Government General Hospital

Introduction: Cardiovascular diseases (CVD) makes a large part of NCDs. In National Health Policy 2017, India aims to reduce premature deaths from CVDs, especially ischemic heart disease to 25% by 2025. Our country with 1.3 billion people with significant cultural and lifestyle diversities is going through a varied epidemiol. transition regarding the trend of ischemic heart disease among its different states from 1990 to 2016. Materials and methods: From Sept. 2020 to August 2021 (1 yr), patients who underwent OPCAB in Department of Cardiothoracic surgery, Government General Hospital, Guntur, Andhra Pradesh, India were studied. Patients were selected depending upon the specific selection criteria. Among all the studied patients, 44 patients were found to meet the below-mentioned selection criteria and enrolled in this retrospective study. As this is a retrospective record-based study, has granted our request for waiver of the written informed consent for the study. Results: Among 44 pts, 17 (38.63%) pts, were pos. with Trop T sensitivity test post operatively and the rest 27 pts, (61.36%) were neg. for the same. There were 8 patients (18.18%) with LVEF <35% in Trop T (+ve) group and 5 patients (10.22%) in Trop T (-ve) group. TAPSE were <14 in 6 patients (7.95%) in Trop T (+ve) group and 3 patients (6.81%) in Trop T (-ve) group. Table 1 compares the preoperative characteristics of patients belonging to two groups with postoperative Trop T (+ve) and Trop T (-ve) results. Age, height, renal function, nutritional status along with left ventricular function and TAPSE were not significantly different between these two groups. Body wt, BMI, Blood pressure status were also not different. Conclusion: In post OPCAB patients, elevation of cardiac enzyme Trop T is used as a prognostic guide especially when preoperative Trop T value is normal. LVEF is another well-known parameter in immediate and in early post-operative period of such patients for guiding postoperative recovery. In triple vessel disease with inferior wall ischemia and/or infarction, there remains a heterogeneity using LVEF alone as a prognostic guide. A RV parameter TAPSE, signifying a global RV function, when added to Trop T and LVEF, they increase the cumulative prognostic value to a greater degree in such patients.

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe skin reaction most often triggered by particular medications. Stevens-Johnson syndrome (SJS) is a life threatening adverse drug reaction. SJS was more commonly seen in children who were susceptible to viral infections, mortality was higher in the elderly. This serious ADR when caused by unknown drugs or those used as self-medication may cause difficulties in diagnosis and management. Metronidazole alone rarely causes SJS. We present a case of an elderly female patient had past medication history of metronidazole use, developed neurol. symptoms followed by pain and blisters on both soles, erythema of face and neck, scrotal itching and erosion, and hemorrhagic encrustation around the lips and oral mucous membrane. As metronidazole is a widely used drug, physicians should be aware of this adverse reaction for early detection and intervention. The patient should also be encouraged to report any abnormal manifestation following use of metronidazole to prevent such potentially life-threatening conditions. A robust ADR monitoring system with a feedback to and the education of the prescribers can help prevent, identify and manage this life threatening condition much more effectively.