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«ABSTRACT BACKGROUND: The role of cardiac hormone like N-terminal pro-B-type natriuretic peptide (NTpro BNP) has been well established in diagnosis ...»

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The Effect of Percutaneous Coronary Revascularisation on Plasma Nterminal Pro-B-type Natriuretic Peptide Levels in Stable Coronary

Artery Disease

Amit Gupta, Nisar A. Tramboo

Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: The role of cardiac hormone like N-terminal pro-B-type natriuretic peptide (NTpro BNP) has been well established in diagnosis and prognosis of heart failure and prognosis in acute coronary syndrome. However, the effect of ischemia resolution on plasma NT- pro BNP is not well established.

OBJECTIVES: The effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA) was evaluated.

STUDY DESIGN: Non-Randomised experimental design (Comparison between before and after intervention).

METHODS: 22 patients with symptoms of CSA on optimal medical treatment, normal left ventricular (LV) systolic functions, and single vessel disease who were to undergo PCR were enrolled over a period from Jan 2011 to Oct 2012. Plasma NT-proBNP concentrations were measured before and 2 months after PCR.

RESULTS: After revacularisation, we documented a statistically significant decrease in plasma NTproBNP levels (from 244.36±218.99 pg/ml to 168.68±161.61 pg/ml, p =0.016). The mean decrease in log NT-proBNP after PCR was 0.496±0.69 (p=0.003) corresponding to a geometric mean decrease of NT-proBNP by a factor of 39.0%. The reduction in NT-proBNP was independent of change in LV systolic function. In patients with PCR done to left anterior descending artery (LAD) (n=12), there was again a significant decrease in NT-proBNP levels (median 136.90 pg/ml vs 77.22 pg/ml, p=0.009). For patients with PCR to non-LAD vessel, NT-proBNP levels also decreased, however this decrease was not statistically significant (median 231.05 pg/ml vs 192.40 pg/ml, p=0.432).

CONCLUSIONS: Our study showed that removal of fixed coronary stenosis and thereby ischemia resolution in CSA decreases plasma NT-proBNP levels and this decrease was more in patients with LAD involvement reflecting its major contribution to LV blood supply.

Key words: NT-proBNP chronic stable angina, percutaneous coronary revascularization.

, Journal of Medical Sciences 2013;16(Suppl 1): 1 Comparison of Gadolinium Enhanced Coronary CT Angiography with Conventional Invasive Coronary Angiography in Assessment of Coronary Artery Disease Wasim Ahmed, Khurshid Iqbal Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: Invasive Coronary Angiography (ICA), though Gold Standard, for assessment of CAD, has inherent risks of an invasive procedure including that of death. Additionally use of Iodinated contrasts in ICA and Coronary CT Angiography is frequently contraindicated due to renal toxicity and hypersensitivity reactions. Hence there is a need to study safer contrast agents in Non-invasive modalities of assessment of CAD.

OBJECTIVES: To assess the feasibility of Gd-enhanced 64-slice cardiac CT (CCT) for the diagnosis of obstructive coronary artery disease in comparison to ICA STUDY DESIGN : Hospital Based Prospective Comparative Study METHODS: 25 patients of CAD were selected, who after informed consent, agreed to undergo Gadolinium Enhanced Coronary CT Angiography and Invasive Coronary Angiography. Patients who had previously undergone Revascularisation or those who had Creatinine Clearance less than 30 ml/min were excluded. Creatinine Clearance was measured before and 48 hours after Gd-Enhanced CTA. Analyses was done by comparing coronary segments with ≥ 50% stenoses detected by ICA versus detection of the same by Gd-Enhanced CTA.

RESULTS : Mean age of patients was 53.52 years (range 41- 70 years). Total number of coronary segments evaluated by ICA was 379 of which 57 showed ≥ 50% stenoses. Gd-Enhanced CTA detected 47 of these lesions. In comparison to ICA, on Per-segment basis, Gd- Enhanced CTA showed Sensitivity of 82.46%, Specificity of 97.50%, PPV of 85.45% and NPV of 96.95%.Weighted Kappa value was 1, suggestive of strong agreement between the two modalities, excluding agreement by chance. No adverse effects occurred after Gadolinium.

CONCLUSIONS : Gadolinium Enhanced Coronary CT angiography is safer alternative for assessment of CAD in patients who have a contraindication for ICA or Iodinated Contrasts.

