Left main coronary stenosis: Is it safe to give a date for CABG 4th July

HCFI 6th March 2019: Mr Ramdas, a farmer aged 48, father of two sons and one daughter, resident of Jila Agra with annual income of 60,000 Rs is covered under Ayushman Bharat Scheme ( 31353 / 33372 / dist118 / local body 800813 / ward 4, Ayushman Bharat id 091500-671850-004000-900050).

He reported to G B Pant hospital on 11 December 18 with unstable angina. His evaluation revealed EF 20% with left main 100% artery blockage and LPV 100 % blockage (135564 CAG).

On 21st January the hospital gave a date for surgery on 8th July and asked him to report with 4 units of blood. He has limited effort tolerance and gets effort chest pain on walking and d eating food.

The HCFI legal cell wrote to Pant Hospital today to give an early date.

How disrupted sleep may lead to heart disease

NIH: Heart disease is the leading cause of death among women and men. In atherosclerosis. White blood cells from the immune system collect at the plaque and cause inflammation. Over time, the plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your heart and other organs. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Recent research has linked sleep deficiency and certain sleep disorders, such as sleep apnea, to an increased risk of heart disease and other health conditions.

To learn more about the impact of sleep deficiency on heart disease, a team led by Dr. Filip Swirski at Harvard Medical School and Massachusetts General Hospital studied a group of mice that were genetically engineered to develop atherosclerosis. The research was supported in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results were published online on February 13, 2019, in Nature.

The researchers repeatedly disrupted the sleep cycles of half the mice, and the other half slept normally. After 16 weeks, the sleep-disrupted mice developed larger arterial plaques than the mice with normal sleep patterns.

The sleep-disrupted mice also had twice the level of certain white blood cells in their circulation than the control mice. And they had lower amounts of hypocretin, a hormone made by the brain that plays a key role in regulating sleep and wake states (also known as orexin). Further experiments showed that hypocretin suppressed the production of stem cells that make the white blood cells in their bone marrow.

Sleep-deficient mice that received hypocretin supplementation tended to produce fewer immune cells and develop smaller artery wall plaques than mice that weren’t given the supplementation. These results suggest that hypocretin loss during disrupted sleep contributes to inflammation and atherosclerosis.

Virtopsy or virtual autopsy is an alternative to traditional autopsy, conducted with scanning and imaging technology. The methods used are whole body or limited CT and or MRI.

CT guided post-mortem biopsies and blood tests for the genetics can be added for histopathological and genetic correlations.

CT is well suited to rule our brain haemorrhage, foreign objects, bone and air or gas distribution throughout the body, whereas MRI can detail organ and soft tissue findings. A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data.

Virtual autopsy can be done in no time, will leave no scar and can be the answers in finding the cause of death and also evaluate the cause in unexplained deaths. The same is necessary to prevent further such episodes in the community or in the family.

It may also be the answer for most medicolegal disputes. In every death doctors should give an option for virtual biopsy with or without mini FNAC/ tissue biopsy. And informed refusal must be noted.

Postmortem CT angiography combined with image-guided biopsy, because of their minimally invasive nature, have a potential role in the detection of the cause of death after acute chest pain.

Second case of sustained HIV remission after stem cell treatment: Is a cure for HIV in sight?

Dr KK Aggarwal, Recipient of Padma Shri

A HIV-positive patient, called the “London Patient”, has experienced sustained remission from HIV-1 infection after stem-cell transplantation becoming only the second person in the world to achieve this, as reported in the journal Nature.

The patient with HIV-1 infection was diagnosed with advanced Hodgkin's lymphoma in 2012. To treat the cancer, the patient received a transplant of hematopoietic stem cells from a donor with two copies of the CCR5 ?32 (delta 32) allele. The patient experienced only a mild reaction to the stem-cell transplant. The patient became homozygous for CCR5 ?32 after transplantation, and anti-retroviral therapy was interrupted after 16 months. The authors confirmed that HIV-1 RNA was undetectable, and the patient has so far been in remission for 18 months..... read more

AHA updated scientific statement on measurement of BP

Dr KK Aggarwal, Recipient of Padma Shri

Good technique with validated, automated blood pressure machine use is key to accuracy, according to an updated scientific statement on BP measurement from the American Heart Association (AHA).

To ensure accurate measurement of BP, the AHA has issued recommendations on training in auscultatory BP measurement, assessment of knowledge of the doctor, skills of the technician or provider, among others.... read more