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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 10 | Issue 3
Page Nos. 79-119

Online since Thursday, September 23, 2021

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EDITORíS PAGE  

Editor's Page July 2021 p. 79
Ravi R Kasliwal
DOI:10.4103/2250-3528.326477  
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ORIGINAL ARTICLES Top

Clopidogrel resistance in cardiovascular disease patients and its association with gene polymorphisms: A pilot study p. 80
S Parameshwara, B Manjula, Geetha Bhaktha, Gurupadappa Kallaganad, GK Ranjith Kumar
DOI:10.4103/jcpc.jcpc_71_20  
Aims: To determine the genotypic and allelic frequencies of multidrug resistance protein 1 (MDR1), CYP2C19, and P2Y12 gene and their polymorphisms in the Shimoga population who admitted for treatment in McGann teaching district hospital-Shimoga Institute of Medical Sciences (SIMS), Shimoga. Materials and Methods: It is a cross-sectional study that was conducted in McGann teaching district hospital, SIMS, Shimoga. Patients who were admitted to the Intensive coronary care unit due to cardiovascular disease (CVD) were recruited for the study. Sociodemographic data with venous blood samples (5 ml) were collected along with informed consent. Genotyping of the MDR1, CYP2C19, and P2Y12 polymorphisms were done using the polymerase chain reaction (PCR) restriction fragment length polymorphism method. Descriptive and inferential statistics were done using the Statistical Package for the Social Sciences software. The genotypic and allelic frequency was calculated using the Hardy-Weinberg equilibrium. Results: Out of 40 CVD cases, 60% were male and 40% were female and the mean age was found to be 57.13 ± 11.57 years. The percentage of the obese group was more compared to other groups of body mass index. Risk factors such as diabetes, hypertension, food custom, smoking, and tobacco consumption were not significant while alcohol consumption was seen to be significant among the study population at a 5% level of significance. The genotypic frequencies for a heterozygous and mutant type of MDR1 (C3435T) and CYP2C19*2 (G681A) were found to be 35%, 2.5%, 57.5%, and 5%, respectively. Whereas the gene polymorphism of CYP2C19*3 and P2Y12 was not observed in the present study population. Conclusions: This is the first gene polymorphism study with respect to clopidogrel resistance in the Shimoga population. We have demonstrated the presence of polymorphism in the MDR1 and CYP2C19 genes in this study population. A further elaborate study should be conducted for a better understanding of genetic with nongenetic factors involved in poor response toward clopidogrel drug using a large population.
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The prevalence, causes, and management strategies for stress among health-care professionals of Delhi-National Capital Region p. 85
Rahul Mehrotra, Mayank Gupta, Mohit Bhagwati, Dinesh Jain
DOI:10.4103/jcpc.jcpc_4_21  
Background: Stress at workplace has an adverse impact not only on the employees in terms of health, well being, and job dissatisfaction, but also affects the organization in terms of quality of output, absenteeism, and attrition which ultimately has detrimental financial implications. Health care professionals comprise of an important group that are majorly affected by workplace stress because of the nature of their work environment. Methods: The current study was undertaken to ascertain the presence of self perceived stress among healthcare workers in multispecialty hospitals of the National Capital Region of Delhi and to find the expected remedial measures that could be implemented to mitigate stress. In a questionnaire based study, a self administered questionnaire was used to assess stress and related factors using convenience-sampling technique. The response data were extracted and analyzed using Microsoft Excel, which was used for data analysis, tabulation, and graphical presentation. Results: Total 110 responses were received. Three quarter of the respondents identified significant stress in their life, with the highest stress reported by nursing staff at 98%, doctors at 67%, and administrative staff at 56%. The study shows a significant association of self reported stress with age of the respondents (P < 0.001). Respondents among age group of 15–25 years reported the highest prevalence of stress (P < 0.001). Women reported a higher level of stress than men, (P < 0.001), and nurses reported the highest level of stress followed by doctors and then administrative staff. Different methods to relieve stress were also discussed and it was found that two thirds (67%) of our study respondents would like to meditate at work. Conclusion: Stress is common among all categories of healthcare workers.Meditation can be a safe, effective, and feasible modality which can be offered at the workplace to safeguard the mental health of the health care workers and reduce their levels of stress.
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Coronary collateral circulation in acute, subacute, and chronic total occlusions p. 95
Ashida Thulaseedharan Sarojadevi, Vinayagamoorthy Venugopal
DOI:10.4103/jcpc.jcpc_5_21  
Context: A study on the pattern of coronary collateral circulation is relevant in coronary artery disease (CAD) where despite advances in revascularization, the prevalence of heart failure is increasing. Aims: The aim was to study the pattern of coronary collateral circulation in acute, subacute, and chronic coronary total occlusions and to find out the association between collateral grade with the severity of CAD. Settings and Design: This was a hospital-based retrospective cross-sectional study of 141 patients with acute, subacute, or chronic total occlusion of coronaries detected by coronary angiography. Subjects and Methods: Data of 141 patients with total occlusion of coronaries detected by coronary angiography were analyzed. Collateral grading was done according to the Rentrop classification and Werner classification. The severity of CAD was assessed using Gensini score and Syntax score. Pattern of collateral circulation in different types of coronary occlusions and the association between collateral grade and severity of CAD were assessed. Statistical Analysis Used: The association of categorical clinical and angiographic features with type of occlusion was tested using Chi-square test and that of continuous variable with student t-test. All tests were two tailed and P < 0.05 was considered statistically significant. Results: Young patients presented predominantly with acute coronary occlusions (82.6%). About 73% of the patients with left ventricle (LV) dysfunction had acute coronary occlusions. Nearly 68.8% of patients with poor Rentrop collateral grades had LV dysfunction. Patients with acute occlusion had low atherosclerotic burden as evidenced by lower Gensini and Syntax scores and had poor coronary collaterals. No significant correlation was seen between Gensini and Syntax scores and collateral grade. Patients who presented with ST-elevation myocardial infarction (STEMI) had poor Rentrop collaterals and higher prevalence of single-vessel disease and double-vessel diseases when compared to those with non-ST-segment elevation acute coronary syndrome and chronic stable angina. Conclusions: Young male patients with low atherosclerotic burden tend to present with acute coronary occlusions. This subgroup has poor collateral circulation and LV dysfunction. No statistically significant difference was seen in the presence of diabetes, hypertension, number of epicardial coronary artery involvement, or the severity of CAD in the STEMI patients with good or poor Rentrop collaterals.
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Prevalence of anemia and iron deficiency among patients with heart failure admitted in a tertiary care hospital of sub-Himalayan region in North India p. 102
Akhil Katna, Himanshu Dhiman, Rajesh Sharma, Sujeet Raina, Mukul Kumar, RS Yadav
DOI:10.4103/jcpc.jcpc_16_21  
Objective: Anemia and iron deficiency (ID) are common in patients with chronic systolic heart failure (HF). The study was planned to find out the prevalence of anemia and ID in patients of chronic HF among patients admitted in a tertiary care hospital from Himachal Pradesh, India. Methods: This was a hospital-based open cohort observational descriptive study conducted on patients diagnosed with chronic HF. The study period was of 1 year. HF was defined on the basis of 2016 ESC Guidelines for diagnosis and treatment of acute and chronic HF. Anemia was diagnosed on the basis of WHO definitions (<13 g/dl in males and <12 g/dl in females). ID was diagnosed as serum ferritin <100 μg/dl (absolute ID) or serum ferritin 100–299 μ/dl and transferring saturation <20% (functional ID). Results: A total 61 patients (41 females and 20 males) were included in the study over 1 year. Out of 61 patients, 48 (78.7%) were found to be iron deficient. Thirty-four patients were having absolute ID, whereas 14 were having functional ID. Anemia was found in 29 patients (47.5%). Nineteen patients were having ID without anemia. Conclusion: Anemia and ID are common in patients with HF in the sub-Himalayan region in North India. Hemogram and iron profile should be included in the investigation protocol during management of HF in Indian patients.
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Comparison of global registry of acute coronary events and thrombolysis in myocardial infarction risk scores in non-ST-elevation acute coronary syndrome p. 106
Satyanarayan Routray, Chhabi Satpathy, Nirmal Kumar Mohanty, Bijay Kumar Dash, Rajendra Prasad Satapathy
DOI:10.4103/jcpc.jcpc_25_21  
Context: The Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in predicting coronary disease severity in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) have not been proved. Aims: We aimed to compare the GRACE score with TIMI risk score for prediction of the angiographic severity of coronary artery disease (CAD) in patients with NSTE-ACS. Settings and Design: This was an observational cross-sectional study. Subjects and Methods: Total 202 NSTE-ACS (NSTE myocardial infarction and unstable angina) patients were included. The GRACE and TIMI scores were estimated. Coronary angiogram was done and the Gensini score and vessel score were used to assess the severity of CAD. Statistical Analysis Used: SPSS software version 27.0 was used for statistical analysis. For comparison of two means, independent sample t-test/Mann–Whitney U-test was used, while for more than two means, one-way ANOVA/Kruskal–Wallis test was used. The receiver operating characteristic (ROC) curve was applied for the predictability of GRACE and TIMI scores for severity of disease. Results: A positive association between the Gensini score and vessel score was observed with both the GRACE (P = 0.001) and TIMI (P = 0.001) scores. The area under the ROC curve for the GRACE score was 0.765 (95% confidence interval [CI] = 0.676–0.854), significantly superior to the area under the ROC curve of the TIMI score (0.715; 95% CI = 0.618–0.812). Risk factors such as higher age, hypertension, smoking history, dyslipidemia, ECG changes such as ST deviation and T inversion, and Killip classification showed a statistically significant association with severity of disease. Conclusions: Both the GRACE and TIMI risk scores were a good predictor of angiographic severity of CAD in patients with NSTE-ACS, and the GRACE score was found to be superior to the TIMI risk score.
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REVIEW ARTICLE Top

