Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 257 - 260

Study of Acute Myocardial Infarction in Young Adults: Risk Factors, Presentation and Angiographic Findings

Sricharan K.N., Rajesh Rai, Rashmi, Meghana H.C., Sanjeev Badiger, Soumya Mathew

1. Assistant Professor, Dept of Medicine, A.J.Institute of Medical Sciences, Mangalore, India. 2. Associate Professor, Dept of Medicine, A.J.Institute of Medical Sciences, Mangalore, India. 3. Associate Professor, Dept of Community Medicine,K.S.Hegde Medical Academy, Mangalore-18, India. 4. Postgraduate, dept of Oral medicine and Radiology, Bapuji Dental College, Davangere, India. 5. Associate Professor, Dept of Community Medicine,K.S.Hegde Medical Academy, Mangalore-18, India. 6. Assistant Professor, Dept of Medicine, A.J.Institute of Medical Sciences, Mangalore, India. NAME OF DEPARTMENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRIBUTED: Department of Medicine, J.J.M.Medical College, Davangere, Karnataka, India.

Correspondence Address :
Rashmi,
Associate Professor, Dept of Community Medicine,
K.S.Hegde Medical Academy,
Mangalore-18, Nitte University Karnataka, India.
phone: 9880496567
E-mail: dr.rashmi.kundapur@gmail.com

Abstract

Background: Acute Myocardial Infarction (AMI) continues to be a major public health problem in the industrialized world and it is becoming an increasingly important problem in the developing countries also.

Method: The diagnosis of myocardial infarction (MI) was based on the WHO criteria. Patients who were aged <15 years and > 40 years, who did not meet the WHO criteria for the diagnosis of MI were excluded. The data were prospectively recorded as per the protocol. In all the participants, details of the age, sex and occupation were recorded, together with details of smoking, alcohol use, a known history of diabetes mellitus and hypertension and a significant family history of ischaemic heart disease. Weight, height, fasting blood glucose, cardiac enzymes (CPK- MB) and the echocardiographic status was evaluated in all the patients.

Results: The mean age of the patients with myocardial infarction was 37.03 years, with a maximum number of patients (70%) in the age group of 35-40 years. There were no patients from the below 25 years age group. Smoking was most common risk factor of MI (70%) in young adults. A family history of ischaemic heart disease (IHD) was present in 13.33% of the patients. Hypertension, diabetes and a body mass index of >25kg/m2, each formed 10% of the risk factors. The most common symptom was chest pain (90% patients). Two third of the patients had anterior wall MI. A majority of the patients (57.14%) had single vessel disease, which was seen on coronary angiography.

Conclusion: Smoking was most common cause of the MI (70%) in young adults. The mean time of presentation of MI after the onset of the symptoms was 20.73hrs. Two third of the patients had anterior wall MI.

Keywords

Cluster headache, Demographic details, Migraine, Symptoms, Tension type headache

Background
Overall, 4-8% of the patients with acute myocardial infarction (AMI) are less than 40 years of age. A recent Bethesda Conference proposed a classification scheme according to the strength of the evidence that risk factor intervention favourably affected the outcome of AMI (1). This was partly due to the increased prevalence of the risk factors for atherosclerosis in the younger age group; especially, the increased incidence of impaired fasting glucose, high levels of triglycerides, low high-density lipoprotein levels and an increased waist to hip ratio. However, non-atherosclerotic coronary artery disease or hyper-coagulability should also be investigated or at least suspected in the younger patients (2). Acute myocardial infarction (AMI), in young adults, presents a typical pattern of the risk factors and the clinical, angiographic and the prognostic characteristics. Consequently, it is possible to hypothesize the presence of a genetic background at the origin of this predisposition (3). The best estimates for the magnitude of the associated risk were derived from a meta- analysis of nine large prospective observational studies with 4,20,00 participants, who occurred over 4850 CHD events during the follow up (4).

A large series of cross-sectional and retrospective studies indicated a positive relationship between mild to moderate hyper homocystinaemia and atherosclerosis. However, because the homocysteine levels increase after MI and stroke (5), such data cannot be used to establish a cause and effect relationship.

ArticleCoronary arteriography remains the “GOLD STANDARD” for identifying the presence or absence of the arterial narrowing which is related to atherosclerotic coronary artery disease and it was found to provide the most reliable anatomical information for determining the appropriateness of the medical therapy, percutaneous coronary intervention or coronary artery bypass surgery in patients with ischaemic coronary artery disease (6). Coronary arteriography can establish the presence or absence of coronary stenosis and it can define the therapeutic option, and determine the prognosis of the patients with AMI at a young age. So, a study was conducted to learn the profile of young patients (15-40 years) with acute myocardial infarction with an emphasis on: • Assessment of the risk factors • Mode of presentation • Coronary angiographic characterization.

