Open Access Case Report

Neonatal Lupus and Complete Atrioventricular Block: Case Report in Mexico

Carla Eugenia Arenas Alvarez, Juan Carlos Marin Mireles, Hebert Israel Flores Leal, Ana Norma Griselda Becerril Gonzalez, Carlos Mario Guzman Sanchez

Cardiology and Angiology: An International Journal, Page 1-7
DOI: 10.9734/ca/2021/v10i330168

Aims: To describe a case of neonatal lupus and complete atrioventricular block in Mexico.

Presentation of case: A 38 years old pregnant patient at  28 + 6 weeks of gestational age, diagnosed with systemic lupus erythematosus six years ago, under treatment with hydroxychloroquine and prednisone, this was suspended eight months prior to pregnancy; and resumed at week 20 of gestational age. The ultrasound scan showed alive fetus, female, polyhydramnios and bradycardia. Fetal echocardiography confirmed complete atrioventricular block, without organic and structural alterations at the cardiac level. Furthermore, the immunological panel reports, positive anti-Ro antibodies. At week 33 of gestational age, the patient was admitted to the obstetric emergency room, through colic type pain and 4 cm dilation of the cervix. Alive newborn got vaginally with a weight of 1,990 g, a height of 43 cm and APGAR 8-9. Echocardiography confirmed congenital complete third degree atrioventricular block; without structural abnormalities.

Discussion: Patients with systemic lupus erythematosus, are more likely to have complications during pregnancy. Neonatal lupus is a rare disorder with an incidence of 1:10,000 - 1:20,000 newborns. This is caused by the transplacental passage of maternal autoantibodies anti-SSA / Ro and/or anti-SSB / La. Besides Atrioventricular block is a complication of neonatal lupus, occurring in approximately 2% of newborns of mothers who have SSA or SSB antibodies. The most interesting finding is that 20% fetal mortality has been for this cause.

Conclusion: The described case is important for its rarity. Besides, the imaging findings and immunological panel emphasized the relevance about complete and adequate evaluation of the fetus, in the context of a mother with systemic lupus erythematosus.

Open Access Case Study

Anterior Mitral Leaflet Tear during Balloon Mitral Valvotomy in a Case of Juvenile Mitral Restenosis

Rohit Rai, Gajanan D. Gawande, Shakil S. Shaikh, Narender O. Bansal

Cardiology and Angiology: An International Journal, Page 8-12
DOI: 10.9734/ca/2021/v10i330169

Recurrent attacks of rheumatic fever can lead to mitral stenosis. In a country like India mitral stenosis can develop in the first decade of life. Our patient presented with recurrent mitral stenosis at twelve years of age. He had undergone balloon mitral valvotomy at the age of seven. However this time he developed anterior mitral valve leaflet tear after balloon mitral valvotomy and had to be taken for mitral valve repair. Due to severe fibrosis of mitral valve the patient underwent mitral valve replacement. He was started on warfarin and dose titrated according to PT / INR. Patient was discharged but has to be on lifelong anticoagulation from the age of twelve.

Open Access Original Research Article

Effect of Calamari Oil on Lipid Profile of Streptozotocin Induced Diabetic Rats

U. J. O. Orji, H. Brown, E. O. Nwachuku, N. Boisa

Cardiology and Angiology: An International Journal, Page 22-31
DOI: 10.9734/ca/2021/v10i330171

Aim: The aim of this study was to assess the effect of Calamari Oil on lipid profile levels in diabetes streptozotocin induced diabetic Rats.

Study design: An experimental study.

Place and duration of study: Animal House, Department of Applied and Environmental Biology, Rivers State University, Port Harcourt and University of Port Harcourt Rivers State, Nigeria, between February 2020 and August 2020.