The association between nonalcoholic fatty liver disease and cardiovascular disease: A window of opportunity p. 112
Narendra Singh Choudhary, Neeraj Saraf, Mohammad Shafi Kuchay, Ravi R Kasliwal
DOI:10.4103/jcpc.jcpc_31_21  
Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in India. People with NAFLD generally share common metabolic risk factors with CVD; yet, NAFLD is independently associated with CVD. As NAFLD is easily diagnosed due to the availability of ultrasound, the awareness regarding association of NAFLD to CVD may prevent both cardiovascular and liver-related morbidity/mortality. We discuss association of NAFLD and CVD and preventive potential in the Indian population.
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CASE REPORT Top

Left-sided anomalous origin of the coronary artery from the opposite sinus: Single anomalous left anterior descending artery originating from the right coronary artery – A rare case p. 117
Ashida Thulaseedharan Sarojadevi, Senthilvelan Thenmozhi, Badrinath Aritakulu Kuppuswamy, Suresh Babu Somasundharam
DOI:10.4103/jcpc.jcpc_8_21  
Anomalous origin of the coronary artery from the opposite sinus (ACAOS) is a significant subclass of coronary artery anomalies. Ischemic symptoms can develop at any age and judicious use of imaging modalities is needed to guide treatment. We present a short review of this rare coronary anomaly left-sided ACAOS diagnosed in a 42-year-old gentleman.
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