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Manoria P.C.,Manoria Heart Care and Critical Care Hospital | Chopra H.K.,Moolchand Medcity | Parashar S.K.,Metro Heart Institute | Dutta A.L.,Vivekananda Institute of Medical science | And 3 more authors.
Indian Heart Journal | Year: 2013

Diabetes mellitus (DM) is a pandemic disease and an important cardiovascular (CV) risk factor. The atherogenic dyslipidemia in diabetes (ADD) is characterized by high serum triglycerides, high small dense LDL levels, low HDL levels and postprandial lipemia. Insulin resistance is a primary cause for ADD. Though statins are highly effective for CVD prevention in DM but a significant residual CV risk remains even after optimal statin therapy. Fibrates, niacin and omega-3 fatty acids are used in addition to statin for treatment of ADD (specifically hypertriglyceridemia). All these drugs have some limitations and they are far from being ideal companions of statins. Many newer drugs are in pipeline for management of ADD. Dual PPAR α/γ agonists are in most advanced stage of clinical development and they have a rational approach as they control blood glucose levels (by reducing insulin resistance, a primary factor for ADD) in addition to modulating ADD. Availability of dual PPAR α/γ agnosits and other drugs for ADD management may improve CV outcomes and decrease morbidity and mortality in diabetic patients in future. © 2013, Cardiological Society of India. All rights reserved.


Wani A.A.,Safdarjang Hospital and Vardhman Mahavir Medical College | Maqsood S.,St Stephens Hospital | Lala P.,Moolchand Medcity | Wani S.,Government Medical College
Journal of the Pancreas | Year: 2013

Context Annular pancreas is one of the rare congenital anomalies that can manifest itself in adulthood also. No specific guidelines and protocols exist about management of such cases. We hereby discuss our experience with two such cases along with a brief review of literature about the subject. Case reports The first patient was a male aged 27 years and presented with features of duodenal obstruction. He underwent duodenoduodenostomy. The second patient, a male aged 32 years, also presented with features of gastric outlet obstruction. He underwent Billroth type 2 reconstruction. Both patients had an uneventful recovery. Conclusion Annular pancreas in adults is a rare clinical scenario. Advancements in imaging modalities have brought to forefront an even larger number of such cases. In adults it is diagnosed mainly because of the complications that arise thereof. Gastroduodenal tuberculosis can be an important differential diagnosis in endemic areas. Treatment and operative protocols have to be individualized.


Chopra H.K.,Moolchand Medcity | Sambi R.S.,National Heart Institute | Krishna C.K.,Moolchand Medcity | Parashar S.K.,Metro Heart Hospital and Research Institute | Gupta R.,Echo and Color Doppler Center
Indian Heart Journal | Year: 2011

Assessment of myocardial viability in patients with chronic coronary artery disease or acute and sub-acute myocardial infarction is clinically important for distinguishing stunned and hibernating myocardium from irreversibly injured myocardium. Patients may benefit from revascularization when viable tissue is present in the dysfunctional area of the myocardium. Several clinical imaging modalities exist for assessment of viable myocardium which have proven useful for chronic chronic coronary artery disease are available but a reliable technique for the assessment of myocardial viability in the sub-acute situation does not exist.


Vaid K.,University of Delhi | Mehra S.,Moolchand Medcity | Verma M.,Moolchand Medcity | Jain S.,University of Delhi | And 2 more authors.
Journal of Clinical and Diagnostic Research | Year: 2014

