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BackgroundA chronic total occlusion (CTO) is defined as an angiographically documented or clinically suspected complete interruption of antegrade coronary flow (Thrombolysis in Myocardial Infarction (TIMI)-0 flow) of greater than 3 months standing. Coronary CTOs represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. Decision to treat or not to treat a CTO is always confusing. This is an attempt to provide clinical profile of patients having totally occluded coronary arteries and their natural history.MethodsThe observational study was carried out in tertiary health center in Mumbai. Totally 117 patients who had CTO on angiography were selected. Their clinical presentation and angiography correlation was done and results were analyzed.ResultsOut of a total of 117 patients, 86 (73.50 %) were males, female 31(26%). All of the patients studied were above 40 years. Age group 40 - 49 years had 25 (21.36%) patients, 50 - 59 years had 32 (27.35%), 60 - 69 years had 43 (36.75%), > 70 years had 17 (14.52%) patients. Smoking as a risk factor was present in 32 (27.35%), tobacco in 45 (38.46%), alcohol in six (5%), no addictions in 35 (29.91%) patients. Diabetes in 63 (53.84%), hypertension in 78 (66.67%) patients, both were present in 49 (41.88%), dyslipidemia in 37 (31.62%) patients. Sixty-three (53.84 %) patients presented with unstable angina (UA)/non ST elevated myocardial infarction (NSTEMI), 32 (27.35%) with chronic stable angina (CSA), ST elevated myocardial infarction (STEMI) in 22 (18.80%). History of prior myocardial infarction (MI) was present in 36 (30.76%), prior coronary artery bypass graft (CABG) in nine (7.6%), prior percutaneous intervention (PCI) in 18 (15.38%). Triple vessel disease (TVD) in 38 (32.47%), double vessel disease (DVD) in 53 (45.29%), single vessel disease (SVD) in 26 (22.22%) patients. Left anterior descending artery (LAD) CTO was present in 40 (34.18%), right coronary artery (RCA) in 61 (52.14%), left circumflex artery (LCX) obtuse marginal (OM) in 16 (13.67%) patients.ConclusionsPatients having CTO of coronary arteries are mostly above age of 40 years. Most common age group was 60 - 69 years. It was most common in males than females. Tobacco chewing was more commonly associated followed by smoking. Hypertension and diabetes were strongly associated with CTO. Most patients presented with unstable angina/NSTEMI followed by chronic stable angina. Old MI was present in one third of patients. Most common artery to be affected was RCA followed by LAD.

The posterior descending artery (PDA) supplying the posterior one-third of the inter-ventricular septum usually arises from the right coronary artery (RCA) or the left circumflex artery (LCX). PDA arising from the left anterior descending artery (LAD) is an extremely rare anomaly. Here we report a rare type of left dominant circulation in which a large LAD is continuing as PDA after winding round the apex in the presence of a diminutive RCA. Such a large LAD continuing as PDA is referred as “hyperdominant” or “superdominant”. A 32–year-old male chronic smoker presented with acute onset retrosternal pain of 4 h duration with profuse sweating in primary health center with electrocardiography (ECG) changes in inferior leads and was thrombolysed with intravenous streptokinase 15 lacs IU over one hour and was referred to our center for further management and coronary intervention. Coronary angiogram revealed PDA as a continuation of the LAD beyond the crux and a non-dominant right coronary as well as LCX. The LAD had plaque in mid-LAD course. Intravascular ultrasound study (IVUS) showed insignificant plaque in mid-LAD (30%). Hence, we decided to keep him on medical therapy only.

Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome can affect the natural course of tuberculosis (TB) and pose diagnostic difficulties and may negatively affect the treatment due to frequent drug interactions in the advanced state of disease. Targeted tuberculin skin testing (TST) for latent tuberculosis infection (LTBI) identifies persons at high risk for TB who would benefit by treatment of LTBI, if detected. Materials and Methods: A prospective observational study conducted at the Department of Pulmonary Medicine and Department of Internal Medicine, MIMSR Medical College, Latur, India from November 2012 to October 2013 included all HIV-positive patients attending the outdoor department. A total of 100 HIV-positive patients subjected to TST were studied. The clinical presentation, CD4 count and tuberculin test result were studied. Chi-square test was applied to know the test of significance. Results: In this study of 100 patients, 48 were male, 52 were female and the male to female ratio was 0.92:1, with majority of the cases in the age group of 31-40 years. The mean age of the patients was 35.89 years. The most common mode of transmission of HIV infection was heterosexual in 93 patients (93%), blood transfusion in four patients (4%) and injections in three patients (3%). Of the 100 patients studied, 56 patients were TST negative (56%), whereas 44 patients were TST positive (44%). Of the 100 patients studied, 48 patients had a CD4 count of <200 cells/mm3; of these 48 patients, 37 patients were TST negative and 11 patients were TST positive. Conclusion: TST reactivity varied directly and that of anergy inversely with absolute CD4 counts. TST should be correlated with CD4 count as indurations to protein purified derivative depend on CD4 count. TST in asymptomatic HIV cases, irrespective of CD4 count, would definitely guide regarding decision of chemoprophylaxis in LTBI. The role of TST in the decision to start chemoprophylaxis in LTBI should be considered cautiously in India, as the prevalence of both HIV and TB is high.

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