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Purpose: Current ICD recommendations are based on studies which were concluded decades ago. Meanwhile, significant changes have occurred in medical therapy, ICD programming and concomitant comorbidities. As a result incidence of ICD therapies and sudden cardiac death have decreased and significant number of patients undergoing ICD never any appropriate therapy discharged. This study was planned to look for prevalence of appropriate therapy and its predictors. Methods: Study was cross-sectional with retrospective collection of clinical, ECG and echocardiographic parameters from ICD implanted patients for primary prevention at the time of interrogation, which had to be at least of 12 months from device insertion. Appropriate ICD therapies were ascertained. Patients with indications for CRT, pacing and wide QRS patients as well as the familial cardiomyopathies and channelopathies were excluded. Resting ECG parameters analyzed included QTc, Tpeak-Tend, QRSd, fQRS, early repolarization pattern. To predict appropriate ICD therapies multivariate logistic regression analysis was carried out with p value <0.05 considered significant. RESULTs: 64 patients were enrolled. 12 patients experienced appropriate therapy while 5 had adverse events related to ICD. QTc, TpTe and fQRS proved to be statistically significant predictors in univariate analysis (p value of 0.04, 0.005, 0.009 respectively). Mult ivariate analysis yield only 2 significant predictors including fQRS with odds ratio of 5.5 (95% CI 1.4-24, p=0.006) and every 10ms increase in TpTe had odds ratio of 1.74 (95% CI 1.21-11.3, p=0.01). ROC curve analysis yielded a cut-off of 103.5ms for optimal prediction of 75% sensitivity and 73% specificity of appropriate therapy by TpTe. Conclusion: Overall, difference between benefit versus risk in a contemporary ICD cohort was narrow. Amongst the various parameters studied only TpTe and fQRS proved to be valuable. Larger prospective cohorts need to be studied for better understanding of variables predicting net ICD benefit. [ABSTRACT FROM AUTHOR]

Objective: Recent studies have elaborated classical echo patterns of typical LBBB, which have preliminarily shown to enhance the CRT prediction over and above ECG. This study was undertaken to understand the relationship of typical echo dyssynchrony pattern with various ECG parameters in heart failure patients with true LBBB. Methods: Subjects with LBBB and EF =35% were involved. ECG parameters studied included intrinsicoid deflection duration, left ventricular activation time, mechanical deflection index along with global QRS duration. Septal flash pattern on echo was chosen to indicate true mechanical dyssynchrony due to LBBB. Standard 12 lead ECG were analyzed manually with use of digital EP calipers. Univariate comparison done with Mann-Whitney U and Chi-square test. Stepwise multivariate logistic regression analysis carried out to predict SF and receiver operating characteristic (ROC) curves constructed. Subgroup analysis done in group with QRSd 130-149ms separately. Significance was set at a probability level of < 0.05 and analysis performed using SPSS software. RESULTs: 220 patients were enrolled. Overall 59.5% patients demonstrated septal flash with positive correlation with QRSd and negative with ischemic etiology of heart failure. Intrinsicoid deflection duration predicted septal flash significantly in multivariate analysis (OR 1.78 for every 10ms increase). Subgroup analysis involving 130-149ms of QRSd patients too showed intrinsicoid deflection duration as only significant predictor (OR 1.9 for every 10ms increase) with ROC analysis providing optimal cut-off of 87ms. Conclusion: Septal flash was present in significant number of patients with QRS duration between 130-149. Ischemic etiology of heart failure had lower septal flash prevalence. Intrinsicoid deflection duration and mechanical deflection index successfully predicted septal flash, even in patients with narrower QRS complex while QRS duration and left ventricular activation time added no value. [ABSTRACT FROM AUTHOR]

Objective: Diabetes mellitus has been claimed to be a risk factor for the development of pancreatic carcinoma. CA 19-9 has a great sensitivity in detection of pancreatic adenocarcinoma. Metformin exhibits a strong and consistent antiproliferative action on several cancer cell lines including pancreatic cancer. We aim to determine the influence of metformin on CA 19-9 levels in type 2 diabetes mellitus patients., Methods: Total 193 patients with type 2 diabetes mellitus were registered for a single centre, cross-sectional study. On the basis of treatment modalities, patients were divided into metformin group (93 patients) and non-metformin group (100 patients). Detailed history, clinical examination, anthropometric measurements, serum CA 19-9 level, glucose and lipid metabolic profiles were determined. Results were presented as mean±SD. Association between CA 19-9 level and other variables were assessed with Pearson correlation and multiple stepwise regression analysis., Results: Mean CA 19-9 level was 18.99±4.30 U/ml in the metformin group as compared to 30.49±5.61 U/ml in non-metformin group (p<0.001). Mean value of CA 19-9 was found highest among all i.e. 37.05±4.94 U/ml in patients taking insulin. Patients having lifestyle modification for the management of diabetes had their mean CA 19-9 level of 21.39±5.62 U/ml. CA 19-9 level is positively correlated with age, duration of diabetes, BMI, 2-hour Plasma Glucose level, HbA1C, VLDL cholesterol, triglyceride, total cholesterol, LDL cholesterol (p<0.005) and negatively correlated with HDL cholesterol (p<0.001)., Conclusion: Metformin is associated with lower level of CA 19-9 in type 2 diabetes mellitus patients. It may have a protective role in preventing pancreatic damage and pancreatic cancer in diabetic individuals. CA 19-9 level could be an effective indicator of glycemic control, disease progression and lipid metabolism in patients with type 2 diabetes mellitus., (© Journal of the Association of Physicians of India 2011.)

