The functional receptor to SARS-CoV-2, the virus responsible for the coronavirus disease 2019 (CO... more The functional receptor to SARS-CoV-2, the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, is angiotensin-converting enzyme-2 (ACE-2), the same enzyme that physiologically counters the renin-angiotensin system (RAS) activation. Some researchers have questioned RAS inhibitors’ safety in COVID-19 patients since these drugs have demonstrated an increase in ACE-2 expression in preclinical studies; therefore, they may facilitate viral invasion. On the contrary, others have hypothesized a protective role of RAS inhibitors against COVID-19-associated lung injury. Overall, the data are grossly inadequate to reach any conclusion since no human trials have yet evaluated the effects of RAS inhibitors in COVID-19. We review the current data and pathophysiological mechanisms behind this intriguing interplay between the RAS inhibitors and the COVID-19.
Journal of Cardiovascular Diseases and Diagnosis, 2017
A 35-years-old female presented to us for evaluation of a recent episode of syncope. She also com... more A 35-years-old female presented to us for evaluation of a recent episode of syncope. She also complained of exertional breathlessness for past 6 months. She denied experiencing orthopnea, paroxysmal nocturnal dyspnea, fever, weight loss and chest pain. At presentation, her vitals were stable (pulse=78/min and regular, BP=120/78 mm Hg). Cardiac auscultation revealed a mild diastolic murmur at the apex raising possibility of mitral stenosis. On transthoracic echocardiogram, a large (45 mm × 25 mm) mobile, irregular mass was seen in the left atrium (Figure 1). This mass was hetero-echoic in echotexture and was attached to the inter-atrial septum in the region of fossa ovalis. All these findings were suggestive of the diagnosis of atrial myxoma. It was prolapsing into the left ventricle during diastole (Figure 2). Colour Doppler revealed increased velocity of blood flow across the mitral valve. On continuous-wave Doppler, peak and mean gradients across mitral valve were 18 mm Hg and 8 m...
This cross sectional, observational study was performed in 170 adult patients with splenomegaly w... more This cross sectional, observational study was performed in 170 adult patients with splenomegaly who reported to Department of Medicine, Pt. B. D. Sharma, PGIMS Rohtak from may 2014 to april 2015, over a period of 1 year. The patients were evaluated for their complete clinical profile & etiology of splenomegaly. Grading of splenomegaly was done by Hacket's grading. Thorough relevant investigations were carried out. Most patients were below 45 years of age. Most common etiological category of splenomegaly was hematological (54.7%) followed by congestive (24.5%), infectious (15.88%) and other (4.7%) causes. Most common splenomegaly patients belong to hacket’s grade II (55%), followed by grade III (28%), grade I (13%) & grade IV(4%). Among hematological etiology chronic myeloid leukemia was most common cause(25.29%). Malaria was the commonest etiology among infectious causes. On clinical examination pallor was present in 87% cases. 44% of patients had hepatomegaly, 26% of patients h...
Lutembacher Syndrome- A Case Report and Reappraisal
Lutembacher syndrome is defined as a combination of mitral stenosis (mostly rheumatic) with a lef... more Lutembacher syndrome is defined as a combination of mitral stenosis (mostly rheumatic) with a left to right shunt at the atrial septal level. It is a rare disease with a higher prevalence in areas, where rheumatic heart disease is common. Diagnosis on physical examination can be challenging and therefore echocardiography is generally required to make the diagnosis. If not diagnosed and treated early, patient may develop right heart failure and arrhythmic complications, which bear a bad prognosis. We present a case-based reappraisal of Lutembacher syndrome in a 23-years old female, who presented with symptoms of pulmonary hypertension and heart failure. Introduction In medical literature the first description of Lutembacher syndrome was mentioned in a letter by anatomist Johann Fredrich Meckel to Albert von Hallerin in 1750 [1]. In 1811, Corvisart first described the Association of Atrial Septal Defect (ASD) and Mitral Stenosis (MS) [2]. Rene Lutembacher in 1916 published the first c...
