BACKGROUND Coronary Artery Disease is the leading cause of death worldwide currently, resulting in around 7 million deaths per year and can rise by 40% around 2020. The prevalence of CAD and the incidence of ACS also are very high and occurs 5-10 years earlier among Indians. The overall cardiovascular mortality is predicted to have risen by 103% in men and 90% in women between 1985 and 2015. Hyperglycaemia is an independent risk factor for cardiovascular diseases. Therefore, we evaluated the effect of HbA1c values on clinical outcomes in diabetic and non-diabetic patients following acute coronary syndromes (ACS). METHODS The study was conducted in patients admitted with acute coronary syndromes in Department of Medicine in Chalmeda Anand Rao Institute of Medical Sciences from January 2017 to September 2018. Chi-square test was used wherever comparisons were needed between the two groups, or between two categories in the same group. A p value < 0.05 was considered significant. RESULTS SVD was seen in 100% of patients with HbA1c <5%. SVD and DVD were seen in 84.2 and 15.7% of patients with HbA1c 5.1-5.6%, respectively. SVD, DVD and TVD were seen in 57.65%, 34.6% and 7.6% of patients with HbA1c 5.7-6.4% respectively. SVD, DVD and TVD were seen in 50%, 15.3% and 34.6% of patients with HbA1c >6.5% respectively. In our study, RCA (42) was most frequently affected vessel followed by LAD (37) and LCX (20). CONCLUSIONS Higher HbA1c values were associated with more severe disease and more extensive involvement of coronary vessels in diabetics as well as pre-diabetics. RCA followed by LAD are common culprit vessel in diabetics.

Coinfections/mixed infections are common in the respiratory tract. Many times existing organisms have similar risk factors and clinical features that make the diagnosis difficult. Coronavirus diagnosed in 2019 (COVID-19) and tuberculosis (TB) are two such diseases. Patients with TB have lower cellular immunity and impaired pulmonary function. In such environment, atypical organisms, can infect and make the outcome unfavorable. A 21-year-old malnourished (body mass index- 15 kg/m2) girl presented with fever and cough for 10 days. Sputum for Cartridge Based Nucleic Acid Amplification Test demonstrated Mycobacterium tuberculosis with no rifampin resistance. Fever persisted (100–101°F) and saturation was dropping even after 10 days of antitubercular treatment. A repeat reverse transcription–polymerase chain reaction was done and was positive. In view of persistent symptoms after 20 days, bronchoscopy was done, and cultures showed Bordetella bronchiseptica. Fever and symptoms resolved completely after initiation of the sensitive drug. Diagnostic delay in coinfections can lead to increased morbidity and mortality.