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Sharma YP, Gawalkar AA, Batta A, Shrimanth YS, Revaiah PC, Karki P, Chaudhary V, Kasinadhuni G, Santosh K, Bootla D, Kumar S, Patel NKJ, Sambyal BS, Panda P. Novel markers of COVID-19 mortality-A comparative study with patients of acute coronary syndrome. J Family Med Prim Care 2023; 12:962-966. [PMID: 37448943 DOI: 10.4103/jfmpc.jfmpc_1629_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
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Vijayvergiya R, Batta A, Kasinadhuni G, Gupta A, Gawalkar AA. A side branch balloon block and support technique for difficult distal main branch access during percutaneous coronary intervention. AsiaIntervention 2023; 9:52-55. [PMID: 36936100 PMCID: PMC10015480 DOI: 10.4244/aij-d-22-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Vijayvergiya R, Gupta A, Kasinadhuni G, Kumar B, Sihag BK, Gawalkar AA, Lal A. Percutaneous coronary intervention of anomalous right coronary arteries arising from the left sinus of Valsalva: a single-centre experience from Northern India. AsiaIntervention 2023; 9:32-38. [PMID: 36936103 PMCID: PMC10015482 DOI: 10.4244/aij-d-22-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/05/2022] [Indexed: 03/14/2023]
Abstract
Background An anomalous right coronary artery (ARCA) arising from the left sinus of Valsalva is an uncommon congenital anomaly. The unusual location, take-off and intramural courses of ARCA pose a considerable technical challenge during percutaneous coronary intervention (PCI). Aims We sought to report our experience of PCI of ARCA in 35 cases of atherosclerotic occlusion. Methods The PCI database of 35 cases of ARCA was retrospectively analysed. The details about demography, clinical presentation, PCI procedure and clinical follow-up were noted. Results The mean age was 56.7±13.5 years. The clinical presentation included stable angina in 45.7%, unstable angina in 20% and acute myocardial infarction in 34.3% of patients. Vascular access was transradial in 37.1% of cases, transfemoral in 60% of cases, and transbrachial in 1 case (2.9%). Judkins left and Amplatz left were commonly used guide catheters. Two patients with balloon-uncrossable, calcified lesions required rotablation-assisted PCI. Intravascular imaging was performed in 12 patients (34.3%). Optical coherence tomography demonstrated a proximal intramural course in 3 patients, and a slit-like orifice in 4 patients. The mean radiation dose and fluoroscopy time were 877±687.3 mGy and 18.8±11.6 minutes, respectively. Twenty-eight (80%) patients had an asymptomatic median follow-up of 49 (interquartile range: 29.0-97.5) months. Conclusions We performed successful PCI in a cohort of 35 patients with ARCA, with favourable long-term clinical outcomes. The selection of an appropriate guide catheter and technical skills were important factors in achieving favourable results.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Basant Kumar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Bhupendra Kumar Sihag
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Anupam Lal
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Thakur S, Rawat N, Sharma B, Sikka P, Dogra N, Aggarwal N, Suri V, Vijayvergiya R, Gawalkar AA. Challenges and outcomes of pregnancy in an uncorrected Tetralogy of Fallot with pulmonary atresia and major aorta-pulmonary collateral arteries (MAPCA): a case report. Egypt Heart J 2023; 75:9. [PMID: 36729200 PMCID: PMC9895401 DOI: 10.1186/s43044-023-00335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy. CASE PRESENTATION We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion. CONCLUSIONS This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome.