The Journal of the Association of Physicians of India, 2019
Fig. 2: Rhythm strip (A) During tachycardia; (B) Termination of tachycardia on application of mag... more Fig. 2: Rhythm strip (A) During tachycardia; (B) Termination of tachycardia on application of magnet; (C) After programming the PVARP 6 yrs male, a known case of dilated cardiomyopathy, was implanted dual chamber permanent pacemaker, two years back, for complete heart block. He presented with increased breathlessness and palpitation for two days. ECG showed wide QRS tachycardia (Figure 1, Figure 2, strip A). There was suggestion of pacing spike before the QRS complex. P waves were not identified. Since ventricular pacing was occurring at inappropriately higher rate, possibility of pacemaker mediated t a c h y c a r d i a ( P M T ) / e n d l e s s l o o p tachycardia was kept. Magnet was kept over the generator, and the tachycardia was terminated (Figure 2, strip B). After this, post ventricular atrial refractory period (PVARP) was increased by programming the pacemaker and ECG showed atrial sensing with ventricular pacing (Figure 2, strip C).
Anemia in the elderly patients is an and impair the quality of life. almost always warranted to i... more Anemia in the elderly patients is an and impair the quality of life. almost always warranted to identify its cause. investigated about the morphological type and the etiological spectrum of anemia in 100 patients with age 60 years and above. Hb< 12gm/dl (in females) and Hb<13gm/dl (in males) Criteria} consisted of 66 male patients and 34 female patients with generalized weakness and easy fatigability as the most common symptom which was present in 100% of cases. The most common cause of anemia in (20%) than malignancy (15%), vitamin B12 and folic acid deficiency (14%), anemia of chronic inflammation (11%) and in 5% others including unexplained anemia. Overall causes were 50% and non was the most common morphological type; was followed by microcytic hypochromic 30%) and then macrocytic as least common (17%). causes were almost equal in our study that is comparable to other Indian studies and some western studies but the pattern vary from study to study indicates geographical va...
To Study the Clinico-Haematological Spectrum of Pancytopenia in a Tertiary Care Centre of North India
The present prospective cross sectional study was conducted at Pt. B.D. Haryana on 100 patients o... more The present prospective cross sectional study was conducted at Pt. B.D. Haryana on 100 patients of pancytopenia of age group 14 hematology and medicine ward during year 201 properly evaluated for their complete clinical profile & etiology of pancytopenia. Panctopenia was diagnosed in the presence of hemoglobin <12gm/dl, total leukocyte count (TLC) <4000/microL, platelet count belong to young age group with mean age 42.87±15.54 years. Most common etiology of pancytopenia was megaloblastic anemia (39%) followed by aplastic anemia (29%), Aleukemic leukemia (15%) and other causes. Among megaloblastic anemia pure vitamin B12 deficiency was observed in 27 cases. On clinical examination pallor was present in 100% cases. 31% of patients had hepatomegaly, 27% of patients had splenomegaly. We compared the studies & concluded that clinico region.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020
To the Editor Dear Sir. We read with great interest the recently published article in this journa... more To the Editor Dear Sir. We read with great interest the recently published article in this journal by Singh A.K et al. [1], regarding the controversies surrounding the use of RASB (Renin-angiotensin system blockers) among hypertensive patients in the COVID-19 (coronavirus 2019) era. Though we agree with the authors on most parts of the review, we have few concerns regarding the rationale and mechanisms for benefit of RASB in COVID-19 (section 3.5 b). We agree with one of the proposed mechanism that involves an increase in the soluble form of ACE-2 (Angiotensin-converting enzyme-2), which acts as an interceptor by binding to SARS-CoV-2 (Severe acute respiratory syndrome coronavirus-2) and does not allow the virus to bind to the membrane bound ACE-2 receptor, thereby inhibiting viral entry inside the cell [1e3]. However, we do not agree with the other proposed mechanism whereby authors have suggested that "RAS blockers increase angiotensin II, which is a substrate for ACE-2.