Key words: CAD, angiography, coronary CT angiography, Gadolinium

Journal of Medical Sciences 2013;16(Suppl 1):

Association of Vitamin D Status with Metabolic Abnormalities in PCOS and Effect of Vitamin D Supplementation on Metabolic Abnormalities in PCOS Khalid J. Farooqui, Shariq Rashid Masoodi, Mushtaq A. Siddiqi, Syed Mudassar Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: A positive correlation between vitamin D deficiency, glucose intolerance and impaired insulin secretion has been demonstrated in subjects with PCOS. Serum levels of 25hydroxyvitamin D [25(OH) D] are inversely correlated with insulin resistance (IR) in subjects with PCOS.

OBJECTIVE:To determine the association between vitamin D status and components of Metabolic Syndrome(MetS) in women with PCOS and the effects of vitamin D supplementation on IR parameters.





STUDY DESIGN: Randomized double-blind, placebo-controlled trial involving 123 subjects with PCOS comparing the effects of Vitamin D supplementation(2000IU/day or 60000IU/month) for 3 months on measures of IR.

METHODS: The fasting blood glucose, insulin, 25(OH) D, HOMA-IR and QUICKIE were measured at baseline and after treatment.

RESULTS: Hypovitaminosis D was present in 115 out of 123 PCOS women (93.4%). Using the IDF criteria Mets was identified in 30 subjects (24.4%).Baseline 25(OH) D did not show any correlation with components of Mets. The mean 25(OH) D levels increased from 13.76±10.60ng/dl to 25.71±15.04ng/dl after intervention (86.84% change).Post Vitamin D supplementation, 48(39%) subjects achieved vitamin D sufficiency as compared to 8(6.5%) at baseline. Similarly the number of subjects with severe, moderate and mild vitamin deficiency before intervention i.e. 55(44.7%), 43(35%) and 17(13.8%) respectively improved to 25(20.3%), 19(15.4%) and 31(25.2%) after intervention. However, the mean HOMAIR did not show any significant change (2.30±4.13 median 1.65 vs. 3.96±6.82 median 1.66).

CONCLUSIONS: Vitamin D3 supplementation caused a significant improvement in the vitamin D status of a predominantly Vitamin D deficient PCOS subjects. However no beneficial effects on parameters of IR could be demonstrated.

Journal of Medical Sciences 2013;16(Suppl 1): 3 Pattern of 25 Hydroxy Vitamin D Status in North Indian People with Newly Detected Type 2 Diabetes- A Prospective Case Control Study Suman Kumar Kotwal, Bashir Ahmad Laway, Zaffer Amin Shah Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: The most prevalent form of diabetes is type 2 diabetes, currently affects more than 300 million people worldwide. Vitamin D deficiency is common at all ages. Vitamin D deficiency has been linked to impaired glucose tolerance and type 2 diabetes in humans.

OBJECTIVE: In view of scarce data on vitamin D status in type 2 diabetes from India, the present study was undertaken to assess the vitamin D status in newly detected T2DM patients.

RESEARCH DESIGN: Prospective case control study.

METHODS: One hundred and two, newly detected type 2 diabetes patients and similar number of age, gender and body mass index matched healthy controls without diabetes mellitus were studied. In addition to basic information, metabolic parameters and serum 25 hydroxy vitamin D levels were measured in both the groups.

RESULTS: Overall serum 25 hydroxy vitamin D mean ± SD, was lower(18.81±15.18 20 ng/mL) in patients with type 2 diabetes as compared to healthy controls (28.46±18.89 20 ng/mL) (p= 0.00). Taking a cut of of 30ng/ml, 81 % of type 2 diabetes patients had either vitamin D deficiency or insufficiency compared with 67% of healthy control subject. Severe vitamin D deficiency (i.e. 25 hydroxy vitamin D of 5ng/ml) was seen in 16.2% of patients with diabetes and 2.5 % of control subjects. Levels of 25 hydroxy vitamin D had a negative correlation with HBA1C, fasting plasma glucose and calcium intake but did not correlate with age, sex, and body mass index.

CONCLUSIONS: Vitamin D deficiency is common in people with new onset T2DM than healthy subjects.

Key words: T2DM, 25 hydroxy vitamin D, vitamin D deficiency.

–  –  –

ABSTRACT

BACKGROUND: Upper gastrointestinal bleed (UGIB) represents a substantial clinical and economic burden. As rebleeding is one of the most important predictor of morbidity and mortality of UGIB;

identifying patients who are likely to rebleed is a critical component of effectively managing patients with bleeding peptic ulcer.

AIMS AND OBJECTIVES:To look for predictors of rebleeding in patients with bleeding peptic ulcer and try to find a new scoring system for Asian patients.

