Sanjay Porwal

CHA2DS2-VASc-HSF score – New predictor of severity of coronary artery disease in 2976 patients

BACKGROUND CHADS2 and CHA2DS2-VASc scores have been used for assessing prognostic risk of thromboembolism in non valvular atrial fibrillation patients. They include similar risk factors for the development of CAD To increase the likelihood of determining CAD severity, the CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF score comprising of hyperlipidemia, smoking and family history respectively in addition to the components of the CHA2DS2-VASc score and male instead of female gender. The aim was to investigate whether these risk scores can be used to predict CAD severity. METHODS AND RESULTS A total of 2976 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients,804 had normal coronary angiograms and served as group 1. The remaining 2172 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or >50%: 834 patients with mild CAD as group 2 and 1338 patients with severe CAD as group 3. The scores were significantly different among the 3 groups. All the four scores correlated significantly with the number of diseased and the Gensini score. CONCLUSION CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF scores could be considered predictive of the risk of severe CAD with CHA2DS2-VASc-HSF the best scoring scheme to predict CAD severity. The risk scoring systems may play an important role as predictive models because they are simple and can be easily applied by physicians without any additional costs in routine practice.

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

Successful deployment of a dislodged sirolimus-eluting stent with a small-balloon technique

Stent dislodgement is a rare but recognized and potentially serious complication of percutaneous coronary intervention. Stent dislodgement was more frequent in the past when stents were manually crimped onto the balloon. Newer and improved balloon-mounted stents with better radio-opacity have reduced the incidence of stent dislodgement but do not completely eliminate it. We report a case of stent dislodgement which was successfully deployed with small-balloon technique. This patient however was successfully treated with small balloon technique at the desired site. <Learning objective: Newer and improved balloon-mounted stents with better radio-opacity have reduced the incidence of stent dislodgement but do not completely eliminate it.>.