14.3 years), predominantly females (72.3%) from rural area (94.1%). Prevalence of AF was 23.9% (95% C. I. 22.1%–25.8%). The independent determinants AF were age (OR 1.04, 95% C.I. 1.03–1.06), LA size (OR 1.10, 95% C.I. 1.08–1.11). The association of AF with age, New York Heart Association functional class, mitral stenosis severity and tricuspid regurgitation was statistically significant and graded. Mitral regurgitation and aortic valve disease had no significant independent association with AF. The prevalence of heart failure, stroke, peripheral embolism and mortality was significantly higher among patients with AF (p < .01). Conclusion AF is common in RHD patients and is significantly associated with heart failure and systemic thromboembolism. Age, mitral stenosis severity, tricuspid regurgitation and LA size were independently associated with AF.

Aortopulmonary window with pumonary atresia with ventricular septal defect with D-transposition of great arteries: extremely rare anomaly

Aortopulmonary window (APW) is rare a congenital heart disease accounting for 0.1%–0.2% of all congenital heart defects. The 35% of the APW has been associated with wide variety of other structural heart diseases such as ventricular septal defect, persistent ductus arteriosus, arch anomalies and coronary artery anomalies. To the best of our knowledge, only six cases of APW with pulmonary atresia with ventricular septal defect has been described in the literature. It resembles the type 1 truncus arteriosus, and differentiation from this condition is important prior to surgical correction. We present a case of 14-year-old girl child; she was diagnosed with APW with pulmonary atresia with ventricular septal defect and D transposition of great arteries with the help of echocardiography, cardiac catheterisation and cardiac CT.

Acute renal artery embolisation: role of local catheter-based intra-arterial thrombolysis

A 45-year-old man without previous comorbidity presented to us with acute onset right-sided flank pain for last 14 hours. His general physical and systemic examination was unremarkable, and there were no clinical signs of peritonitis. The ultrasonography did not reveal any evidence of nephrolithiasis or hydronephrosis. His contrast-enhanced CT scan revealed hypoattenuated areas of right kidney and evidence of right renal artery thrombosis. He was immediately shifted to cardiac catheterisation lab, and his renal angiography showed thrombotic occlusion of right renal artery. The bolus dose of streptokinase (250 000 IU) was given locally in renal artery by right judkins catheter followed by systemic infusion of streptokinase (100 000 IU/hour) for 24 hours. After that he was started on low molecular weight heparin. Repeat renal angiography done after 5 days showed completely normal right renal artery. His cardiac and thrombophilia work up was negative, and he was discharged on antiplatelets, oral anticoagulants and statins.

Massive Pericardial Effusion-Rare and Only Presentation of Hypothyrodism-Myxedematous Heart

Cardiovascular symptoms are often predominant features in patients with hyperthyroidism. But cardiovascular findings in hypothyroidism are more subtle. Hypothyroidism mainly presents as lethargy, cold intolerance, constipation, proximal muscle weakness, weight gain, decreased appetite, coarse dry skin, hair loss and nonpitting edema. Cardiovascular findings in hypothyroidism are mild degree of bradycardia, diastolic hypertension and narrow pulse pressure. Mild degree of pericardial effusion is seen in up to 30% of overtly hypothyroid patients. There are several case reports on myxedema ascites, but only few case reports of hypothyroidism presenting as massive pericardial effusion. We report a case of 54-year-old female presenting with breathlessness and found to have massive pericardial effusion without tamponade. After extensive workup, she was found to have primary hypothyroidism. In contrast, she had no other symptoms and clinical signs suggestive of hypothyroidism. She was improved after treatment with levothyroxine.

SMS campaign – Can it facilitate prevention of cardiovascular diseases in India?

In the current decade, worldwide there is an increase in the number of women undergoing coronary artery bypass grafting (CABG). This is a surrogate marker of the fact that CAD in women is recognised more often and much earlier than in previous years. This has been reflected in our data. We compared two groups of women undergoing CABG – group I (1998–2002; n = 293) and group II (2010–2014; n = 395). There was an increase from 11% of the total number of female patients who underwent CABG from Group I to 19.5% from Group II. The mean age is higher and there was increase in the percentage of women having previous PCI in group II. Despite the increase in severity of disease and comorbid conditions, improved outcomes were observed.

Post MI pericarditis or recurrent infarction-Diagnostic dilemma

There are many causes of ST segment elevation in multiple leads in electrocardiogram. Differentiation is based on history, clinical examination and most importantly on electrocardiogram features like nature of ST segment elevation, leads specific ST segment elevation, reciprocal changes, presence or absence of Q wave, PR segment depression and ST/T wave ratio in V6. We report a case of 57 year male, presented with acute coronary syndrome in form of ST elevation inferolateral myocardial infarction and subsequently on day 3rd he developed chest pain, the diagnosis of post myocardial infarction pericarditis was made based on specific electrocardiogram findings. Correspondence to: Sachin Sondhi, Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, Tel: +91-8219508161; E-mail: ssachin119@gmail.com

Intestinal amebiasis presenting as life threatening lower GI bleed-A rare presentation

Amoebiasis is a common intestinal protozoan infection due to Entamoeba histolytica. In India, the prevalence of the disease varies from 2% to 67%.[1] Acute Fulminant Colitis is a rare complication of intestinal amebiasis. Life threatening lower Gastrointestinal bleed is very rare presentation of amebiasis. Here, we are presenting a case of severe lower GI bleed proved to be caused by amebiasis along with extra intestinal complications.