Sushil Kumar Singh

Therapeutic Dosing of Acenocoumarol: Proposal of a Population Specific Pharmacogenetic Dosing Algorithm and Its Validation in North Indians

Objectives To develop a population specific pharmacogenetic acenocoumarol dosing algorithm for north Indian patients and show its efficiency in dosage prediction. Methods Multiple and linear stepwise regression analyses were used to include age, sex, height, weight, body surface area, smoking status, VKORC1 -1639 G>A, CYP4F2 1347 G>A, CYP2C9*2,*3 and GGCX 12970 C>G polymorphisms as variables to generate dosing algorithms. The new dosing models were compared with already reported algorithms and also with the clinical data for various performance measures. Odds ratios for association of genotypes with drug sensitive and resistant groups were calculated. Results The pharmacogenetic dosing algorithm generated by multiple regression analysis explains 41.4% (p-value <0.001) of dosage variation. Validation of the new algorithm showed its predictive ability to be better than the already established algorithms based on similar variables. Its validity in our population is reflected by increased sensitivity, specificity, accuracy and decreased rates of over- and under- estimation in comparison to clinical data. The VKORC1-1639 G>A polymorphism was found to be strongly associated with acenocoumarol sensitivity according to recessive model. Conclusions We have proposed an efficient north India specific pharmacogenetic acenocoumarol dosing algorithm which might become a baseline for personalised medicine approach for treatment of patients in future.

Total Arterial Revascularization on Beating Heart: Experience in 803 Cases

To avoid the deleterious effects of cardiopulmonary bypass, total arterial revascularization was performed on the beating heart, using an Octopus stabilizer, in this prospective study of 803 patients without selection bias. Single-vessel disease was present in 71 (9%) patients, double-vessel disease in 204 (25%), and triple-vessel disease in 528 (66%). An ejection fraction < 30% was found in 127 (16%) cases. Angiography was carried out before discharge in 204 (25%) patients. Grafts included left and right internal mammary arteries and the radial artery. There were 2,661 grafts placed with a mean of 3.31 grafts per patient (range, 1 to 6). Operative mortality was 0.5%. There was no postoperative stroke and few incidences of renal impairment, even in patients with chronic renal failure. Blood transfusion was not required in 558 (69%) patients. Mean hospital stay was 5.6 days. Overall angiographic patency was 98.6%. Total arterial revascularization on the beating heart was found to be safe, effective, and reproducible in almost all patients, with excellent short-term patency rates and minimal morbidity.

Fast magnetic-field annihilation in the relativistic collisionless regime driven by two ultrashort high-intensity laser pulses.

The magnetic quadrupole structure formation during the interaction of two ultrashort high power laser pulses with a collisionless plasma is demonstrated with 2.5-dimensional particle-in-cell simulations. The subsequent expansion of the quadrupole is accompanied by magnetic-field annihilation in the ultrarelativistic regime, when the magnetic field cannot be sustained by the plasma current. This results in a dominant contribution of the displacement current exciting a strong large scale electric field. This field leads to the conversion of magnetic energy into kinetic energy of accelerated electrons inside the thin current sheet.

Surgical treatment for coronary artery aneurysm: a single-centre experience

OBJECTIVES Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity. METHODS Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King Georges Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting. RESULTS Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up. CONCLUSIONS Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

Multivessel total arterial revascularization via left thoracotomy.

Off-pump coronary artery bypass grafting is now becoming the preferred method of coronary revascularization. The trend is towards complete revascularization, preferably arterial. We are describing here a method of multivessel, total arterial, complete revascularization via an anterolateral thoracotomy approach in 27 patients. There was an average of 3.2 grafts/patient. Angiograms were performed in 9 patients (33.33 %). There were no operative mortalities. None of the patients required conversion to cardiopulmonary bypass or midsternotomy.

Aneurysmal Aorto-Right Ventricular Tunnel

A successful closure of an aneurysmal aorto-right ventricular tunnel (ARVT) in a 16-year-old male patient is reported here. An attempt at device closure had failed in this patient. Diagnosis was confirmed by Doppler echocardiography, 3-dimensional computed tomography, and cardiac catheterization. Surgical closure with a Dacron patch (W.L. Gore & Associates, Flagstaff, AZ) at the aortic end and direct closure at the ventricular end was done successfully with the patient under mild hypothermia. The postoperative echocardiogram showed a competent aortic valve with a closed ARVT.

Post-traumatic left ventricular pseudoaneurysm

Left ventricular pseudoaneurysms (LVPs) occur as a complication of myocardial infarction, cardiac surgery and, rarely, due to thoracic trauma, infective pericarditis or iatrogenisis due to accidental perforation of the myocardium. Ventricular pseudoaneurysms are acquired by blood-filled spaces outside the cardiac chambers communicating with the ventricle. We present a case of LVP presented after a blunt non-penetrating chest injury. The patient underwent successful aneurysmorrhaphy.

Esophagopleural Fistula following Spontaneous Rupture of Traction Diverticulum

A rare case of esophagopleural fistula following spontaneous rupture of a traction diverticulum of the esophagus in a 25-year-old man was successfully treated by diverticulectomy.

Calcified left atrial myxoma with osseous metaplasia.

An intracardiac myxoma is the most common tumour of the heart with an estimated incidence of 0.5 per million population per year. Extensive calcification is rare in these tumours. We describe a rare case of a large left atrial myxoma, visible on the chest radiograph, with extensive calcification and osseous metaplasia.

Giant Aorto–Right Ventricular Fistula With Single Coronary Artery

A 15-year-old boy with symptoms of dyspnea and fatigue since early childhood was referred to our institution for evaluation. Physical examination of the patient showed long, slender extremities and a pectus carinatum deformity of the chest (Figure 1A). His arm span–to-height ratio was 1.03, and his upper segment–to–lower segment ratio was 0.82. He had blood pressure of 126/70 mm Hg, with a heart rate of 96 bpm; a grade 4/6 continuous murmur was present in the right lower parasternal area. A 12-lead ECG showed right bundle-branch block (Figure 2), and chest radiography (posteroanterior view) revealed mild cardiomegaly. Radiography of the thoracolumbar spine of the patient disclosed a mild degree of scoliosis (inset, Figure 1A). Two-dimensional echocardiography (parasternal long-axis view) showed a large fistula (2 cm in diameter) arising from the right aortic sinus (Figure 1B; online-only Data Supplement Movie I). A tilted apical 4-chamber view showed a turbulent jet (velocity 3.5 m/s) at the free wall of the right ventricle (Figure 1C; online-only Data Supplement Movie II). Three-dimensional echocardiography in a tilted apical 5-chamber view showed a broad tunnel arising from the aorta (Figure 1D; online-only Data Supplement Movie III). Computed tomographic cardiac angiography revealed the presence of a …