Heterozygous Protein-C Deficiency Presenting As Stroke Due To Cerebral Venous Sinus Thrombosis: A Case Report
Iranian Journal of Neurology, 2016
Plasma protein-C is a natural anticoagulant in our body & has inhibitory effects on factors V and... more Plasma protein-C is a natural anticoagulant in our body & has inhibitory effects on factors V and VIII. Hereditary protein C deficiency is transmitted as an autosomal dominant disorder. In Homozygous individuals it usually manifests as purpura fulminans in newborns whereas heterozygous protein C-deficient individuals are at increased risk for venous thrombosis. We are presenting a case of young male patient with heterozygous protein-C deficiency who experienced right sided hemiparesis due to cranial venous sinuses thrombosis without underlying major risk factors. Cerebrovascular accidents in young without underlying major risk factors should be evaluated for thrombophilia including protein C deficiency.
Heparin-induced thrombocytopenia (HIT) is an immune mediated adverse drug reaction caused by the ... more Heparin-induced thrombocytopenia (HIT) is an immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin. Despite thrombocytopenia, bleeding is rare. HIT is strongly associated with thromboembolic complications involving both the arterial and venous systems. A number of laboratory tests are available to confirm the diagnosis; however, when HIT is clinically suspected, treatment should not be withheld pending the result. Fortunately, therapeutic strategies have been refined, and new and effective therapeutic agents are available. We present a case of HIT Type II. A review of HIT is presented, examining the important clinical symptoms and diagnostic indicators. The treatment of HIT is then discussed, with an emphasis on current therapies. An extensive literature review has been performed to present a comprehensive review of the causes, pathophysiology and treatment of HIT.
Use of judkins left as a multipurpose catheter for simultaneous transradial percutaneous coronary angioplasty of left and right coronary arteries: A time-saving and cost-effective innovation
Proper hardware selection during percutaneous coronary angioplasty (PCI) remains the key to the s... more Proper hardware selection during percutaneous coronary angioplasty (PCI) remains the key to the successful procedure, especially in the setting of an acute coronary syndrome (ACS) where minimizing the procedure time and the amount of dye is of utmost importance. Recent studies have demonstrated the benefit of complete revascularization in cases of multivessel disease in the ACS setting. During transradial intervention in a case of multivessel PCI, guiding catheter-induced radial artery spasm is a major concern. People have used guiding catheters such as Ikari for simultaneous PCI of right and left coronary arteries. This minimizes the risk of radial spasm and saves precious time, especially in the setting of ACS where each second counts. Limited data exist regarding the use of Judkins left (JL) catheter for PCI of simultaneous right and left coronary artery. Here, we describe an interesting case of simultaneous PCI of left anterior descending – infarct-related artery and right coron...
This study was performed in 100 patients receiving first-line highly active antiretroviral therap... more This study was performed in 100 patients receiving first-line highly active antiretroviral therapy (HAART) through the National AIDS Control Programme of India in May-July 2013 at ART centre PGIMS Rohtak (Haryana). The patients were followed for six month for analysing the immune response and toxicity profile of first line antiretroviral therapy. Of the 100 patients the median CD4 count of enrolled patients was 233.33±151 cells/ cumm at treatment initiation; 14% had baseline CD4 count <100 cells/ cmm. Of the 100 patients 91% were alive after 6 months. The mean CD4 count of the cohort was increased from 233.33±151 cells/cumm to 434.8 ± 217cells/cumm at six month, (P < 0.0001). Mean weight increased from 48.9 ± 10 Kg to 57 ± 10.7 Kg, Mean BMI increased from 22.2 ± 4 Kg/m2 to 25.9 ± 4 .3 Kg/m2 and Mean haemoglobin increased from 10.6 ± 2 gm% to 12.8 ± 1.2 gm%. The rise was statistically significant (P < 0.0001). The side effects of HAART were reported in 70 % of the patients. ...
Uploads
Papers by Naresh Gaur