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Competing Interests: Conflict of interestThe authors have no conflict of interest.

Early rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis. The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value. It reduces the time to diagnose acute myocardial infarction from 6h to 3h. A recent study has demonstrated that hs-cTnI can further reduce the time to 1h in 70% of all patients with chest pain. The European Society of Cardiology 2015 guidelines recommend including a second sample of hs-cTnI within 3h of presentation This increases the sensitivity of the hs-TnI assay from 82.3% (at admission) to 98.2% and negative predictive value from 94.7% (at admission) to 99.4%. Combining the 99th percentile at admission with serial changes in troponin increases the positive predictive value to rule in acute coronary syndrome from 75.1% at admission to 95.8% after 3h. The 2015 ESC Guidelines recommend the use of a rapid rule out protocol (0h and 1h) when hs-cTnI with a validated 0 to1h algorithm is available. Training and displaying the clinical algorithm depicting the role of hs-TnI assay in acute cardiac care units and in EDs are an efficient way to deliver the new standard of care to patients. Compared with contemporary troponin assays, the hs-cTn assay accelerates the diagnostic pathway to 0-1h, thus reducing the time for diagnosis of NSTEMI and hence, its management., (Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to evaluate the maturity levels of the individual by comparing the correlation between dental, skeletal and the chronological ages., Materials and Methods: Intraoral periapical radiographs of the complete right side of the dentition and posteroanterior radiographs of the hand and wrist were obtained from 260 subjects, ranged from 3 to 15 years of age. Evaluation of handwrist roentgenograms for skeletal age and intraoral roentgenograms for dental age was done., Results: The findings of present study indicated that participated children were skeletally and dentally, retarded in maturation as compared with the standards except at 3 and 6 years of age. The girls were found to be skeletally more advanced than boys at all ages except 7 and 10 years of age. The dental maturity is more for girls than that of boys., Conclusion: No significant correlation was found among skeletal age, dental age and chronological age. Dental age and skeletal age was found to be correlated at 6, 10 and 11 years in boys and 6 and 9 years of age in girls., Clinical Significance: The results of this study could enhance the diagnosis and treatment planning in orthodontics and other dental disciplines.

Background and Aims: Malnutrition and low serum albumin among human immunodeficiency virus (HIV)-infected individuals are cofactors for HIV disease progression. The present study aimed to identify the proportion of HIV-infected individuals with low serum albumin and the possible cofactors among highly active antiretroviral therapy (HAART) experienced and HAART naïve individuals., Methods: A total of 835 HIV-infected individuals (HAART-experienced, HAART-naïve) were included in the study., Results: Of the 835 individuals, 44.6% had normal (4.2-5.2 g/dL) and 55.4% had abnormal (<4.2 g/dL) albumin levels. The abnormal group had significantly lower body mass index (BMI) compared with the normal group (P = .02). Among those with abnormal albumin, 388 (84%) were HAART experienced compared with 239 (64%) with normal albumin (P < .001). Among the abnormal group, 259 (55.9%) had CD4 count <200 cells/mL as compared with 124 (33.3%) in the normal group (P < .001)., Conclusions: CD4 count and lower were the major cofactors for low serum albumin among HIV-infected individuals. Therefore, serum albumin would be a useful biochemical test for HIV disease in resource-limited settings.

Background: The co-factors underlying abnormal lactate level remains to be determined in resource-limited settings. In a cross-sectional study conducted between January 2004 and July 2006, we determined the proportion of HIV-infected persons with abnormal lactate levels and correlated the association of certain co-factors of abnormal lactate levels at a tertiary HIV care centre in Chennai, Southern India., Methods: Lactate was estimated by the enzymatic method using an Olympus AU 400 autoanalyzer. Absolute CD4+T lymphocyte count was determined by the Guava personal cell analyser (Guava Technologies Inc., Hayward, CA, USA). Subjects were classified to have normal or abnormal values of lactate based on the reference interval (0.3-2.2 mmol/L). A p value 0.05 was considered statistically significant., Results: A total of 225 HIV-infected individuals (HAART experienced 213 (95%) and HAART naïve (5%)) were included in the analysis. Mean age was 34+/-8 and 36+/-9 years for the individuals with normal and abnormal lactate levels respectively. Of these 185 (82%) had normal (0.3-2.2 mmol/L) and 40 (18%) had abnormal (>2.2 mmol/L) lactate levels. Significant difference in relation to female gender was observed between the normal and abnormal groups (p=0.03). Among the abnormal group, 39 (97.5%) subjects were HAART experienced compared to 174 (94.1%) normal group. Among the abnormal group, 24 (60%) individuals had a CD4 count of <200 cells/microL as compared to 76 (41.1%) normal subjects., Conclusion: Female gender should be carefully monitored with respect to their clinical, laboratory and biological data to diminish the occurrence of lactic acidosis.

Background: We established the biochemical and hematological reference intervals among a south Indian healthy adult population attending an HIV referral centre in Chennai, southern India., Methods: In a cross sectional study, 213 study subjects (129 male and 84 female) were studied between March and August 2005. All of the parameters were analyzed using standard hematological and biochemical techniques., Results: Certain biochemical (viz. total bilirubin, alanine transaminase, albumin, creatinine, total protein, lipid profile, creatine phosphokinase, uric acid and lactate) and hematological (mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and lymphocyte levels) parameters presented higher upper limits. In addition, the upper limits of white blood cell count, platelet count, hematocrit, red blood cell count and hemoglobin level were low in comparison to the currently reported ranges., Conclusion: Ethnic variation in reference intervals was observed in certain biochemical and hematological analytes in a south Indian adult population.

A 34-year old male renal transplant recipient developed thrombotic microangiopathy (Hemolytic Uremic Syndrome) in the early post-transplant period following combined immuno-suppressive therapy with tacrolimus and everolimus. The management consisted of discontinuation of tacrolimus and substitution with mycophenolate mofetil. His renal functions improved, the hematological abnormalities reversed and he continues to have good graft function one year later.

A middle-aged man presented with recent-onset dyspnea and recurrent syncopal attacks at our institute. Echocardiography revealed a large mass arising from the inferior vena cava and prolapsing into the right atrium and ventricle. Histopathologic examination revealed the classic features of a myxoma. This report is of a rare case of a cardiac myxoma arising from the inferior vena cava.

Lipomatous hypertrophy is a condition that is being increasingly diagnosed with the advent of newer modalities. A middle aged lady was referred to us with recent onset dyspnea and palpitations. Echocardiography revealed diffuse thickening of the right ventricular free wall and outflow tract. Endomyocardial biopsy revealed this as a lipomatous hypertrophy involving the right ventricle. This is the first reported case of lipomatous hypertrophy involving the right ventricle.