Search

Multivalvular heart disease (MVD) is an aggregate of regurgitant and/or stenotic lesions of at least two cardiac valves. Ventricular tissue deformation imaging is a powerful predictor of subclinical myocardial dysfunction in patients with MVD.The aim of this study was to examine the left and right ventricular strain patterns in MVD as well as observe any association between right–sided valvular involvement (tricuspid or pulmonary valve lesion) with that of aortic and/or mitral valve lesion. Patients with at least moderate forms of MVD were included in the present study. 72 patients with mean age of 56.69 ± 14.59 years and various presentations of MVD were finally enrolled in this study. The commonest cause for MVD was rheumatic heart disease in these patients. Conventional 2-dimensional parameters as well as tissue deformation imaging parameters were assessed in offline mode for these patients. The Mean ± SD values for various quantitative 2D echocardiographic conventional and tissue deformation imaging were assessed. It was observed that LV strain parameters including the global longitudinal strain (GLS) were preserved whereas the RV strain parameters were mildly reduced (RV GLS total is − 19.49 ± 6.08%). Also, when conventional echocardiographic parameters were assessed to see any association between aortic and/or mitral valve disease with that of right-sided valvular lesions (tricuspid or pulmonary); 2D conventional echocardiographic parameters like left atrial dimension (p = 0.034), TAPSE (tricuspid annular plane systolic excursion) (p

Vitiligo is the most common depigmenting dermatosis causing immense psychosocial concern. When medical therapies fail to cause re-pigmentation, surgical modalities are developed to combat the same in stable vitiligo patients. Here we are comparing two such surgeries: smash skin grafting (SSG) and autologous non-cultured epidermal cell suspension (NCES).The aim of this article is to compare the efficacy of SSG and NCES in re-pigmentation of stable vitiligo and to know the feasibility of both the surgeries.It is an open, randomized, and prospective study conducted in dermatology outpatient department at a tertiary care center. Thirty patients with single stable vitiligo lesion were randomized into two groups: 15 each in Group A (SSG) and Group B (NCES). Following the surgery, excimer lamp phototherapy was initiated twice weekly. Patients were followed up till 16 weeks of surgery. Photo-documentation was done every month. Grading was performed for the response in the form of re-pigmentation as excellent (75%), good (50-75%), fair (25-50%), and poor (25%). The χBoth the surgeries showed initial specks of re-pigmentation at 10-14 days post-surgery. Excellent response (75% re-pigmentation) was observed in 10 (66.67%) patients in Group A and 9 (60%) patients in Group B. Both the surgeries showed equal response and uniform texture of re-pigmentation.SSG is equally effective when compared with NCES, in causing re-pigmentation. Also, SSG is simple, easy to perform, faster learning curve, less time-consuming, and cost-effective when compared with NCES.

Background: Viral infections can be diagnosed and treated accordingly. Atypical presentation or sometimes presenting with other dermatological condition can be difficult for diagnosis. Dermoscopy provide rapid diagnostic aid for diagnosis. Aim: To evaluate dermoscopic patterns in viral infections. Materials and Methods: This study was conducted in dermatology department in tertiary hospital. Ethical clearance and informed consent was obtained. Patients with viral infection were subjected to dermoscopy. DermLite4 with 10x magnification, attached to a smartphone was employed for dermoscopy. Results: 106 patients were enrolled. Dermoscopy of Pityriasis rosea (n=10, 9.43%) showed brown dots and red dots in patients (100%). Light pink back ground in 80% patients. Molluscum (n=9, 8.49%) showed whitish structure in poly lobulated pattern (40%). In chicken pox (n=08. 7.54%), erythematous background (100%) and brown dots (100%). All the warts (n=48, 45.28%) showed red or blackish red dots (100%). Grouped red dots with white halo, finger-like projection with hairpin vessel surrounding white halo, knob like structure with hairpin like vessels were observed in common, filiform, genital warts respectively. Black dots in plantar and periungual warts. In herpes labialis (n=10, 9.43%) 3 zones, centre brown pigmentation, white colour and peripheral erythema. Cloudy white polyglobular structure with central brown dots in Herpes Zoster (n=8, 7.43%). Yellowish/brown pigmentation, brown dots, brown globules and crusting in Hand Foot Mouth Disease (n=5, 4.71%). Bluish globules and whitish area in Orf nodule (n=1, 0.94%). Conclusion: Dermoscopy is gaining importance in the realm of dermatology. In this study, dermoscopic patterns in viral infections were correlated clinically. Keywords: Viral infections dermoscopy diagnosis patterns.

