Journal of Cardio -Thoracic Medicine
Volume:11 Issue: 1, Winter 2023

 Early intravenous thrombolysis in elevated ST-segment myocardial infarcted patients reduces morbidity/mortality, however in non-responsive patients, it can delay the endovascular revascularization process. Increased epicardial adipose tissue thickness (EATT) is associated with adverse cardiovascular events and artery patency. Our aim was to evaluate if EATT influences the response to thrombolytic therapy in patients with acute myocardial infarction. This prospective cohort study included fifty patients (40 males and 10 females) with a mean age of 60 ± 9 years old and a presumptive acute myocardial infarct diagnosis. All the patients were hospitalized in the intensive care coronary unit. According to ESC and ACC guidelines, the diagnosis of acute myocardial infarct was corroborated. Patients were treated with 0.5 mg/kg IV bolus of the specific recombinant plasminogen activator Tenecteplase. The transthoracic 2-dimensional echocardiography was performed to recognize EAT from the parasternal long-axis view. The time lapse between initial symptoms and thrombolysis was 227±43 mm. Sixteen patients showed positive reperfusion less than 90 minutes after thrombolysis, and the remaining 34 required a percutaneous coronary intervention. The mean EATT value of thrombolysis-responding patients was 2.4 ± 0.4 mm vs 6.5 ± 0.6 mm of the non-responders (p= 0.001). In responders, the percentage of  body mass index  (BMI)  was 26.1 ± 0.02% vs 29.1± 0.02% (kg/m2)  in non-responders (p= 0.001). Interestingly, an EATT value > 2.5 mm and a BMI > 26 showed a highly significant inverse correlation response to thrombolysis and positive myocardial reperfusion (r = -0.71 y 0.55, p = 0.001 respectively). These values had a prognostic sensitivity of 93% and specificity of 84%. EATT and BMI could be usefull serve as early decision indicators to determine the possible response to thrombolysis and positive myocardial reperfusion in acute myocardial infarcted patients, although there is a need for studies with larger sample sizes.

An association between heat shock protein 27 (Hsp27) antigen with cardiovascular risk factors has been shown previously. Furthermore, higher levels of serum anti-HSP27 antibodies are also related to higher cardiovascular morbidity and mortality. In the current study, we looked at the relationship between serum Hsp27 antibodies and hypertension, as an important cardiovascular risk factor, in individuals without evidence of cardiovascular disease (CVD).

A sub-population of hypertensive patients (HTN+) without underlying CVD were recruited from the Mashhad stroke and atherosclerosis heart disease (MASHAD) study to assess the association between serum Hsp27 antibodies and hypertension; independent of other cardiovascular risk factors. A total of 1599 people were studied of whom 288 individuals had hypertension and 1311 were used as controls (HTN-).

Mean serum Hsp27 antibody titers were 0.20 (0.27) OD in the whole population sample and was not significantly different in the normotensive (HTN-) compared to HTN+ individuals with different degrees of hypertension.

There were no significant associations between serum anti-Hsp27 concentrations and either the presence or severity of hypertension. Future studies are warranted to explore the association of anti-Hsp27 antibody and antigen levels and other cardiovascular risk factors.

Aim of this study is to compare COSTA’S and LIGHT’S criteria in identifying exudative from transudative pleural effusions.

A prospective study that is hospital-based was conducted at GHCCD, during Jan 2017 to August 2018 in 80 patients who presented with pleural effusion. Light’s and Costa’s criteria were applied to differentiate them into transudative and exudative effusions.

Among the pleural effusions, 83.75% were exudates and 16.25% were transudates. Tuberculous effusion (45%) was the most common among exudates, and chronic kidney disease (10%) was the most common among the transudates. On biochemical analysis of effusions, the mean pleural fluid cholesterol levels were 74.02±20.51mg/dl and 29.23±7.44mg/dl in exudative and transudative effusions respectively. On ROC analysis, the cut-off value for pleural fluid cholesterol was considered >50mg/dl and <29mg/dl for exudative and transudative effusions respectively. The mean pleural fluid LDH cut-off values on ROC analysis was >231U/L for exudative effusions and <231U/L for transudative effusions. The sensitivity, specificity, PPV, NPV of Lights criteria observed to be 100%, 61.5%, 93.05% & 100% with accuracy of 93.75% whereas the values of Costa’s criteria were 97%, 92%, 98%, 85.7% with accuracy of 96.25% in differentiating exudates and transudates. P-value was statistically significant for both criteria.

Pleural fluid LDH and cholesterol are found to be excellent parameters to differentiate transudates and exudates. Costa’s criteria is simple, convenient with almost equal sensitivity and more specificity in comparison to Light’s criteria, with fewer pleural fluid parameters compared to Light’s criteria.

There is no definite algorithm for the treatment of first episode primary spontaneous pneumothorax. Although interventional methods are recommended in patients with dyspnea or respiratory distress, conservative treatments are more prominent in patients with non-specific symptoms or asymptomatic patients. In this study we aimed to compare conservative treatment and chest tube application in patients with first-episode large spontaneous pneumothorax without respiratory distress. The data of patients who were treated for primary spontaneous pneumothorax in our clinic between February 2022 and December 2022 was reviewed. Patients with first-episode large pneumothorax without respiratory distress were included in the study. Characteristics and follow-up results of the patients were recorded.       A total of 28 patients who met the criteria were included in the study. The chest tube was applied to 20 of the patients included in the study, and 8 patients were followed up with O2 inhalation without surgical intervention. The mean hospital stay was longer in the chest tube group, while the mean time for lung expansion and the number of outpatient visits after discharge were found to be higher in the conservative group (p=0.014, p=0.00, p=0.015, respectively). The conservative approach in the treatment of first-episode large primary spontaneous pneumothorax is an alternative to interventional procedures, with a shorter hospital stay and similar recurrence rates in patients without respiratory distress or low oxygen saturation.

An idiopathic chronic pericardial effusion which has occurred due to pericardial fluid collection can continue for over a three-month duration without obvious cause. Massive chronic pericardial effusion without cardiac tamponade is quite unusual. We present a male patient with chronic huge pericardial effusion who underwent a pericardial window procedure with 3600 milliliters drainage of pericardial fluid.

With increasing prevalence of patients with advanced heart failure (AHF), increasing amount of readmission frequencies, duration of maximum medical therapy, and the 50% mortality during one-year, Left ventricular assist devices (LVAD) are considered to be an acceptable treatment option in these cases. Advanced newer‑generation of LVAD devices improves outcomes, and deceases morbidity . LVAD is considered as a bridging therapy in cases of decompensated HF which are scheduled for heart transplantation (HTx), or as destination therapy (DT) for cases either elder or with severe comorbid condition . LVAD is mechanical device that assists the pumping function of left ventricle (LV) by diverting blood into an external circulatory circuit connecting to the aorta. LVAD usually consists of (A) pump implanted to LV, (B) percutaneous driveline, and (C) externally controller and batteries .

Laryngeal tuberculosis (TB) is not a very common laryngeal pathology, therefore it can be easily missed. Laryngeal TB and Cancer of Larynx can have similar clinical presentations. Here we discuss a case of a 57-year-old female presenting in outpatient department with complaints of Hoarseness of voice since 6 months and shortness of breath since 3 months. Patient was further evaluated and diagnosed as a case of laryngeal tuberculosis. Treatment was started with fixed dose anti tubercular drugs and patient showed improvement on follow up.