Material and Methods

The approval of the ethics committee of J.J.M.Medical College, Davangere was obtained. This study was conducted at Bapuji Hospital which was attached to J.J.M.Medical College Davangere, Karnataka, India for 2 years in order to obtain 49 patients. The patients were all below 40 years of age. This was a cross-sectional study (case series) which enrolled the study subjects who fell into the inclusion criteria consecutively for 2 years.

The diagnosis of myocardial infarction was based on the WHO criteria, which required at least 2 of the following 3 to be present:1. A history of an ischaemic type of chest discomfort 2. Evolutionary changes on the serially obtained ECG tracings. 3. Rise and fall of the serum cardiac markers.

The data were prospectively recorded as per the protocol. In all the participants, details of the age, sex and occupation were recorded with the details of smoking, alcohol use, a known history of diabetes mellitus and hypertension and a significant family history of ischaemic heart disease. Weight, height and waist and hip circumference was recorded for each person. Fasting blood glucose, fasting lipid profile, serial ECGs and the cardiac enzymes (CPK- MB) were evaluated (as at the start of the study, only CPK-MB testing was available at the hospital and Troponin-T and K came up later, which was not considered for study purposes, as (CPK-MB) with ECHO gave a good diagnosis), Echocardiography was done in all the patients. All these patients were taken up for coronary angiography which was performed by the standard Judkin’s technique after adequate preparation. The risk factors which were studied were hypertension, diabetes mellitus, smoking habits, overweight (a BMI of > 25 kg/m2), the waist to hip ratio, (a WHR of >0.91cms was considered as a risk factor), hyperlipidaemia (serum cholesterol of 200 mg%), a past history of IHD (ischaemic heart disease), and a family history of ischaemic heart disease. The patients with a past history of diabetes and/or with a fasting blood sugar value of >125mg% were considered to be diabetic. The patients who were currently smoking and those who claimed to have stopped smoking since one year were considered as smokers and others were considered as non-smokers. The coronary angiographic profile was studied in all these patients to assess the number of vessels which were involved and the type of the vessels which were involved.

Results

The mean age of the patients with myocardial infarction was 37.03 years, with a maximum number of patients (70%) being within the age of 35-40 years and 3.33% of the patients being in the age group of 25-30 years. The youngest patient was age 27 years old and the oldest was 40 years old. 90% of the patients were males. All the patients had a WHR ratio which ranged from 0.87cms to 0.92cms and so the WHR ratio was not an important risk factor in our study.

Smoking was most common risk factor for myocardial infarction (70%) in the young adults, hyperlipidaemia being the second common risk factor (36.67%). 20% of the patients were diabetic, of which 10% were newly detected. 13.33% of the patients had a family history of ischaemic heart disease (IHD). Hypertension and a BMI value of >25kg/m2, each formed 10% of the risk factors. The most common symptom was chest pain, which was present in 90% of the patients, followed by sweating (50%), breathlessness (20%), restlessness (6.7%) and palpitations (3.3%). The mean time of presentation after the onset of the symptoms was 20.73hrs. 46.67% of the patients had multiple risk factors for acute MI. 46.67% had a single risk factor, while 6.67% had none of the risk factors.

Anterior wall MI was found in 2/3rd of the patients and 1/3rd of them had inferior wall MI. 66% of the patients had septal and apical defects with anterior wall hypokinaesia in the electrocardiogram findings and the remaining 34% had inferior and posterior wall hypokinaesia. A majority of the patients (57.14%) had single vessel disease which was seen on coronary angiography, followed by normal coronaries (22.45%). 16.3% had double vessel diseaseangiographyand 4% had multi vessel disease. 63.33% of the patients had involvement of the left anterior descending artery, 20% had involvement of the right coronary artery and 16.6% had involvement of the left circumflex coronary artery, which was seen on coronary angiography (Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6).

Discussion

The distribution of the ages of our patients showed a striking increase of the disease with ageing, even in young adults, whichwas a very obvious fact which was seen in earlier studies also (6),(7). One of the best documented and the most consistent risk factors for coronary atherosclerosis seems to be the male sex. The protective effects of oestrogens in preventing atherosclerosis have been clearly demonstrated in epidemiologic studies (8). In another study (9), a profile of acute MI in young patients showed a male: female ratio of 20:1 (9),(10),(11), where as in our study, it was 9:1, but the trend remains the same.

