IntroductionDiagnosis of acute coronary syndrome (ACS) is often challenging especially in presence of initial normal troponins and non‐specific electrocardiogram. The index study aimed at determining the diagnostic value of strain echocardiography in patients with suspected ACS but with non‐diagnostic electrocardiogram and echocardiography findings.MethodsThe study was conducted on 42 patients with suspected ACS and non‐diagnostic electrocardiograms, normal quantitative troponin‐T levels, and left ventricular function. All patients underwent conventional and 2D‐strain echocardiography followed by coronary angiography, within 24 h of admission. Patients with regional wall motion abnormalities (RWMA), valvular heart disease, suspected myocarditis, and past coronary artery disease (CAD) were excluded.ResultsAmongst the global strains, the global circumferential strain (GCS) was significantly reduced (p = .014) amongst those with significant CAD on angiography as opposed to global longitudinal strain (GLS) which was similar in the two groups (p = .33). The GCS/GLS ratio was also significantly reduced in patients with significant CAD compared to those with normal/mild disease on coronary angiography (p = .025). Both the parameters had good accuracy in predicting significant CAD. GCS displayed a sensitivity of 80% and a specificity of 86% at an optimal cut‐off 31.5% (AUROC: .93, 95% CI: .601–1.000; p = .03), and likewise GCS/GLS ratio had a sensitivity of 80% and a specificity and 86% at a cut‐off of 1.89% (AUROC: .86, 95% CI: .592–1.000; p = .049). GLS and peak atrial longitudinal strain (PALS) did not differ significantly in patients with/without significant CAD (p = .32 and .58, respectively).ConclusionGCS and GCS/GLS ratio provides incremental value in comparison to GLS, PALS, and tissue Doppler indices (E/e’) in patients with suspected ACS and non‐diagnostic electrocardiogram and troponins. GCS at cut‐off of >31.5% and GCS/GLS ratio >1.89 can reliably exclude patients with significant CAD in this setting.
Background: Metabolic syndrome is defined as at least three of the five following medical conditions: central obesity(mandatory), high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). It has been shown that obesity causes physiological impairment in respiratory system.Methods: In this observational cross sectional study, 60 patients who fulfilled the IDF criteria for metabolic syndrome were included after applying the exclusion criteria and were subjected to spirometry.Results: Most of the patients had a restrictive pattern (43.3%) (n=26). 33.3% (n=20) of the patients had a mixed pattern while 16.7% (n=10) of the patients had a normal picture. Only 6.7% (n=4) of the patients had an obstructive pattern (p<0.001). Mean value of FEV1 had no correlation with increasing number of components of metabolic syndrome whereas mean value of FVC showed a decreasing trend with increasing number of components of metabolic syndrome. Mean FEV1 of the patients was significantly higher in males (1.82±0.71 L) than females (1.24±0.42 L) (p 0.007). Similarly, the mean FVC was significantly higher in males as compared to females. Mean FVC was 2.45 (±0.86) L in males while females had a mean FVC of 1.65 (±0.49) L (p 0.002).Conclusions: In conclusion, Patients with metabolic syndrome have significant impairment of the pulmonary function with restrictive pattern being the most common one.
Background: Amitraz is a member of the formamidine family of pesticides. Its structure is 1,5 di-(2,4-dimethylphenyl)-3-methyl-1,3,5-triazapenta-1,4-diene. It is used as an agricultural insecticide for fruit crops and as an acaricide for dogs and livestock. Awareness about amitraz, its toxicity, and its management remains poor among physicians, which is probably the reason for underreporting of amitraz intoxication in remote rural areas. In this systematic review on amitraz intoxication, we focus on demographics, toxicokinetics, mechanisms of toxicity, clinical features, and treatment modalities in amitraz poisoning. Materials and methods: EmBase and Medline databases were searched for the following terms: "amitraz, " "intoxication, " "poisoning, " and "toxicity. " Case reports, case series, and original articles describing human cases of amitraz poisoning were included. Results: A total of 251 articles were retrieved after excluding citations common to the two databases. A total of 63 articles described human cases. The clinical manifestations varied from central nervous system (CNS) depression (drowsiness, coma, and convulsions), miosis or mydriasis, respiratory depression, bradycardia, hypotension, hyperthermia or hypothermia, hyperglycemia, polyuria, vomiting, and reduced gastrointestinal motility. Only six reported deaths have been reported (case fatality rate, 1.9%). The proposed lethal dose of the toxin was reported to be 200 mg/kg. Around 33% of patients developed respiratory failure and 20% of them needed mechanical ventilation. Interpretation and conclusion: Amitraz poisoning occurs in either accidental or suicidal manner and is more common in children than adults. There is no specific antidote for this toxin till date. It has an excellent prognosis with supportive management.
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