ObjectiveCoronary Artery Disease (CAD) is the leading cause of morbidity and mortality all around the world. We evaluated the correlation of Red blood cell Distribution Width (RDW) with the severity of lesion on coronary angiography as assessed by Modified Gensini score (MGS) in CAD patients.MethodsA total of 576 consecutive patients admitted in Department of Cardiology over a period of one year, who underwent coronary angiography after diagnosis of CAD or presence of angina like chest pain and/or positive treadmill test were enrolled in the study (August 2014–May 2015). Patients were divided into two groups, with CAD (Group A) and without CAD (Group B). The RDW Cofficience of variance (RDW CV) and RDW standard deviatiton (RDW SD) of each patient, and their correlation with severity of CAD was assessed.ResultsOf the total 576 patients enrolled, 438 were in Group A and 138 were in Group B. The mean age of presentation in Group A and Group B was (53.64 ± 10.36 vs 49.4 ± 9.73) years (p < 0.0001). The Male and Female ratio overall was 2.42:1. Patients in Group A had significantly elevated RDW CV and RDW SD levels compared with those in Group B [(14.59 ± 1.04)% vs (13.6 ± 0.68)%, p < 0.0001], [(45.78 ± 4.76) vs (40.77 ± 3.01), p < 0.0001 respectively]. A significant positive correlation between RDW CV, RDW SD and MGS was noted (r = 0.33, p < 0.0001) (r = 0.43, p < 0.0001) respectively. On multivariate logistic regression analysis, RDW was demonstrated to be an independent predictor for angiographic CAD (OR = 4.17, 95% CI 3.05–5.69, p < 0.0001). On receiver operating characteristic curve (ROC) analysis, an RDW value of 14.3% was identified as an effective cut off point in diagnosing CAD with a sensitivity of 58.9% and specificity of 84.8%.ConclusionsRDW is an independent predictor of CAD and severity of coronary stenosis, suggesting that it can be a readily available marker for prediction and severity of CAD.

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Background: Diphtheria is still endemic in India due to inadequate immunization. The incidence of myocarditis is higher in these patients. Objectives: The objective of this study was to study clinical profile, clinical outcomes as well as immunization status of the patients diagnosed with diphtheria myocarditis in Indian scenario. Methodology: This prospective observational study was carried out in one of the tertiary care hospital of south India from August 2011 to December 2012. A total of 33 cases with clinically confirmed diagnosis of diphtheria myocarditis were enrolled depending upon the inclusion and exclusion criteria of the study. Electrocardiography and 2-dimensional echocardiography was done at the time of admission and repeated when required. Results: The most common age group affected is 5 -10 years, with no sex difference in occurrence. Only 1 patient, out of 33 patients, was adequately immunized. Asymptomatic myocardial involvement (with only changes in electrocardiogram) was seen in 21 patients whereas 12 patients were symptomatic. The average duration of resolution of electrocardiographic changes was 4 -6 weeks. It should be noted that out of 28 patients who developed conduction abnormalities, 24 patients died. Temporary pacemaker support was given for 8 patients, of whom only one patient recovered. The patient was followed till hospital discharge. Conclusion: The mortality associated with diphtheria myocarditis is higher in Indian population. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for 90% coverage with three doses of diphtheria toxoid in children below one year of age and immunity towards it should be maintained by booster doses.

BACKGROUND Serum bilirubin is having protective effect as an antioxidant with capacity to remove reactive species of oxygen. Studies have suggested that an increased bilirubin level promotes protection against atherosclerosis. We have evaluated the level of serum bilirubin in patients with suspected coronary artery disease and its correlation with severity of lesion as assessed by modified Gensini score on angiography. MATERIALS AND METHODS A total of 540 patients have been enrolled in the study. Patients with diagnosis of acute coronary syndrome, stable angina, history of typical angina, Treadmill test positive were enrolled in the study. All patients were confirmed to have normal liver and renal function and were taken written consent for coronary angiography. The severity of lesion on angiography was assessed by modified Gensini score. Based on angiography results, the patients have been divided into CAD and control group. RESULTS The no. of patients in CAD group were (n=380) and control group were (n=160). Mean age of presentation in CAD group was 51.40±10.31 yrs. compared to controls 49.80±10.01 yrs. (p=0.1). Males were 70.26% in CAD group and 62.5% in controls (p = 0.08). The serum bilirubin was significantly lower in cases than in controls (0.56±0.28 mg/dL vs. 0.79±0.30 mg/dL, p <0.0001). There was a significant difference between other parameters assessed, i.e. RDW CV (14.46±0.74 vs. 13.72±0.85, p <0.0001), RDW SD (45.61±4.42 vs. 44.41±5.68, p = 0.0086), serum uric acid (7.10±2.06 mg/dL vs. 5.96±1.96 mg/dL, p <0.0001). Univariate analysis have been done followed by multivariate logistic regression analysis for assessing the independent risk factors for CAD. Serum bilirubin, RDW, Sex, Age and Diabetes were found to be independent predictors of presence of CAD. Serum bilirubin negatively correlated with presence of CAD (n=540, r=-0.46, p<0.0001). The cutoff value of serum bilirubin based on Receiver Operating Characteristic curve (ROC) analysis was 0.52 mg/dL for presence or absence of CAD with sensitivity of 80.3% and specificity of 89.1%. The correlation of low bilirubin with severity of CAD was (n=380, r=-0.34). The low serum bilirubin in smokers compared to nonsmokers (both in cases and control groups) did not attain statistical significance. The effect of smoking on level of bilirubin was minimal. CONCLUSION Low Serum bilirubin predicts the presence of CAD and is negatively correlated with the severity of CAD.