Although studies have proven that liver cirrhosis affects cardiac hemodynamics by means of circulatory overload, they present with definite cardiac functional alteration mostly with end-stage disease. There is limited data on relationship between progression of cirrhosis, cardiac mechanics and sub-clinical dysfunction. This study was done to assess ventricular myocardial mechanics using speckle tracking and deformation imaging among Child-Turcotte-Pugh (CTP) classification A and B cirrhosis.Seventy patients with cirrhosis of Child-Pugh A/B class and sixty-two healthy subjects were prospectively evaluated by standard conventional echocardiography and deformation imaging with rotational echocardiography. Clinical stage of liver cirrhosis was assessed by model for end-stage liver disease (MELD) scores and CTP classification.Mean ages of patients with cirrhosis and controls were 55.64±14 years and 52.24±12 years, respectively. Though left ventricular (LV) dimensions (end diastolic dimension: 47.27±4.6 mm vs. 45.03±3.8 mm, p = 0.003; end systolic dimension: 30.33±4.9 mm vs. 28.40±2.91 mm, p = 0.006) and volumes (end diastolic volume: 82.08±22.53 mL vs. 68.18±15.75 mL, p = 0.001; end systolic volume: 28.60±8.42 mL vs. 22.18±7.48 mL, p = 0.001) were significantly higher in patients with cirrhosis, mean ejection fraction (EF) by Simpsons method was higher among controls (65.83±5.79% vs. 68.35±5.79%, p = 0.009). Left atrial volume was higher in cirrhosis group indicating presence of diastolic dysfunction (41.24±14.10 mL vs. 26.08±6.4 mL, p = 0.001). Global longitudinal strain as assessed by speckle tracking echocardiography did not show statistical significant difference between two groups (-22.35±4.08% vs. -21.80±2.54%, p = 0.348). Median value of torsion parameters in patients with cirrhosis did not differ compared to controls (torsion in degrees: 2.46 vs. 2.79, p = 0.268).Patients with Child-Pugh A and B stages of cirrhosis present with preserved longitudinal strain, normal torsion but with subtle diastolic dysfunction. Higher MELD score may correlate with increased longitudinal strain possibly due to hyperdynamic state.

Background Global left atrial strain (LA) has been used as a novel assessment tool to evaluate left atrial function. However, not much has been investigated to study the effect of percutaneous balloon mitral valvotomy (BMV) in patients with rheumatic severe mitral stenosis on global LA strain. We studied the relationship between global left atrial (LA) strain and severe mitral stenosis and the effect of BMV on LA strain. Results A total of 29 patients satisfying the criteria for severe mitral stenosis underwent balloon mitral valvotomy (67% females; mean age, 39.53 ± 11.78 years). Global left atrial strain was assessed by speckle tracking echocardiography before and after valvuloplasty. Global LA strain was impaired in patients with severe mitral stenosis and improved 24–48 h following BMV (13.4 ± .75% vs 17.37 ± 6.95%, p p p 2 vs 1.94 ± 0.22 cm2, p Conclusion Global LA strain can be taken as an indicator of left atrial function, and its improvement following valvotomy may be taken as a good indicator of successful BMV.

Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial infarction. Serum cortisol is one such laboratory marker. There are only few studies done in the recent past which prove that cortisol is a prognostic marker in STEMI. Methods: We studied a total of 168 patients who presented with STEMI and underwent primary percutaneous intervention (PPCI) within 12 hours of symptom onset between April 2016 and November 2016. Results: The average age of study population was 61 ± 0.12 years. Males were predominant (n = 132, 78.57%). 155 patients survived, whereas 13 patients died in the hospital. Mean syntax score was 16.65 ±5. 33 among patients who died, whereas it was 13.11 ± 5.62 among survivors (P = 0.03). Mean cortisol was significantly higher among the patients who died (46.13 ± 14.61 mcg/dl) than the survivors (31.16 ± 13.16 mcg/dl) (P = 0.003). The ROC AUC for in-hospital mortality was 0.77 (95% confidence interval [CI], 0.645–0.897). An optimal cut-point identified from the ROC curve was a random serum cortisol concentration of 33.66 mcg/dl, with corresponding sensitivity and specificity of 69.2 % and 64 %, respectively. At a cut-point of 29.55 mcg/dl, sensitivity and specificity were 84.6 and 50 %, respectively. Conclusion: This study showed that serum cortisol level is a strong predictor of mortality in patients undergoing PPCI for STEMI. Levels more than 33.66 mcg/dl can predict mortality with a sensitivity of almost 70 percent and specificity of 64 percent.

Binary Comparators that are also called as digital comparators are used for testing a binary word or number that is greater than less than or equal with another binary word or number. Generally, a binary comparator gives three outputs after comparison they are (G>F) G greater than F, (G G) based on single inequality relation (F>G). However, the power, area and delay of the prefix - parallel structure of comparator will be more. Therefore, in this paper an 8-bit parallel - prefix binary comparator using a merging circuit is proposed for the reduction of power, area and delay. The advantage of using merging circuit is that it reduces the power and delay of proposed binary comparator is correlated to other comparators. The proposed comparator is modelled in Verilog HDL with the help of Xilinx to study its performance. It is reported that the 8-bit parallel prefix binary comparator consumes 19.12%, 0.3% and 0.6% less power, area and delay compared to 8-bit comparator respectively.

A dual left anterior descending artery (LAD) system where the short LAD arises from the left main coronary artery (LMCA) directly, while the long LAD arises from the bifurcation of the LMCA, is a rare finding. Our patient, a 45-year-old lady, presented with angina at rest and underwent a coronary angiogram. The angiogram showed a normal right coronary artery (RCA). The LMCA gave rise to the short LAD, which entered the interventricular groove and provided septal branches. The LMCA terminated in a bifurcation, which gave rise to the long LAD (which supplied diagonal branches) and the left circumflex artery (LCX). This configuration has only been reported once in literature and has been dubbed Type VII dual LAD system. In the other six types of dual LAD systems, the short LAD and long LAD, either both arise from a branch of the LMCA (types I-III) or from the LMCA and RCA, respectively (types IV-VI). Through this report, we emphasize the importance of a single and standard nomenclature for dual LAD system.

Takotsubo syndrome (TS) or transient left ventricle apical ballooning syndrome is characterized by apical hypokinesia with increased compensatory contraction of basal segments usually in presence of non-obstructive coronary artery disease. TS has been described after variety of physical and emotional stress, including surgical procedures and rarely after atrio-ventricular block and arrhythmias. Perioperative TS is a well-recognized entity. TS after balloon mitral valvotomy for severe mitral stenosis has been described only once till now. We report only the second only reported case of TS following balloon mitral valvotomy in a 45-year-old female for severe rheumatic mitral stenosis.