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Affiliation(s)
- Surekha Thakur
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neha Rawat
- grid.415131.30000 0004 1767 2903Department of Anesthesia, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Bharti Sharma
- Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Pooja Sikka
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neeti Dogra
- grid.415131.30000 0004 1767 2903Department of Anesthesia, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neelam Aggarwal
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vanita Suri
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rajesh Vijayvergiya
- grid.415131.30000 0004 1767 2903Department of Cardiology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Atit A. Gawalkar
- grid.415131.30000 0004 1767 2903Department of Cardiology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Kasinadhuni G, Batta A, Gawalkar AA, Budakoty S, Gupta A, Vijayvergiya R. Validity and correlation of quantitative flow ratio with fractional flow reserve for assessment of intermediate coronary lesions. Acta Cardiol 2023; 78:91-98. [PMID: 35382706 DOI: 10.1080/00015385.2022.2059857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The angiographic percent diameter stenosis (%DS) do not assess the physiological significance of epicardial coronary stenosis. The currently practised physiological indices require pressure wires with or without adenosine-induced hyperaemia. Quantitative flow ratio (QFR) is an angiography-based method to determine the functional significance of coronary stenosis. The present study aimed to analyse the diagnostic performance of QFR in comparison to fractional flow reserve (FFR) in intermediate coronary lesions. MATERIALS AND METHODS It was a single centre retrospective study to analyse the diagnostic performance of offline QFR with the previously performed FFR in the last six years. A total of 56 interrogated vessels were included for the analysis. Offline QFR analysis was performed and correlated with FFR values in the intermediate coronary stenoses. RESULTS The mean age of the study population was 62.4 ± 9.1 years, including 81% men. The left anterior descending artery (50%) was the most common analysed vessel followed by left circumflex (27%) and right coronary (21%) arteries. The mean % DS and % area stenosis were 45.25 ± 11.22% and 57.45% ± 16.25%, respectively. The mean FFR and QFR values were 0.83 ± 0.06 and 0.82 ± 0.10, respectively. A strong positive correlation was found between FFR and QFR with a Spearman correlation coefficient of 0.56. Receiver operating curve analysis for QFR and %DS with a FFR cut off value <0.80 showed an area under the curve of 0.97 and 0.77, respectively. The sensitivity, specificity and diagnostic accuracy of QFR were 87.5%, 95% and 92.8%, respectively. There was a discordance in four vessels (7.1%) between QFR and FFR. CONCLUSION QFR has a good diagnostic performance in comparison to the gold standard FFR for physiological assessment of intermediate lesions. Its performance is significantly better than the anatomical % DS (p < 0.001).
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Affiliation(s)
- Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudhanshu Budakoty
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Vijayvergiya R, Kasinadhuni G, Batta A, Gawalkar AA, Singhal M. Percutaneous Intervention of Coarctation of Aorta in an Adult Man Presenting With Congestive Heart Failure. J Invasive Cardiol 2022; 34:E890. [PMID: 36476824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is unusual to detect coarctation of aorta (CoA) in an adult person during their 6th decade of life. We came across a 52-year-old male who presented with left ventricular failure with low ejection fraction and atrial fibrillation, who was incidentally detected to have critical CoA. It was successfully managed with balloon angioplasty and had a favorable 6 months of clinical follow-up.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh - 160 012, India.
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Vijayvergiya R, Gawalkar AA, Kasinadhuni G, Kaushal S, Batta A, Kumar B. Percutaneous coronary intervention in dextrocardia patients with situs inversus. AsiaIntervention 2022; 8:132-135. [PMID: 36483282 PMCID: PMC9706777 DOI: 10.4244/aij-d-22-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 05/02/2023]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjeev Kaushal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Basant Kumar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Gupta S, Dayal D, Rohit MK, Gawalkar AA, Raj KM, Attri SV, Sachdeva N, Kaur H. Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study. J Pediatr Endocrinol Metab 2022; 35:1059-1068. [PMID: 35822711 DOI: 10.1515/jpem-2021-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Growth hormone deficiency (GHD) in adults is associated with an increased risk of cardiovascular morbidity and mortality. Although children with GHD are also believed to have a similar cardiovascular disease (CVD) risk beginning at an early age, the available data in children is scarce. We aimed to determine the various CVD risk parameters in children with isolated GHD (IGHD). METHODS A cross-sectional case-control study was conducted at a tertiary care centre in North India comparing various auxological, biochemical, and echocardiographic parameters between 20 IGHD children aged 5-15 years and their age and sex-matched healthy controls. RESULTS The mean age of children with IGHD and controls was similar (10.5 ± 2.6 yr vs. 9.9 ± 2.7 yr, p=0.48). Children with IGHD had significantly higher waist-hip-ratio (p=0.01), total cholesterol (p=0.02), non-high-density lipoprotein-cholesterol (p=0.02), serum homocysteine (p<0.001), C-reactive protein (CRP) (p=0.01) and pro-brain natriuretic peptide (pro-BNP) (p=0.04) levels as compared to healthy controls. Left ventricular mass (LVM) and interventricular septal thickness were significantly lower (p=0.04; p=0.02) in IGHD children. Correlation analysis showed that pro-BNP and CRP levels had negative correlation (p<0.001, r=-0.70; and p=0.04, r=-0.44, respectively) and LVM had a positive correlation (p=0.02, r=0.53) with height SDS among IGHD children. CONCLUSIONS Children with IGHD showed abnormalities in several biochemical and cardiac parameters that may be associated with an increased CVD risk in later life. More extensive studies, including younger children with IGHD, are needed to determine the lower ages at which the CVD risk is detectable.
