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Lucknow, India

Syal S.K.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Kapoor A.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Bhatia E.,Sanjay Gandhi PGIMS | Sinha A.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | And 4 more authors.
Journal of Invasive Cardiology

Background and Methods: Vitamin D deficiency has been linked to an increased risk of coronary artery disease (CAD) and cardiovascular (CV) death. Endothelial dysfunction plays an important role in pathogenesis of CAD and vitamin D deficiency is postulated to promote endothelial dysfunction. Despite rising trends of CAD in Asians, only limited data are available on the relationship between vitamin D, CAD, and endothelial dysfunction. Results: In a study of 100 patients undergoing coronary angiography, mean 25(OH)D level was 14.8 ± 9.1 ng/mL; vitamin D deficiency was present in 80% and only 7% had optimal 25(OH)D levels. Nearly one-third (36%) were severely deficient, with 25(OH)D levels <10 ng/mL. Those with vitamin D deficiency had significantly higher prevalence of double-or triple-vessel CAD (53% vs 38%), diffuse CAD (56% vs 34%), and higher number of coronary vessels involved as compared to those with higher 25(OH)D levels. Those with lower 25(OH)D levels had significantly lower brachial artery flow-mediated dilation (FMD; 4.57% vs 10.68%: P<.001) and significantly higher prevalence of impaired FMD (values <4.5%; 50.6% vs 7%; P<.002). A graded relationship between 25(OH)D levels and FMD was observed; impaired FMD was noted in 62.2%, 38.6%, and 13.3% in those with 25(OH)D levels <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively. Conclusion: Indian patients with angiographically documented CAD frequently have vitamin D deficiency. Patients with lower 25(OH)D levels had higher prevalence of double-or triple-vessel CAD and diffuse CAD. Endothelial dysfunction as assessed by brachial artery FMD was also more frequently observed in those with low 25(OH)D levels. Source

Misra U.,Sanjay Gandhi PGIMS | Kalita J.,Sanjay Gandhi PGIMS
Annals of Indian Academy of Neurology

A provoked seizure may be due to structural damage (resulting from traumatic brain injury, brain tumor, stroke, tuberculosis, or neurocysticercosis) or due to metabolic abnormalities (such as alcohol withdrawal and renal or hepatic failure). This article is a part of the Guidelines for Epilepsy in India. This article reviews the problem of provoked seizure and its management and also provides recommendations based on currently available information. Seizure provoked by metabolic disturbances requires correction of the triggering factors. Benzodiazepines are recommended for treatment of seizure due to alcohol withdrawal; gabapentin for seizure seen in porphyria; and antiepileptic drugs (AED), that are not inducer of hepatic enzymes, in the seizures seen in hepatic dysfunction. In severe traumatic brain injury, with or without seizure, phenytoin (PHT) may be given for 7 days. In ischemic or hemorrhagic stroke one may individualize the AED therapy. In cerebral venous sinus thrombosis (CVST), AED may be prescribed if there is seizure or computed tomographic (CT) abnormalities or focal weakness; the treatment, in these cases, has to be continued for 1 year. Prophylactic AED is not recommended in cases of brain tumor and neurosurgical procedures and if patient is on an AED it can be stopped after 1 week. Source

Kalita J.,Sanjay Gandhi PGIMS | Kumar B.,Sanjay Gandhi PGIMS | Misra U.K.,Sanjay Gandhi PGIMS | Pradhan P.K.,Nuclear Medicine
Pain Medicine

Objective. The objective of this study was to report clinical spectrum of central post stroke pain (CPSP) and correlate these with magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) findings. Design. The study was designed as a prospective study. Setting. The study was set in a tertiary care teaching hospital. Subject and Method. Twenty-three consecutive CPSP patients were included and their severity of pain, sensory threshold, allodynia, hyperalgesia, and temporal summation were assessed by quantitative sensory testing (QST). Cranial MRI and 99Tc ethylene cystine dimmer SPECT findings correlated with QST. Results. The duration of CPSP was 5 months (0.25-108). Allodynia was present in 12 patients, punctuate hyperalgesia in 11, and temporal summation in 12. SPECT was abnormal on visual analysis in 17 patients; hypoperfusion in corresponding thalamus in nine, and parietal cortex in 11 patients. Semiquantative analysis revealed hyperperfusion of thalamus in four and parietal cortex in five patients. MRI revealed infarction in 14 and hematoma in nine patients. The QST findings were similar in thalamic and extrathalamic CPSP. The MRI and SPECT findings were also not different in CPSP patients with and without allodynia. Conclusion. The QST findings in patients with CPSP were similar in patients with thalami and extrathalamic lesions. SPECT and MRI findings were also not different in CPSP patients with and without allodynia. Wiley Periodicals, Inc. Source

Sahoo D.,Sanjay Gandhi PGIMS | Kumar S.,Sanjay Gandhi PGIMS | Kapoor A.,Sanjay Gandhi PGIMS
Journal of Cardiology Cases

Rheumatic heart disease (RHD) and congenital heart disease (CHD) rarely co-exist in the same patient. However, such associations are not unknown in areas where RHD is endemic. We report a rare combination of severe rheumatic mitral stenosis, severe pulmonary artery hypertension (PAH), and an incidental clinically silent patent ductus arteriosus (PDA). The patient was initially subjected to a balloon mitral valvotomy to assess if the resultant fall in PA pressure would alter the flow dynamics of the PDA. Since the ductal flow remained small and clinically inaudible, no further intervention was advised. The case highlights the importance of detailed echocardiographic examination in patients with RHD to detect co-existent CHD and logical decision making in their management.<. Learning objective: A detailed echocardiographic examination is needed in all cases even when a diagnosis is apparent. Despite obvious rheumatic mitral stenosis, meticulous echocardiography revealed a small PDA, which was clinically silent. Since severe PAH can alter findings of PDA, we first performed balloon mitral valvotomy to see if resultant fall in PA pressure would alter the flow dynamics of PDA. Despite fall in PA pressures, the PDA flow remained trivial and it was clinically inaudible. Hence, no further intervention was advised.>. © 2016 Japanese College of Cardiology. Source

Yadav R.K.,Sanjay Gandhi PGIMS | Kalita J.,Sanjay Gandhi PGIMS | Misra U.K.,Sanjay Gandhi PGIMS
Pain Medicine

Objective: To evaluate the migraine triggers in consecutive patients and correlate these with demographic and clinical variables. Design: A prospective study. Setting: Tertiary care teaching hospital. Subject and Methods: A total of 182 patients with migraine were included whose age ranged between 14 to 58 years and 131 were females. Duration of migraine ranged between 6 and 260 months. Endogenous and exogenous migraine triggers were inquired using a questionnaire. Severity of migraine, associated symptoms, and functional disability were recorded. Presence of trigger was correlated with various demographic and clinical variables. Results: Migraine triggers were present in 160 (87.9%) patients and included emotional stress in 70%, fasting in 46.3%, physical exhaustion or traveling in 52.5%, sleep deprivation in 44.4%, menstruation in 12.8%, and weather changes in 10.1% patients. Multiple triggers (>2) were present in 34.4% patients. Conclusion: The triggers in the Indian migraine patients are similar to other populations but for dietary factors. © American Academy of Pain Medicine. Source

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