Objective Diabetes mellitus (DM) is a risk factor for developing in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). This study aimed to examine the presentation and outcomes of drug-eluting stent (DES) ISR in diabetics. Methods This retrospective study included consecutive patients with clinical DES-ISR, who were hospitalized between January 2013 and December 2017 and who were grouped based on the presence or absence of DM. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI), and repeat-target lesion revascularization] were compared. Results Baseline characteristics of the DM group (n=109) were comparable to the non-DM group (n=82), except for the higher prevalence of hypertension and dyslipidemia in the former (60.6% vs. 46.3%, p=0.050; 74.4% vs. 57.8%, p=0.034, respectively). Clinical presentation was similar in both groups [acute coronary syndrome (ACS): 62.4% vs. 61%, p=0.843; MI: 34.9% vs. 34.1%, p=0.918). Diabetics had a higher prevalence of stent-edge restenosis (20.3% vs. 9.2%, p=0.019). The treatment strategy was similar in both groups with 52.3% in the DM group and 57.3% in the non-DM group undergoing PCI (p=0.513). One-year outcomes of the DM group were not different from those of the non-DM group (14.7% vs. 17.1%, p=0.683). Age [hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.01-1.10; p=0.017], MI presentation (HR, 2.34; 95% CI, 1.14-4.80; p=0.020), and chronic kidney disease (CKD: HR, 2.82; 95% CI, 1.21-6.58; p=0.016) were predictors of poor outcomes. Conclusion Stent-edge restenosis is more common in diabetics. Clinical presentation and 1-year outcomes following DES-ISR are similar in diabetics and non-diabetics. Age, MI presentation, CKD, and not DM were predictors of poor outcomes following DES-ISR.

We report a case of 2 year old female child who was referred to cardiology out-patient department with congenital left upper limb deformity. On examination she had a small forearm with radial deviation of hand and hypoplasia of four fingers. On retrospective evaluation she was found to have repeated respiratory tract infection. Chest roentgenogram revealed cardiomegaly and echocardiogram revealed a 10-11 mm Atrial septal defect (ASD) with left to right shunt. In view of limb deformity, she underwent soft tissue release followed by JESS fixator application and distraction. We emphasise the importance of syndromic diagnosis in all paediatric cases presenting with limb abnormalities. Key words: Holt Oram syndrome, Atrio-digital dysplasia, Heart-hand syndrome, Atrial Septal defect.

Lithium is a commonly used drug in psychiatric practice. It is used in the treatment of depression and bipolar disorder. It has a narrow therapeutic index with documented adverse effects even near therapeutic levels. It has myriad of manifestations at toxic levels. The cardiovascular effects range from relatively benign ST-T wave changes to fatal arrhythmias. We describe a case of lithium toxicity which presented as a junctional rhythm and later showed a variety of manifestations such as complete heart block, atrial fibrillation, sinus bradycardia, and finally reverted to sinus rhythm at par with serum lithium levels.

Pleomorphic adenoma is a benign tumour of salivary glands that has elements of both epithelial and mesenchymal tissues. It commonly arises in parotid or submandibular glands. Infrequently, it may arise from minor salivary glands and present with intraoral mass over the palate or lip. Therefore, we report a unique presentation of pleomorphic adenoma over the palate, resembling deep fungal infection.

Infective endocarditis by Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia is a common association and carries a high mortality. However, rising Minimum Inhibitory Concentrations (MICs) for vancomycin amongst MRSA strains is an emerging threat which carries poor prognosis and higher mortality. Here, we report a case of 41-year-old young non-addict gentleman presenting with fever of 3 days duration following recovery from an acute kidney injury necessitating haemodialysis. Systemic examination revealed signs of mitral regurgitation and left sided cerebellar signs. Laboratory investigations revealed anaemia, MRSA bacteraemia and transthoracic echocardiogram showed a mitral valve vegetation. He was diagnosed with MRSA mitral valve endocarditis with acute left cerebellar infarct. He was initially treated with intravenous vancomycin based on MIC at the dose of one gram every twelfth hourly. As the MRSA strain was shown to demonstrate a vancomycin creep phenomemon along with worsening clinical condition of the patient, treatment was changed to intravenous daptomycin at dose of 9mg/kg as per blood culture and sensitivity pattern which was administered for 6 weeks. Following initiation of daptomycin patient became afebrile and vegetations reduced in size and finally disappeared.

Chronic Mesenteric Ischemia (CMI) presenting as acute abdomen can be treated percutaneously. An endovascular intervention has surpassed surgical revascularization over the past decade due to its lesser perioperative complication rate. Trans-femoral approach of revascularising is limited by its difficulty in coaxial alignment of the guiding catheter and hence, brachial artery and recently the radial approach have been utilized for mesenteric artery revascularisation for over a decade. Here by we report a case of chronic mesenteric ischemia having total occlusion of two and 70% occlusion of one of the three mesenteric vessels. The patient had presented with acute abdomen which in turn was percutaneously revascularised via the left brachial artery for the two major abdominal visceral vessels being superior mesenteric artery and inferior mesenteric artery.