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Affiliation(s)
- Saniya Gupta
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Manish Raj
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harvinder Kaur
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Shrimanth YS, Gawalkar AA, Barwad P, Ghosh S, Verma S, Sharma A, Naganur S. Successful endovascular repair with coil embolization of ruptured right internal thoracic artery aneurysm. J Vasc Bras 2022; 21:e20210223. [PMID: 35911476 PMCID: PMC9296063 DOI: 10.1590/1677-5449.20210223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Internal thoracic artery aneurysms (ITAAs) are rare with wide variation in clinical presentation and a high risk of rupture. Endovascular techniques are increasingly being used for treatment of such aneurysms over surgical repair in recent times. A 34-year-old male presented with progressive swelling of the right anterior chest wall for 2 weeks and was diagnosed with right internal thoracic artery aneurysm with contained rupture. He underwent successful endovascular repair with coil embolization of ruptured right ITAA. Post intervention computed tomography (CT) angiography confirmed sealing of the ruptured aneurysm with no residual filling of the sac. At six months follow-up he is doing well with complete resolution of hematoma. This case demonstrates that an endovascular approach with coil embolization is a feasible and safe option for treating the rare ruptured ITAAs.
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Affiliation(s)
| | | | - Parag Barwad
- Post Graduate Institute of Medical Education & Research, India
| | - Soumitra Ghosh
- Post Graduate Institute of Medical Education & Research, India
| | - Samman Verma
- Post Graduate Institute of Medical Education & Research, India
| | - Arun Sharma
- Post Graduate Institute of Medical Education & Research, India
| | - Sanjeev Naganur
- Post Graduate Institute of Medical Education & Research, India
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Gawalkar AA, Ghosh S, Bootla D, Revaiah PC, Singh C, Otaal PS. Restrictive physiology masked by cardiac tamponade: A rare cooccurrence in a child with lymphoblastic T-cell lymphoma. Ann Pediatr Cardiol 2022; 15:70-72. [PMID: 35847393 PMCID: PMC9280095 DOI: 10.4103/apc.apc_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
Cardiac involvement in T-cell lymphoma is not uncommon. Pericardial effusion is the most common manifestation of cardiac involvement with restrictive cardiomyopathy (RCM) due to tumor infiltration being extremely rare. The presence of paroxysmal nocturnal dyspnea and orthopnea in a patient presenting with pericardial effusion could be related to tamponade or underlying myocardial disease. Hence, reevaluation after pericardiocentesis is warranted. We describe a 14-year-old boy with advanced T-cell lymphoma presenting with cardiac tamponade. Repeat echocardiography after pericardiocentesis revealed mediastinal mass infiltrating cardiac chambers and great vessels along with features of RCM secondary to tumor infiltration.
