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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 8 | Issue 1
Page Nos. 1-30

Online since Tuesday, March 22, 2022

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ORIGINAL ARTICLES  

Evaluation of CHA2DS2-VASc score and R2CHADS2 score in patients with acute pulmonary thromboembolism and right ventricular dysfunction p. 1
Cagri Zorlu, Sefa Erdi Omur, Cemal Koseoglu
DOI:10.4103/ijca.ijca_42_21  
Background and Aim: Acute pulmonary embolism (APE) is one of the fatal emergencies. Imaging methods are not available to all physicians as an emergency and depend on the individual. For this reason, besides imaging methods, more easily applicable and individual-independent parameters are investigated to help the diagnosis. Some scoring systems are also used according to the patient's current disease status. R2CHADS2 score is used more in patients with chronic renal failure (CRF). The aim of the study was to compare CHA2DS2-VASc and R2CHADS2 scores in patients with APE and right ventricular dysfunction (RVD). Methods: The study was conducted retrospectively. The patient group of the study consisted of 392 patients diagnosed with APE. Patients with nonmassive pulmonary embolism and submassive pulmonary embolism (SPE) without RVD were defined as Group 1 (n = 213) and massive pulmonary embolism and SPE with RVD were defined as Group 2 (n = 179). CHA2DS2-VASc and R2CHADS2 scores were compared as a scoring system in patients. Results: CHA2DS2-VASc scores and R2CHADS2 scores were evaluated in the two groups. The R2CHADS2 score was statistically significant in Group 2 (P < 0.001). There was a statistically significant difference between the groups in terms of CRF and estimated glomerular filtration rate (15 [7.2%] vs. 29 [16.4%], P < 0.001, and 57.6 vs. 46.4 mL/min/1.73 m2, P < 0.001). Conclusions: Our findings show that the CHA2DS2-VASc score and R2CHADS2 are independent predictors of RVD in patients with APE. However, the R2CHADS2 scoring system is observed better than the CHA2DS2-VASc scoring system in patients with APE and RVD.
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Role of serum adiponectin levels and IL-10 as a marker for angiographic stenosis in coronary artery disease p. 8
Nitin Tyagi, Charanjeet Kaur
DOI:10.4103/ijca.ijca_47_21  
Objectives: This study aimed to determine the association of interleukin (IL)-10 and adiponectin (Ad) levels with the angiographic severity of coronary artery disease (CAD). Methods: In this case–control study, the study population included 50 patients with angiographically proven CAD as the case group and 50 apparently healthy age and sex-matched adults as a control group. The severity of CAD was assessed by SYNTAX scores. Serum Ad levels and IL-10 were measured using ELISA-based kits. The levels of Ad and IL-10 were associated with angiographic severity of CAD. P < 0.05 was considered statistically significant. Results: Cases had significantly lower Ad level (1.89 ± 1.18 vs. 2.59 ± 1.48, P = 0.0003) and significantly higher IL-10 level (8.96 ± 6.84 vs. 3.5 ± 3.57, P < 0.0001) as compared to controls. There was a significant correlation between the levels of Ad and IL-10 (r = 0.315, P = 0.026). There was a significant negative correlation between the Ad and angiographic stenosis of CAD (r = ‒0.939, P < 0.001). Both Ad and IL-10 showed a significant association with the severity of CAD in terms of SYNTAX score. Conclusion: Patients with CAD had lower Ad levels and higher IL-10 levels. Ad levels showed a significant decrease with increasing coronary artery stenosis. Both the markers (Ad and IL-10) showed significant association with the severity of CAD, thereby signifying their role as a marker for CAD.
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Bolus versus continuous infusion of nitroglycerin for the treatment of acute hypertensive heart failure p. 14
Mahmoud Shawky Abdelmoneum, Mohammed I Eitta, Khaled A Elrabat, Ahmed Mahmoud Bendary
DOI:10.4103/ijca.ijca_48_21  
Background: The use of intravenous nitroglycerin by intermittent bolus doses in hypertensive acute heart failure patients (AHF) is still unclear. Aim and Objectives: This study aimed to determine intermittent bolus nitroglycerin's effect on the use of resources, admissions to intensive care unit (ICU), hospital length of stay (LOS), and safety. Patients and Methods: This prospective, randomized, parallel, single-blind clinical study, which included patients diagnosed with hypertensive AHF, was conducted from May 2019 to October 2020 at Benha University Hospital. Two hundred patients were recruited and randomly allocated into two groups, each composed of 100 patients. Results: The prevalence of hypertension and chronic obstructive pulmonary disease patients was significantly higher in patients given intermittent boluses of nitroglycerin than in standard therapy (88.0 vs. 77.0%, P = 0.041) and (27.0 vs. 15.0%, P = 0.037), respectively. Dyslipidemia was significantly lower in patients on intermittent doses of nitroglycerin than those on standard infusion therapy (30 vs. 66%, P < 0.001). The median initial troponin was significantly higher in group I compared to group II (0.145 vs. 0.065 ng/ml, P < 0.001). Conclusion: Nitroglycerin intravenous boluses were associated with fewer ICU admissions and a shorter LOS in the hospital as opposed to ordinarily infusion therapy. In addition, the mean mechanical ventilation duration was slightly shorter. Finally, continuous nitroglycerin infusion use in AHF management is being questioned.
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The effect of COVID-19 pandemic on time in therapeutic range in patients using warfarin p. 20
Adem Aktan, Tuncay Guzel, Bayram Arslan, Mehmet Ozbek, Muhammed Demir, Burhan Aslan
DOI:10.4103/ijca.ijca_54_21  
Introduction: Patients receiving anticoagulant therapy experience a serious problem at a time when the rates of outpatient visits for the international normalized ratio (INR) monitoring are gradually decreasing owing to the risk of virus transmission during the pandemic. The aim of this multicenter study was to investigate how the coronavirus disease 2019 pandemic affected the time in therapeutic range (TTR) value, which shows the use of effective doses of warfarin, and its monitoring in patients using warfarin. Materials and Methods: A total of 158 patients with 3 consecutive prepandemic INR levels and at least 3 postpandemic INR levels without time limitation were retrospectively evaluated. TTR values were calculated and the preepidemic and postepidemic values were compared. TTR was obtained using the conventional method. Results: The mean preepidemic and postepidemic TTR values were found to be 64.4 (61.8%–67.0%) and 34.9 (30.8%–39.0%), respectively. TTR rate was statistically significantly lower in the postpandemic period than in the prepandemic period (P < 0.001). While the prepandemic TTR of 68 (43%) patients was <60, the postpandemic TTR of 125 (79%) patients was <60. Discussion and Conclusion: Patients using warfarin were found to have lower TTR values during the pandemic. One of the most important reasons for this result is patients' delayed admission to the hospital due to fear of infection. The importance of regular follow-ups and alternative solutions should be emphasized for the effective treatment of these patients.
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CASE REPORTS Top