Methodology: Thirty Six (36) albino rats were purchased and allowed to acclimatize for two (2) weeks in the laboratory at the animal farm house of the Department of Animal and Environmental Biology, Rivers State University. They were fed the normal rat feed (Chow feed) and water was allowed ad libitum. The rats were weighed and randomly grouped into six (6) groups with six rats in each group. Group 1 (Negative control) was placed on normal diet while groups 2 to 6 were placed on a high fat diet (HFD) prior to the induction with Streptozotocin to achieve diabetes and the animals were treated according to their groupings for four weeks by means of oral gavage. The dose of Calamari Oil administered to the rats was extrapolated from human doses. The high fat diet was prepared by mixing the animal feed (Chow diet) with margarine in a ratio of 3:1. After each period of treatments, blood samples were collected from the rats at the end of the treatments via cardiac puncture by anaesthetizing the rats with chloroform after a six (6) hour fast. Fasting blood glucose was determined using the Glucose Oxidase method, lipid profile was analysed spectrophotometrically and Atherogenic coefficient (AC) and Castelli ratio index-1 level (CRI-1) were calculated. The GC–MS analysis of bioactive compounds from Calamari Oil was done using Agilent Technologies GC systems with GC-7890A/MS-5975C model. Data generated were analysed using SPSS version 22.0 of windows statistical package. Results were considered statistically significant at 95% confidence interval (p < 0.05).

Results: The results showed that after week 1 - 4 of exposure, the mean TG (Triglyceride) value of the Negative control group (NC), Positive control (PC) group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 130.89 ± 2.52, 174.94 ± 3.11, 166.64 ± 1.95, 160.61 ± 0.60, 153.37 ± 2.24 and 141.62 ± 0.99 respectively. Mean TC (Total cholesterol) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 160.93 ± 2.99, 194.96 ± 2.09, 188.18 ± 1.41, 180.63 ± 0.59, 169.96 ± 1.47 and 159.71 ± 1.43 respectively. HDL (High density lipoprotein) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 83.05 ± 2.96, 65.68 ± 1.78, 66.97 ± 1.28, 72.75 ± 0.52, 76.35 ± 0.77 and 78.94 ± 0.86. Mean LDL (Low density lipoprotein) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 51.7 ± 3.21, 94.3 ± 0.48, 88.15 ± 1.08, 75.76 ± 0.62, 62.95 ± 0.94 and 52.46 ± 0.59 respectively. The mean non- HDL cholesterol value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 159.93 ± 2.99, 193.96 ± 2.09, 187.18 ± 1.41, 179.63 ± 0.59, 168.96 ± 1.47 and 158.71 ± 1.42  respectively. Also, mean cholesterol ratio value of the NC, PC groups, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 1.94 ± 0.07, 2.97 ± 0.06, 2.81 ± 0.04, 2.48 ± 0.02, 2.22 ± 0.01 and 2.02 ± 0.01respectively.

Conclusion: Type 2 diabetes is associated with dyslipidemia and as such the treatment with the Calamari Oil in the treated groups had positive effect on lipid profile markers  with TG, TC, LDL, AC, CRI-1 decreasing and HDL increasing with increase in duration of time.

Open Access Original Research Article

Relation between Shock Index, Severity of Coronary Artery Disease and Outcomes in ST Elevation Myocardial Infarction Patients

Mohamed Salama Sharban, Ahmed Farouk Alaarag, Mona Adel Elsaidy, Magdy Mohamed El-Masry

Cardiology and Angiology: An International Journal, Page 13-21
DOI: 10.9734/ca/2021/v10i330170

Background: Coronary artery disease is considered a major cause of death in both male and female subjects in the developed world and carries a risk of several complications.

Multiple scores have been developed in order to set risk stratification and predict the outcomes for ischemic patients. Another scores have been developed in order to assess the severity of the coronary arteries lesions.

Methods: The prospective cross sectional cohort study included 68 consecutive patients with STEMI; they were divided into two groups based on the shock index at presentation. Group A: included 43 patients with SI ˂0.7. Group B: included 25 patients with SI ˃ 0.7. All participants were subjected to trans-thoracic echocardiography, PPCI, SYNTAX score calculation and follow up during the hospitalization period.

Results: There was a significant myocardial damage in group B supported by the reduced LVEF and elevated serum troponin at presentation. There was a significant more coronary artery lesion severity in group B as assessed by the SYNTAX score. As regard in-hospital outcomes, patients in group B had the worst outcomes during the hospitalization period.

Conclusions: Shock index is a useful and quick tool to predict the severity of the underling coronary artery disease and correlate with the SYNTAX score in patients with STEMI. Shock index is a good indicator of the hemodynamics and the extent of myocardial damage. Shock index is a quick bedside tool with a good prediction value for the in-hospital outcomes in STEMI patients undergoing PPCI.