Introduction: Tuboperitoneal pathology is responsible for 40-50% cases of infertility. Hysterosalpingography (HSG) & laparoscopy are the two classic methods available for evaluation of tubal pathology and are complementary to each other. Though pelvic sonography and HSG are good enough to exclude gross intrauterine pathology, but subtle changes in the form of small polyps, adhesions and seedling fibroid are better picked up on magnification with hysteroscopy. Combined hysterolaparoscopy may obviate need for HSG, as complete evaluation and treatment is possible in the same sitting. Aim: To assess the utility of Hysterolaparoscopy as one step procedure and compare it with HSG, in the subset of ovulatory infertile women with normal pelvic sonography / seminogram /hormonal assays. Materials and Method: In this analytical prospective study, 193 infertile women aged 19 to 42 years underwent HSG and Hysterolaparoscopy over a period of 6 months. They were confirmed to have ovulatory cycles and normal seminogram. Patient with active genital infection were excluded. Findings were categorized as normal/abnormal and therapeutic intervention done, if required. Statistical evaluation was carried out using Chisquare test. Result: On comparing HSG and Hysteroscopy, uterine findings matched in 66.3% patients.HSG failed to detect uterine pathology in 32.12% patients (62/193) with a sensitivity of 21.3% and specificity of 97.45%. Ninety three percent of intrauterine adhesions/ polyps were missed on HSG. Hysteroscopic intervention was required in 23.83% cases, adhesiolysis being the commonest. On comparing tubal patency on HSG and laparoscopy, the sensitivity of HSG in detecting bilateral tubal block was 80.6% and specificity of 81.5%. With regard to unilateral tubal block, sensitivity was 34.6% and specificity 89.8%. The agreement between the two was 74%. Pathology such as adhesions, fimbrial agglutination and endometriosis were dealt surgically in 65.8% patients. As per HSG, 112/193 women had both tubes patent and 177 revealed normal uterine cavity. When these 112 women (58.03%) with normal HSG report were further subjected to hysterolaparoscopy, only 35/193 (18.13%) of them actually had normal tubes and uterus; rest 77 women (39.89%) were benefited by one step procedure of hysterolaparoscopic evaluation and intervention and further treatment done. Conclusion: Hysterolaparoscopy (Pan Endoscopic) approach is better than HSG and should be encouraged as first and final procedure in selected infertile women.


This case report describes the management of a middle-aged hypertensive male patient who presented with acute inferior ST-segment elevation myocardial infarction accompanied with severe hyperkalemia. His coronary angiography revealed a thread like right coronary artery along its entire course and normal left coronary artery system with patent coronary stents in the left anterior descending and left circumflex arteries. Subsequent to correction of hyperkalemia with intravenous calcium gluconate and regular insulin the patient underwent primary percutaneous coronary intervention (PPCI) of the right coronary artery with the deployment of a sirolimus eluting stent. The patient received overnight an infusion of tirofiban at half the usual dose between the diagnostic coronary angiogram and PPCI.


Chopra H.K.,Moolchand Medcity
Indian heart journal | Year: 2011

AIMS & OBJECTIVE: To evaluate the impact of enhanced external counterpulsation (EECP) on various echo variables by 3D-Echocardiography. 60 adult patients from indoor and outdoor patient department; consisting of 16 patients with heart failure (HF) with left ventricular systolic dysfunction, 20 patients with heart failure with normal ejection fraction (HFNEF), 4 patients with prior percutaneous coronary intervention (PCI), 3 patients with prior coronary artery bypass grafting (CABG) and 17 patients with syndrome X; were subjected to Echocardiographic evaluation. The various echo variables included were left ventricular myocardial performance index (LVMPI), left ventricular mass index (LVMi), left ventricular diastolic dysfunction (LVDD), left ventricular systolic function (LVEF) and left atrial volume index (LAVi). Once randomized, patients underwent 35 hrs EECP treatment sessions, each lasting 1 hour, could be given once or twice per day. There was a significant reduction in the overall prolonged mean LVMPI from baseline (0.54 +/- 0.2) to post ECP treatment (0.43 +/- 0.1) in the total study population (p < 0.001). EECP treatment significantly reduced baseline grade II or grade III diastolic dysfunction and E/E' ratio > 12, but not in patients with baseline E/E' < 12, baseline normal diastolic function or grade I diastolic dysfunction. Similiarly the mean LVEF in the subset of patients with HF treatment was 30.7 +/- 3.1; post ECP the mean LVEF was increased to 36.9 +/- 3.2 which was statistically significant (p < 0.001). In the remaining patients, who had mean LVEF within normal range, there was no significant difference pre and post EECP (p value- NS). Pre EECP the mean LAVi in the total population was increased up to 33.4 +/- 5.6 ml/m2. Post EECP the mean LAVi reduced to 24.8 +/- 4.2 ml/m2, which was also statistically significant (p < 0.001). Regarding mean LVMi as well as in the patterns of LVH, there were no significant changes seen as compared to baseline. Enhanced External counterpulsation is noninvasive, non-surgical method of choice for CVD & heart failure protection. It is very useful in Single vessel or multivessel disease, heart failure, HFNEF, Post PCI or post CABG and syndrome X. It reduces LVMPI and improves global cardiac function, increases LVEF in patients with ejection fraction of less than 50%, reduces grade II or grade III diastolic dysfunction and E/E' ratio more than 12, decreases LAVi by 25.7%; thereby reducing adverse clinical events in CAD and heart failure.

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