Among the many factors that have been shown to be important are hyperlipidaemia, hypertension, cigarette smoking, the male sex and diabetes mellitus. These have generally been associated with an increased incidence of fibrous plaques and their sequalae. The associations are relatively strong and they are made on a group comparison basis, although all the studies have demonstrated a high degree of variability among individuals within even the most homogenous of groups (12). Smoking was the most common risk factor (87%) which was seen in a study (13), which showed a profile of acute MI in young patients (below 40 years) in a rural/ semi-urban population. Smoking was established as the main cause of MI and other chronic cardiovascular diseases in many other studies (14),(15),(16),(17),(18) and it was established as the main cause in our study also. Cigarette smoking accelerates CHD and increased atherosclerosis, which increase thrombus formation and this could contribute to MI at an earlier age. Most of the MI cases (80-90%) are mostly caused due to cigarette smoking. So, a reduction in smoking, which is one of the main causative factors, can reduce AMI in young adults.

The results of the Lipid Research Clinics Trail (19),(20) demonstrated a direct association between the plasma lipoprotein profile, the cholesterol levels and the morbidity and mortality from coronary atherosclerosis. Hyperlipidaemia, which is very common in young Asian adults as per earlier studies (15),(19),(20),(21),(22),(23),(24),(25), was the second common risk factor in our study.

Diabetes and hypertension were more common as the risk factors among the older MI patients but they were less common in young adults in our study, which was seen in earlier studies also (15),(25). A positive family history of IHD had been found as a significant cause only among the young adults as compared to the older patients in earlier studies (25),(26),(27),(28). Whereas only 13.3% of patients had a positive family history of IHD in our study (29).

A body mass index of >30kg/m2 was the common cause in all the earlier studies which were done (26),(27) but a majority of them were western studies. But Indian studies reported BMI (18) to pose a lesser risk, which was seen in our study also. Chest pain was the most common presentation in our study, which was similar to that which was seen in earlier studies also (30). The arrival of the patients at the health care facility was mostly delayed by >10 hrs,as in earlier studies also (31),(32),(33). We too had a mean arrival time of 20.73hrs. As in earlier studies (34),(35), in our study too, anterior wall MI was very common among the patients, irrespective of their ages. We could see that single vessel disease was evidently more common among the young adults, which had been reported by others also earlier (15), (35).

Limitattattations This study did not have any control group and so the risk of each factor could not be analyzed. Also, the statistical significance of the factors couldn’t be analyzed. There were few lab tests like Troponin-T and K for which the facilities weren’t available and so they were not done. As this study was the thesis topic of a postgraduate student, the required sample size wasn’t calculated. This was because this study had a time limit and the samples which were available in two years (49) were used to determine the objectives.

Conclusion

Smoking was the most common risk factor of MI (70%) which was seen in young adults. The mean time of presentation after the onset of the symptoms was 20.73hrs. 2/3rd of the patients had anterior wall MI. A majority of the patients (57.14%) had single vessel disease which was seen on coronary angiography. The cessation of smoking would play a major role in preventing MI in young adults. Also, on the early hospitalization of these patients, they need to be educated on this topic.

References

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Fuster V, Pearson TA. Matching the intensity of the risk factors with the hazards for the coronary heart disease events. J Am Coll Cardiol 1996;27:957-1047.
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Cengel A, Tanindi A. Myocardial infarction in the young. J Postgrad Med. 2009 Oct- Dec;55(4):305-13.
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The role of genetic polymorphisms in myocardial infarction in the young. Clinical Hemorheology and Microcirculation. 2010;46(4): 291-98
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Wibon PW, D’ Agostino RB , Levy D. Prediction of coronary heart disease by using the risk factor categories. Circulation 1998; 1837-47.
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Egeston W, Silberberg J, Cooks R. Serial measures of plasma homocysteine after acute myocardial infarction. Am J Cardiol 1996; 77: 759-61.
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Popma JJ. “Coronary angiography and intravascular ultrasound imaging”. Chapter 18. In Douglas P. Zipes, peter Libby, Robert O, Bonow, Eugene Braunwald (eds), Braunwald’s Heart Disease A textbook of Cardiovascular Medicine, 7th edition, 2005; 423-55.
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Ismail J, Jafor TH, Jafaray FH. Risk factors for non- fatal MI in young south Asian adults. Heart 2004; 90:259-63.
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DOI: JCDR/2012/3853:1995

Financial OR OTHER COMPETING INTERESTS:
None.


Date Of Submission: Dec 27, 2011
Date Of Peer Review: Jan 30, 2012
Date Of Acceptance: Feb 16, 2012
Date Of Publishing: Apr 15, 2012

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