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Affiliation(s)
- Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soumitra Ghosh
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pruthvi C Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Department of Clinical Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parminder Singh Otaal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Parminder Singh Otaal, Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India. E-mail:
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Shrimanth YS, Vemuri KS, Gawalkar AA, Ghosh S, Vijay J, Prarthana T, Sihag BK. Kounis syndrome secondary to nimesulide ingestion: a case report. Egypt Heart J 2021; 73:106. [PMID: 34928466 PMCID: PMC8688661 DOI: 10.1186/s43044-021-00233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Kounis syndrome, also known as "allergic myocardial infarction," is a rare co-occurrence of acute coronary syndrome (ACS) in the setting of hypersensitivity reaction to any agent. Non-steroidal anti-inflammatory drugs (NSAIDs) like are often implicated in causing allergic reactions. Here, we present a case of anterior wall myocardial infarction (AWMI) occurred following angioedema secondary to intake of Nimesulide, not described earlier in literature. Case presentation A 45-year-old female developed generalized pruritic, erythematous maculopapular rash, facial puffiness, oral ulcers and hoarseness of voice within few hours following consumption of Nimesulide for fever and body-ache. Due to development of hypotension, electrocardiogram (ECG) was done, which revealed ST elevation in V2–V6, with marked elevation of troponin (TnI) and creatine kinase (CK-MB). He had no chest pain or shortness of breath. Echocardiography showed regional wall motion (RWMA) abnormality in left anterior descending artery (LAD) territory with an ejection fraction of 25%. Coronary angiography showed a complete thrombotic cutoff of LAD, for which Tirofiban infusion was started to decrease thrombus burden. Repeat angiography on next day showed 80% lesion in proximal LAD for which she underwent revascularization with a drug-eluting stent. The patient later showed improvement in cardiac function at 8 months of follow-up. Conclusions The occurrence of ACS requiring percutaneous coronary intervention (PCI) in the setting of allergic reactions is rarely reported in the literature. One should be aware of the rare possibility of Kounis syndrome in the setting of hypersensitivity reaction when accompanying features of symptoms suggestive of coronary artery disease co-exists. When indicated, ECG monitoring and cardiac biomarkers in patients with allergic responses help to identify this rare and treatable condition.
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Affiliation(s)
| | - Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Soumitra Ghosh
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jyothi Vijay
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Thammannagowda Prarthana
- Department of Dermatology Venereology Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhupendra Kumar Sihag
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Otaal PS, Gawalkar AA, Shunmugarajan A. Optical coherence tomographic insights of very late stent thrombosis of a second-generation drug-eluting stent: a case report. Eur Heart J Case Rep 2021; 5:ytab490. [PMID: 34993408 PMCID: PMC8728720 DOI: 10.1093/ehjcr/ytab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Very-very late stent thrombosis (VVLST) occurring more than 5 years after implantation of drug-eluting stent (DES) is extremely rare, being restricted to few case reports. Mainly described with first-generation stents, this life-threatening complication has not been described with later-generation stents. We describe the first case of VVLST occurring 3309 days (>9 years) after implantation of second-generation DES.
Case summary
A 62-year-old man presented with the acute coronary syndrome. He has a history of percutaneous coronary intervention (PCI) to the right coronary artery using the three second-generation DES more than 9 years ago. Coronary angiogram revealed in-stent restenosis (ISR) with doubtful angiographic thrombus. Optical coherence tomography (OCT) confirmed the diagnosis of stent thrombosis (STh) localized to the stent overlap zone with underlying ISR. Patient underwent OCT-guided PCI with DES implantation and was discharged on dual antiplatelet therapy including ticagrelor. He is doing well on follow-up at 6 months.
Discussion
Stent thrombosis can occur in second-generation stents nearly a decade after implant. Stent overlap segment is more prone to neo-atheroma formation and vulnerable plaque leading to STh. In addition to confirming the diagnosis, OCT provides exciting insights into the underlying mechanism. This has implications for long-term antiplatelet therapy in patients implanted with multiple stents.
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Affiliation(s)
- Parminder Singh Otaal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Room No 3007, Sector-12, Chandigarh 160012, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Room No 3007, Sector-12, Chandigarh 160012, India
| | - Ajay Shunmugarajan
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Room No 3007, Sector-12, Chandigarh 160012, India
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Chaudhary V, Kumar B, Gawalkar AA, Rajan A. The bailout left main stenting after diagnostic catheter-induced coronary artery dissection. Indian Heart J 2021. [DOI: 10.1016/j.ihj.2021.11.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kumar R, Halder V, Shrimanth YS, Gawalkar AA, Chauhan R, Prasad K, Rohit MKU, Karri S, Walia S, Singh A. Acquired cyanosis secondary to RVOT obstruction due to pacemaker lead prolapse and vegetation in a child with ASD. J Cardiol Cases 2021; 25:207-209. [DOI: 10.1016/j.jccase.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022] Open
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Batta A, Singhal M, Gawalkar AA, Otaal PS. Unusual cause of mediastinal widening and atrial fibrillation: mediastinal lipomatosis with infiltration into the interatrial septum. BMJ Case Rep 2021; 14:e246980. [PMID: 34753735 PMCID: PMC8578960 DOI: 10.1136/bcr-2021-246980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Akash Batta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parminder Singh Otaal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gawalkar AA, Singh N, Gupta A, Barwad P. Looped wire advancement—not always safe! Fat—not so useless! a case series. Eur Heart J Case Rep 2021; 5:ytab400. [PMID: 34816082 PMCID: PMC8603226 DOI: 10.1093/ehjcr/ytab400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/03/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Abstract
Background Coronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it. Case summary We hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP. Discussion Distal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.