MATERIAL AND METHODS: This was a prospective hospital based study. All patients admitted in our hospital as non variceal UGIB were enrolled and 480 consecutive patients of endoscopically proven peptic ulcer bleed were taken for study between November 2010 to November 2012.

RESULTS: Men predominated the studied population [406/480 (85%)] with mean age of 40.9 ± 15.9 years. Majority (71%) presented with malena. Major co-morbidities were hypertension, Diabetes mellitus (DM), coronary artery disease and chronic kidney disease (CKD) with mean No. of 1.7± 0.8 comorbidities. DM and CKD were significantly associated with risk of rebleeding. Among 480 patients 267 required endotherapy (55.6%); 14 out of 480 patients rebled (2.9%); 13 in the endotherapy group. Six patients needed emergency surgery. Overall 2 patients (0.41%) died. Important parameters in univariate analysis associated with rebleeding were degree of smoking, presence of comorbid illnesses (DM,CKD), presence of shock at presentation, number of blood transfusions, mean ulcer size and Forest class CONCLUSION: Rebleeding rate and mortality in UGIB of peptic ulcer etiology is low in our population. The major predictors of rebleeding in our study were: degree of smoking, co-morbid illnesses, shock at presentation, ulcer size, Forest class, and number of blood transfusions.

Key words: Upper gastrointestinal bleeding, rebleed, peptic ulcer, predictors, morbidity and mortality.

Journal of Medical Sciences 2013;16(Suppl 1): 5 Pancreatic Duct Stents versus Rectal Diclofenac Sodium for Prevention of Post-ERCP Pancreatitis in High Risk Patients Mohd. Yasin Mujoo, G. N. Yattoo, Altaf H. Shah Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangio-pancreatography (ERCP). Post-ERCP pancreatitis (PEP) is associated with substantial morbidity and occasional mortality. The incidence of PEP in high risk patients is as high as 25%.

The risk of PEP is a strong reminder to remain diligent about establishing a clear indication for performing ERCP.

OBJECTIVE: To compare the efficacy (incidence and severity of post-ERCP pancreatitis), safety and cost-effectiveness of pancreatic duct stents versus rectal diclofenac sodium suppository in prevention of post-ERCP pancreatitis in high risk patients.

STUDY DESIGN: Prospective Randomized Interventional Comparative Study.

METHODS: All consecutive 100 high risk patients above 18 years of age admitted for ERCP were randomized to receive either PD stent or rectal diclofenac sodium suppository at the time of ERCP.

Patients were classified as high risk if they had more than three risk factors.

RESULTS: The incidence of PEP in the diclofenac group was 16% (p=0.003, OR 8.6035 CI 2.0431 to 36.229) and 0% in the PD stent group (p=0.003).No mortality was seen in two groups. In terms of severity, the RR of developing mild PEP was 17.83 (OR 17.83 CI 0.9889-321.2464) and severe PEP was 3.123 (OR 3.1237 CI 0.1242-78.55591) in the diclofenac group. The duration of hospital stay due to PEP was more in the diclofenac group (p=0.004) than in the PD stent group. No interventional related complications were seen in either group. However, diclofenac being cheap, cost analysis favors use of diclofenac sodium for prophylaxis of PEP.

CONCLUSIONS: PD stents are more effective in preventing the dreadful complication of post-ERCP pancreatitis than diclofenac suppositories (p=0.003). PD stents must be used in all high risk patients.

Key Words: ERCP Post ERCP pancreatitis, PD Stents, Diclofenac Suppository.

,

–  –  –

Mohd. Lateef Wani, A. G. Ahangar, Shyam Singh Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India

ABSTRACT

BACKGROUND: There is growing interest in beating heart cardiac surgery without aortic crossclamping and, if possible, without the use of a cardiopulmonary bypass (CPB) pump, since better results can be obtained with this procedure than with conventional myocardial protection techniques using cardioplegic solutions. This led us to considerer mitral valve replacement (MVR) with beating Heart.

OBJECTIVES: To see the Safety and efficacy of beating heart mitral valve replacement without cross clamp.

STUDY DESIGN: Prospective randomized study comparing beating heart mitral valve replacement with conventional arrested heart mitral valve replacement.

MATERIAL AND METHODS: Prospective study of patients with isolated mitral valve disease requiring Mitral Valve Replacement (MVR) as per the ACC/AHA guidelines. Fifteen patients underwent Mitral valve replacement using beating heart technique (Group A) and 15 patients underwent mitral valve replacement using arrested heart technique(Group B). Patients were randomized to either group by Computer Generated Numbers.



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