Background: Increase in prolactin during pregnancy has been identified as a major stimulus for β cells. These effects have been demonstrated in both in-vitro and in-vivo non-pregnant animal models. Recently, bromocriptine has also been approved for the therapy of type 2 diabetes, regardless of the baseline prolactin level, with its mechanism of action poorly understood. Hence, this study was planned to assess whether prolactin levels within normal range associates with prediabetes and diabetes., Methods: A total of 300 participants, 180 males and 120 females, with equal number of subjects in the prediabetes, diabetes and normal group were analyzed. The participants were categorized into sex-specific quartiles of serum prolactin, with the first quartile representing subjects with the lowest prolactin levels and the fourth quartile having the highest levels. In addition, multinomial logit analyses were performed to evaluate the odds ratio and 95% confidence interval of having prediabetes & diabetes for each quartile., Results: Prolactin levels in the normal group were 10.99 ± 3.65 ng/ml for the males and 12.25 ± 3.67 ng/ml for the post-menopausal females. The prolactin levels for the males in prediabetes group were 9.46 ± 3.43 ng/ml and for diabetes group were 8.98 ± 3.43 ng/ml (p value = 0.005). In females, the prolactin levels were 10.20 ± 3.99 ng/ml for the prediabetes group and 9.60 ± 3.85 ng/ml for the diabetes group (p value = 0.007). The mean fasting plasma glucose for the four male quartiles in their numerical order were 135 mg/dl, 128 mg/dl, 120 mg/dl and 110 mg/dl (p value = 0.04) and the mean HbA1c in the same order for the quartiles were 7%, 6.4%, 6.1% and 5.9% (p value = 0.01). Similarly, the mean fasting plasma glucose for the four female quartiles in their numerical order were 138 mg/dl, 131 mg/dl, 124 mg/dl and 107 mg/dl (p value = 0.03) and the mean HbA1c in the same order for the quartiles were 7.2%, 6.7%, 6.3% and 5.8% (p value = 0.01). The age adjusted odds ratio for 2nd, 3rd and 4th quartiles as compared to the 1st quartile for prediabetes in men were 0.82, 0.72 and 0.61 and for diabetes were 0.84, 0.65 and 0.55, respectively. Risk for diabetes in females ranged from 0.04 to 0.72 for the 3rd quartile and 0.03 to 0.56 for the 4th quartile as compared to 1st quartile. The risk for prediabetes in females ranged from 0.06 to 0.95 for 3rd quartile and 0.04 to 0.74 for the 4th quartile as compared to 1st quartile., Conclusions: Mean prolactin levels in both males and females were lower in prediabetics and lowest in diabetics. Prolactin, on quartile based analysis, associated with better HbA1c and fasting plasma glucose. Decreasing relative risk trends for both prediabetes and diabetes were found with increasing serum prolactin concentrations. No association was found with obesity and dyslipidemia.

Objective: Thrombocytopenia in dengue fever is a common and serious complication. However, no specific treatment is available for dengue fever induced thrombocytopenia. In few countries (Pakistan, Malaysia, Sri Lanka and other Asian countries) the leaf extract of Carica papaya has been effectively used for thrombocytopenia. So, the study is planned to access effect of Carica papaya leaf extract on platelet count in dengue fever patients., Methods: All participants were randomised into two groups, study group and control group; the study group was given papaya leaf extract capsule of 500 mg once daily and routine supportive treatment for consecutive five days. The controls were given only routine supportive treatment. Daily complete blood counts, platelet counts and haematocrit level, liver function test, renal function test of both groups were observed., Results: On the first day platelet count of study group and control group was (59.82±18.63, 61.06±20.03 thousands, p value 0.36). On the 2nd day platelet count of both study and control groups was not significantly different (61.67±19.46 and 59.93±19.52 thousands, p value 0.20) but on 3rd day platelet count of study group was significantly higher than control group (82.96±16.72, 66.45±17.36 thousands, p value < 0.01). On 4th and 5th day platelet count of study group (122.43±19.36 and 112.47±17.49 thousands respectively) was also significantly higher than the control group (88.75±21.65 and 102.59±19.35 thousands) (p value < 0.01). On 7th day platelet count of study group and control group were not significantly different (124.47±12.35 and 122.46±19.76 thousands respectively, p value 0.08). Average hospitalization period of study group v/s control group was 3.65±0.97 v/s 5.42±0.98 days (p value < 0.01). Average platelet transfusion requirement in study group was significantly less than control group (0.685 units per patient v/s 1.19 units per patient) (p value <0.01)., Conclusions: It is concluded that Carica papaya leaf extract increases the platelet count in dengue fever without any side effect and prevents the complication of thrombocytopenia. So, it can be used in dengue fever with thrombocytopenia patients.