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Affiliation(s)
- Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research , Sector 12 , Chandigarh 160 012, India
| | - Navreet Singh
- Department of Cardiology, Air Force Central Medical Establishment, Subroto Park, New Delhi, 110010 , India
| | - Ankush Gupta
- Department of Cardiology, Military Hospital, Bani Park, Jaipur, Rajasthan, 302016 , India
| | - Parag Barwad
- Department of Cardiology, Post Graduate Institute of Medical Education & Research , Sector 12 , Chandigarh 160 012, India
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17
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Kumar B, Rakesh Ram R, Dahiya N, Gawalkar AA. Real-World Clinical Outcomes of Indigenous Biodegradable Polymer Drug-Eluting Stents. Cureus 2021; 13:e17886. [PMID: 34660085 PMCID: PMC8503863 DOI: 10.7759/cureus.17886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction The durable polymer has been shown to cause neoatherosclerosis, and chronic local inflammation, predisposing individuals to in-stent restenosis and stent thrombosis (ST). The biodegradable polymer stents, which degrade after the desired function of drug release is achieved, allow for endothelial healing. Indigenous coronary stent manufacturing and its use are on the rise nowadays, and their safety and efficacy have been studied in well-structured clinical trials. However, data are scarce on their safety and efficacy in the real-world clinical setting. In this study, we examine the real-world one-year performance of bioresorbable or polymer-free stents manufactured in India. Materials and methods This was a single-center, single-arm prospective observational study involving 210 patients undergoing intracoronary stenting using bioabsorbable or polymer-free drug-eluting stents (DES) from Indian manufacturers. All patients were followed up for 12 months prospectively for any major clinical events. Results The mean age of the enrolled patients was 57.04 years (IQR: 34-84 years), among which 159 (75.7%) were male; 99 (43.8%) patients had presented with acute myocardial infarction (MI). A total of 294 stents were deployed with a mean diameter of 3.1 ±0.4 mm, and a mean length of 29.4 ±9.1 mm. Two patients had experienced major adverse cardiovascular events (MACE). After three months of follow-up, one patient developed ST, and the same patient developed a cerebrovascular accident (CVA) after six months. After one year of follow-up, one patient died of cardiac causes. Conclusion Based on our findings, in the real-world clinical setting, the indigenously made biodegradable polymer DES are both safe and effective.
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Affiliation(s)
- Basant Kumar
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Raikot Rakesh Ram
- Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Neelam Dahiya
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Atit A Gawalkar
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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Affiliation(s)
- Yash Paul Sharma
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit A Gawalkar
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Samman Verma
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Panda
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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19
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Shrimanth YS, Prasad K, Karthik AA, Barwad P, Pruthvi CR, Gawalkar AA, Santosh K, Naganur S. Correction to: Spontaneous pulmonary artery thrombus in a neonate. Egypt Heart J 2021; 73:45. [PMID: 33987700 PMCID: PMC8119528 DOI: 10.1186/s43044-021-00169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Y S Shrimanth
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India
| | - Krishna Prasad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India
| | - Adari Appala Karthik
- Department of Pediatrics, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Chandigarh, India
| | - Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India
| | - C R Pruthvi
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India
| | | | - Sanjeev Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160, 012, India.
