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  Citation statistics : Table of Contents
   2014| October-December  | Volume 15 | Issue 4  
    Online since February 9, 2015

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Tight glycemic control and cardiovascular effects in type 2 diabetic patients
Latha Subramanya Moodahadu, Ruchi Dhall, Abdul Hamid Zarġar, Sudhakar Banġera, Lalitha Ramani, Ramesh Katipally
October-December 2014, 15(4):111-120
DOI:10.4103/1995-705X.151084  PMID:25774253
Diabetes Mellitus (DM) with poor glycemic control is one of the leading causes for cardiovascular mortality in diabetic patients. Tight glycemic control with glycosylated haemoglobin of <7 gms% is recommended as a routine and < 6.5 gms% is recommended for young and newly diagnosed diabetics. Treatment goal aims at achieving near normal blood glucose level, and directed at management of other co morbid conditions such as obesity, hypertension and dyslipidemia. Oral hypoglycemic agents are the preferred drugs, alone or in combination. Preference for glitazones is declining due to the increasing evidences of associated adverse events. Gliptins appear as promising agents with lesser tendency to cause hypoglycemia, but their long term safety and efficacy is yet to be established. We emphasize the role of preventive measures in prediabetics and in established DM, treatment should be individualized and customized to minimize hypoglycemic effects and to retain quality of life.
  11 6,076 196
Paradoxical coronary artery embolism - A rare cause of myocardial infarction
Fayaz A Hakim, Evan P Kransdorf, Muaz M Abudiab, John P Sweeney
October-December 2014, 15(4):124-126
DOI:10.4103/1995-705X.151089  PMID:25774255
Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.
  8 2,573 79
The SYNTAX score can predict major adverse cardiac events following percutaneous coronary intervention
Hadi Safarian, Mohammad Alidoosti, Akbar Shafiee, Mojtaba Salarifar, Hamidreza Poorhosseini, Ebrahim Nematipour
October-December 2014, 15(4):99-105
DOI:10.4103/1995-705X.151081  PMID:25774251
Objectives: The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention (PCI). We investigated the association between the incidence of major adverse cardiac events (MACE) following PCI and the SYNTAX score in patients with three-vessel disease. Methods: We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low (≤16), intermediate (16-22) and high (>22). The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction (MI), or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups. Results: The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE (hazard ratio = 2.36; P = 0.02) even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure. Conclusion: The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease.
  8 3,573 283
Night blindness and ancient remedy
H.A. Hajar Al Binali
October-December 2014, 15(4):136-139
DOI:10.4103/1995-705X.151098  PMID:25774260
The aim of this article is to briefly review the history of night blindness and its treatment from ancient times until the present. The old Egyptians, the Babylonians, the Greeks and the Arabs used animal liver for treatment and successfully cured the disease. The author had the opportunity to observe the application of the old remedy to a patient. Now we know what the ancients did not know, that night blindness is caused by Vitamin A deficiency and the animal liver is the store house for Vitamin A.
  4 3,314 104
The Role of ischemia modified albumin in acute pulmonary embolism
Zeynettin Kaya, M Kayrak, EE Gul, G Altunbas, A Toker, A Kiyici, M Gunduz, H Alibaşiç, H Akilli, A Aribas
October-December 2014, 15(4):106-110
DOI:10.4103/1995-705X.151083  PMID:25774252
Background: Acute pulmonary embolism (PE) is a life-threatening and a relatively common cardiovascular pathology. Although the pathogenesis of PE is well defined, there is no ideal diagnostic biochemical marker. Previous studies showed an increased ischemia modified albumin (IMA) levels in acute PE; however, the relationship between IMA and right ventricular (RV) dysfunction has not been examined. The aim of this study was to evaluate the diagnostic value of IMA and the relationship with RV dysfunction in acute PE. Materials and Methods : A total of 145 patients (70 females) with suspected acute PE was enrolled to the study. Eighty-nine patients were diagnosed with acute PE via computed tomographic pulmonary angiography. Sixty-five patients with similar demographic and clinical characteristics were assigned to the control group. All patients were evaluated for RV dysfunction using transthoracic echocardiography. Results: Serum IMA levels were significantly increased in acute PE compared with control group (0.41 ± 0.06 vs. 0.34 ± 0.11, P = 0.001). There was no relationship between serum IMA levels and RV dysfunction. IMA levels were positively correlated with shock index and heart rate. Receiver operating curve analysis demonstrated that serum IMA levels higher than 0.4 put the diagnosis at sensitivity of 53.85% and at specificity of 85.96%. Conclusions: Although IMA levels are increased in patients with acute PE, it failed to predict RV dysfunction.
  3 2,454 147
Abnormal chest x-ray postmyocardial infarction
Ahmed M Abuosa, Ayman H EL-Sheikh, Abdulhalim Jamal Kinsara
October-December 2014, 15(4):121-123
DOI:10.4103/1995-705X.151086  PMID:25774254
Pulmonary hemorrhage is a rare complication of fibrinolytic therapy. Only a few cases are reported in the literature. We present a patient who had myocardial infarction, treated with fibrinolytic therapy and developed pulmonary hemorrhage. We discuss the features that suggest and support the diagnosis.
  1 3,860 94
Acute stent thrombosis
Fahad Al Kindi, Salah El Deen Arafa, Abdul Rahman Arabi
October-December 2014, 15(4):133-134
DOI:10.4103/1995-705X.151094  PMID:25774258
  - 1,863 82
Art, medicine and technology
Rachel Hajar
October-December 2014, 15(4):135-135
DOI:10.4103/1995-705X.151097  PMID:25774259
  - 1,692 66
Displacement of impella post chest compressions
Sourabh Aġġarwal, Susan Bannon
October-December 2014, 15(4):127-128
DOI:10.4103/1995-705X.151090  PMID:25774256
The Impella is a left ventricular assist device which is implanted via the transcutaneous femoral route and is placed across the aortic valve into the left ventricle. We report an interesting case where cardiopulmonary resuscitation was associated with displacement of Impella device. Impella is being increasingly used these days especially in patients with cardiogenic shock. Clinicians should have high index of suspicion for displacement of Impella in appropriate clinical setting.
  - 469 1
Heart failure caused by atrial fibrillation in a patient with isolated adrenocorticotropic hormone deficiency and hashimoto's thyroiditis
Ryo Maemura, Takashi Kajiya, Nobuyuki Koriyama, Souki Lee
October-December 2014, 15(4):129-132
DOI:10.4103/1995-705X.151093  PMID:25774257
We report the case of a 75-year-old female patient with a history of Hashimoto's thyroiditis who presented with congestive heart failure caused by atrial fibrillation associated with isolated adrenocorticotropic hormone (ACTH) deficiency. This is the first case of the combination of these complex conditions. Clinical conditions in a patient with isolated ACTH deficiency and Hashimoto's thyroiditis can be variable. Thus, it is sometimes difficult to establish a diagnosis. The mechanism underlying heart failure may be complex in some cases. Various conditions can affect patients simultaneously. Therefore, making a proper diagnosis is necessary to improve the patient's prognosis.
  - 2,851 58