A 60-year-old male patient with type 2 diabetes mellitus (DM)and hypertension presented to cardiology department (January2018) with exertional dyspnea [New York Heart Association(NYHA) class II] since last two months. General examinationrevealed pulsus parvus et tardus along with systolic blood pressure(SBP) of 90 mmHg in right hand supine position. Cardiovascu-lar examination revealed heaving apex, grade IV/VI late peakingsystolic murmur at aortic area with decreased intensity of aor-tic closure sound. Previously, in 2010 also he had presented withNYHA class II dyspnea and exertional giddiness.

Background Atrial fibrillation (AF) is one of the most common arrhythmias accounting for significant mortality and morbidity, especially in elderly. Though oral anticoagulation (OAC) is an effective mode of prevention of stroke in patients of AF, bleeding complication remains a major concern. Because of these issues, a significant proportion of patients either does not receive or receive suboptimal doses of OAC. Methods In such patients, percutaneous left atrial appendage (LAA) closure remains an interesting option. Experience and literature of this procedure from India have been sparse. We report the first single center experience, from India, of percutaneous LAA closure with Amplatzer Cardiac Plug in 10 patients of non-valvular AF. These patients had contraindications for OAC or had high risk of bleeding or labile international normalized ratio (INR) on therapy. Results We successfully deployed the devices in all of the cases with no major complications perioperatively and on short-term follow-up. We also report a comprehensive review on the technique of percutaneous LAA closure using Amplatzer Cardiac Plug, including some novel modification with our experience of doing percutaneous mitral balloon valvuloplasty.

A 53-year-old woman diagnosed with rheumatic mitral stenosis (at the age of 40 years) presented with worsening dyspnoea New York Heart Association class III of 1 month duration. She was on regular treatment with diuretics, β-blockers and warfarin (in view of valvular atrial fibrillation). However, 1 month prior to presentation, she was off all medications except warfarin, which she was compliant on. Blood investigations revealed the presence of subclinical hypothyroidism with an optimal international normalised ratio of 2.64. ECG …

A 55-year-old man presented with a 6-month history of New York Heart Association II exertional dyspnoea. There was no history of diabetes mellitus or hypertension. Being a reformed smoker, he was on treatment for obstructive airway disease. General and cardiovascular examinations were unremarkable. ECG showed loss of R wave progression in precordial leads. Echocardiography was normal. Coronary angiogram revealed selective opacification of two right coronary arteries arising from separate ostia of the same sinus coursing towards …

A 41-year-old man presented with dyspnoea and giddiness on exertion for the last 1 month. A resting ECG during showed trifascicular block with complete right bundle branch block, left anterior fascicular block and a prolonged PR interval of >0.24 s. His echocardiography showed no evidence of wall motion abnormality. He was subjected to a treadmill test for exercise-induced ischaemia, which showed complete atrioventricular (AV) block during first stage of Bruce protocol. His symptoms of dyspnoea and giddiness were also reproduced. The test was terminated and ECG returned to trifascicular block, similar to that at his baseline ECG during recovery. Coronary angiogram (CAG) was performed to rule out any ischaemic cause for this exercise-induced AV block, which was normal. In view of his reproducible symptoms and demonstration of complete AV block on exercise, a dual-chamber pacemaker (DDD) was implanted. His symptoms disappeared and he remained asymptomatic on follow-up.

Functional imaging using radionuclide Tc99m pertechnetate is routinely used in the evaluation of the problems related to the thyroid gland. Scintiscan has been useful in the visualization of thyroid tissue in ectopic sites due to congenital developmental anomalies. Similarly, the scan helps in establishing the diagnosis of autonomously functioning nodule when the nodule being evaluated appears “hot” with suppression of rest of the gland activity. Here, we present a very rare case of autonomously functioning thyroid adenoma in an ectopic focus of accessory thyroid tissue in the mediastinum.