An unusual co-occurrence of lown-ganong-levine syndrome with neonatal focal lipomatous hypertrophy of interatrial septum with patent foramen ovale p. 24
Debasish Das, Satya Mishra, Tutan Das, Subhas Pramanik
DOI:10.4103/ijca.ijca_40_21  
We report an extremely rare co-occurrence of focal lipomatous hypertrophy of the interatrial septum (LHIS) with patent foramen ovale (PFO) in a neonate and electrocardiogram evidence of Lown-Ganong-Levine syndrome (LGL). Although atrial arrythmias in the form of supraventricular tachycardia like atrial premature contractions, atrial fibrillation, and atrioventricular block have been described in lipomatous hypertrophy interatrial septum, co-occurrence of LGL syndrome with LHIS has not been described in literature so far. Baby presented in the cardiology outpatient department for presurgical cardiological evaluation of congenital hydrocephalus. Typically, LHIS spares fossa ovalis and affects both side of the interatrial septum making interatrial septum dumbbell shaped. There is even no literature description of focal hypertrophy of interatrial septum in early infancy and child hood including neonatal period. Our case is a unique illustration of a rare co-occurrence of LGL syndrome in focal lipomatous hypertrophy of interatrial septum in a neonate with PFO.
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Radial loop: Can straightening of the loop push the guiding catheter? Do we need to be more watchful? A case report and literature review p. 28
Bhupesh Shah, Harshal Shah, Darshil Shah
DOI:10.4103/ijca.ijca_53_21  
Radial loops are the most common radial anatomical entity for deferring or failure of transradial approach. Complex loops may not straighten immediately after traversing the loop and may take a few minutes to straighten out. Here, we describe a case of a complex radial artery loop encountered during transradial percutaneous coronary intervention. We furthermore present a literature review and outline tips and techniques to successfully traverse the radial loop.
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