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20
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Shrimanth YS, Prasad K, Karthik AA, Barwad P, Pruthvi CR, Gawalkar AA, Santosh K, Naganur S. Spontaneous pulmonary artery thrombus in a neonate. Egypt Heart J 2021; 73:43. [PMID: 33939053 PMCID: PMC8091146 DOI: 10.1186/s43044-021-00167-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background Pulmonary artery thrombosis is rare in neonates and mimics as persistent pulmonary hypertension or congenital heart disease. Risk factors include septicemia, dehydration, polycythemia, maternal diabetes, asphyxia, and inherited thrombophilias. They present with cyanosis and respiratory distress. Careful echocardiogram assessment helps in identifying the thrombus in the pulmonary artery and its branches. Computed tomography pulmonary angiography confirms the diagnosis. Case presentation We present a case of term neonate who presented with respiratory distress and cyanosis and a detailed echocardiogram revealed thrombus in the origin of left pulmonary artery. The neonate was managed initially with unfractionated heparin and later with low molecular weight heparin with which there was significant resolution of the thrombus Conclusion Spontaneous pulmonary artery thrombosis though rare should be suspected in any cyanotic neonate with respiratory distress. Management in these cases depends on the haemodynamic instability and lung ischemia.
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Affiliation(s)
- Y S Shrimanth
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India
| | - Krishna Prasad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India
| | - Adari Appala Karthik
- Department of Pediatrics, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Chandigarh, India
| | - Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India
| | - C R Pruthvi
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India
| | | | - Sanjeev Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute for Medical Education and Research (PGIMER) Chandigarh, Sector 12, Chandigarh, 160 012, India.
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Gawalkar AA, Bahl A, Ahluwalia J, Sood A, Sharma A, Sharma S, Dhir V. Prevalence of antiphospholipid antibodies in patients with overt myocardial dysfunction in systemic lupus erythematosus. A case-control study. Lupus 2020; 29:1503-1508. [DOI: 10.1177/0961203320947784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Small case-series have reported overt myocardial dysfunction to be associated with positive antiphospholipid antibodies in patients of systemic lupus erythematosus (SLE). However, there is no case-control study that has examined this association. Methods This case-control study recruited patients of SLE (fulfilling SLICC criteria) with overt myocardial dysfunction as cases and those without this as controls. Overt myocardial dysfunction was defined by echocardiography as global left ventricular dysfunction and reduced ejection fraction (<50%). Those patients with a prior diagnosis of anti-phospholipid antibody syndrome, coronary artery disease, rheumatic heart disease or severe pulmonary artery hypertension were excluded. Antibodies tested included lupus anticoagulant, anticardiolipin antibodies (IgM and IgG) and anti-beta 2 glycoprotein 1 antibodies (IgM and IgG). Patients with positive tests underwent repeat testing for persistent positivity after 12 weeks. Results This study included 51 patients (21 cases and 30 controls) having a mean (SD) age of 33 (13.3) years, and disease duration (median, IQR) of 28 months (12−38 months). The mean ejection fraction of cases was 31.7 (9.3)% while that of controls was 55.7 (1.7)% (p = 0.03). The frequency (percentage) of positive antiphospholipid antibodies was not significantly different between cases and controls (43%, 40%, p = 0.8). The frequency (percentage) of anti-cardiolipin antibody was also not significant between the groups (38%, 37%, p = 0.57). Serositis and leucopenia were more prevalent in SLE patients with myocardial dysfunction (p = 0.005). Conclusion This study did not find any significant association of anti-phospholipid antibodies with overt myocardial dysfunction in patients of SLE.
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Affiliation(s)
| | - Ajay Bahl
- Department of Cardiology, PGIMER, Chandigarh, India
| | | | - Ashwani Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Shefali Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Varun Dhir
- Department of Internal Medicine, PGIMER, Chandigarh, India
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Affiliation(s)
- Sudheer Tale
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Bharath A Chhabria
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Atit A Gawalkar
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Hanuma N Banavath
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashish Bhalla
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Affiliation(s)
- A A Gawalkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tale
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B A Chhabria
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chhabria BA, Nampoothiri RV, Gawalkar AA, Jain S. Janeway lesions. QJM 2017; 110:471-472. [PMID: 28444237 DOI: 10.1093/qjmed/hcx067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- B A Chhabria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - R V Nampoothiri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - A A Gawalkar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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