Background: Strong relationship has been demonstrated between the presence of occlusive CAD and coronary artery calcification (CAC) detected at autopsy, fluoroscopy and computed tomography (CT scan). CT scan quantifies the relative burden of CAC deposits as a marker of atherosclerosis. Study explored utility of multi-slice spiral CT scan for detection of CAC in post myocardial infarction cases.Methods: Fifty-one post myocardial infarction cases were enrolled in the study. Detailed clinical history was recorded in every case regarding age, sex, history of risk factors for CAD like systemic hypertension, diabetes mellitus, smoking and family history of CAD. Every case was evaluated for fasting and postprandial blood sugar and fasting lipid profile. Body mass index (BMI) was also calculated. Coronary artery calcium was estimated in each patient by multi -slice spiral CT scan. Conventional angiography was also undertaken in 18 patients. Co-relation of coronary calcium with different age groups, sex, risk factors, electrocardiography and angiography was drawn.Results: Out of 51 cases scanned, 40 cases (78.4%) had detectable CAC. In 30 cases (58.8%), CAC score ranged from 1 to 100 (mild score); 6 cases (11.8%) had score between 101-400 (moderate score) while in 4 cases (7.8%) CAC score was more than 400 (severe score %). For detection of angiographically detectable disease, the sensitivity of multi-slice CT was 100% and the specificity was 33.3%.Conclusions: CAC is a valid measure of atherosclerotic plaque burden and is recommended as a screening tool for demonstrating significant atherosclerosis in susceptible subjects.

Sickle cell haemoglobin D disease (D-Punjab) is a rare variant of sickle cell disease (SCD) reported from central India. Exact incidence of pulmonary thrombosis in patients with HbSD is unknown. Pulmonary thrombosis is known complication of SCD but rare in case of HbSD pattern. We reported a case of 34-year-old male patient with HbSD (D-Punjab) with acute chest syndrome (ACS). CT pulmonary angiogram revealed near complete thrombosis of right middle lobe segmental and subsegmental branches with pulmonary infarct. Our patient responded to anticoagulant therapy. This case report is a reminder that HPLC should be done in all patients with sickle cell disease along with solubility test and hemoglobin electrophoresis to detect exact incidence of hemoglobin D disease in central India.

Purpura fulminans (PF) is an acute emergency condition manifested as purpuric rash secondary to thrombosis of microvasculature. It is rapidly progressive, can cause thrombosis in large as well as small vessels and tissue infarction. Although it is commonly associated with Meningococcal and Streptococcal infections, here we report this case of PF associated with scrub typhus infection. Our patient presented with generalised body rash and progressed to multiorgan dysfunction. On evaluation, common causes of PF were ruled out and eventually patient came out to be IgM scrub typhus serology kit test positive. Lower limb angiography and pulmonary artery angiography revealed vascular thrombosis. The patient started on IV antibiotics, other supportive managements, anticoagulation. Later the patient improved clinically, skin rash resolved with excoriations but developed gangrenous changes in both lower limbs. Hence the uncommon presentation of scrub typhus infection as purpura fulminans needs early identification and effective treatment to achieve mortality and morbidity benefit.