The Bubble that Broke the World (LvMI)

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Also, the tone of the book puts me off a little. I can't tell if the author is being sarcastic or serious often. Further, the work flows more like a stream of consiciousness than an actual book. Really nice description of the 'behind the scenes' of what happened during and shortly after the First World War.

The point of view as expected is american, but it gives you a good picture of the lending and borrowing, defaults, moratorium, etc that happened that time. If you truly want to understand how banks generate money, how credit is created and what was going on between US and Europe after WW1 to Great Depression, regarding economics, then this book is the best thing you'll ever read. William rated it really liked it Sep 25, Rich rated it really liked it Apr 18, Spencer Pfeifer rated it liked it Jun 14, NormaCenva rated it it was amazing Jul 02, Jul 04, Andries rated it it was amazing.

Very good. Jason Reiner rated it really liked it Dec 15, Jim Warmke rated it it was amazing Dec 12, Nebogipfel rated it liked it Feb 08, Nathan rated it really liked it Feb 18, Christian West rated it liked it Sep 18, Juvoni rated it really liked it Dec 19, Juan P. Jason Crigler rated it liked it Apr 20, Thomas rated it really liked it Mar 26, Kelvin Phua rated it really liked it Aug 10, Lachlan Brooks rated it it was ok Apr 02, Scott rated it it was amazing May 08, Steve rated it liked it Jun 24, Davraena rated it liked it Nov 04, Because of this, permanent residents are able to purchase, own, and carry firearms; they are required to register with the selective service; and they are treated for tax and welfare purposes as are U.

When they re-enter the country, the agent says "Welcome Home," which is a big change from their visa days. They are not Americans, and they mustn't pretend to be. But they are as close as one can get without being one. Another game of '17 has been to shoot down the insane anti-Trumpers who post outrageous fabrications on Facebook to make the President look bad.

I started to do this Saturday night. I disagree profusely but he campaigned on it and yadda yadda What's that? He is detaining green card holders? Women in Seatlle are told by their employer not to visit their parents in Canada for fear of being denied re-entry?

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Kellyanne Conway points out that , people were not detained at the airport! Why look at all the black people who were not lynched in the Jim Crow Era! I understand they are backing off the green-card bit. Good for them. But can any of our indefatigable defenders contradict Jonathan Adler? Whatever one thinks of the underlying policy, the degree of administrative incompetence in its execution is jaw-dropping. Like Orin below, I think it's worth quoting this Benjamin Wittes post from the Lawfare blog: The malevolence of President Trump's Executive Order on visas and refugees is mitigated chiefly--and perhaps only--by the astonishing incompetence of its drafting and construction.

Even the righties at Instapundit who welcome the restrictions are not pleased. Did he get good value? I guess it is going well. I sought it out this morning, on white house dot gov, but didn't find it. The order is reprinted by the NY Times. Some highlights:. Firstly, did anyone know that there has been a waiver program on the "requirement" that all visa applicants be interviewed face-to-face?

I didn't. And then there's the "ban" language, "indefinitely" prohibiting the entry of all muslims. Err, all muslims from seven countries seven countries named by congress AND the Obama Administration as dangerous. But there are these exclusions from the "ban:". And the "ban" is temporary: 90 days for regular visas and days for the refugee program. More of a "specific suspension" than an "indefinite ban" if you asked me.

Might there be things they could have fine tuned, done differently, or implemented better? It's been one day! Can we give them a few more hours, at least, before drawing up articles of impeachment? That was yesterday. Today, McCarthy is defatigable. Or at the very least, Monday-morning quarterbacking. I am sympathetic to the new Administration's motive to implement policy without timetables, which the enemy may exploit.

Yes, they probably went too far in this case. So fix it and move on. Then implement the next "deplorable" policy quickly, so that this one fades from the headlines. Blame it on my Youth. Wishing y'all a prosperous and generally awesome ! I found a new free market blog last week when following some inside-baseball information on FERC regulations on the power industry.

This short article , from the heretofore unknown Ashley Baker, brilliantly sums up the case for passing and enforcing the REINS act, and takes a paragraph or two to expose HuffPo's rather unsavory Carl Pope as either mendacious or stupid. In fact, the REINS Act would remove the bureaucrat-driven rulemaking process from behind closed doors and hold elected officials accountable for new regulations. Under the current process, Congress escapes scrutiny when regulatory agencies issue new rules that affect the lives of Americans.

Unlike executive bureaucrats, elected officials can be held accountable by their constituents. Regulators, lacking this type of accountability, are free to promulgate rules without much regard for the costs they will impose. The fatal weakness of the scheme is that you cannot stop. When new creditors fail to present themselves faster than the old creditors demand to be paid off, the bubble bursts.

Then you go to jail, like Ponzi, or commit suicide, like Ivar Kreuger. The book is copyright , And if I may practice criminal understatement, the author is not very keen on debt and leverage. And in the years before , average Americans, not only governments and institutions were chasing yield. That yield-chase led them to take on riskier and riskier investments.

Stop me if you've heard this. The committee was hearing bankers on the question of establishing a national economic council and it was asking him what the bankers had done to restrain a wild use of American credit before the collapse. He said: "Speculation was in the air, and the speculators wanted to buy, buy, buy, and the bankers and brokers dealing in securities supplied that demand.

In other words, I do not think you would be justified in holding the bankers responsible for the wide speculative craze that worked through the country. I think they were trying to supply what the customers wanted. I think the banker is like the grocer. He supplies what his customer wants. It, indeed, features brilliant prose and brilliant insights: I will get to the discussion of the Gold Standard. But I am a huge fan of financial innovation and Garrett is a Luddite. His novel, The Driver has been called a precursor Atlas Shrugged and a likely source of the last name Galt. No actual money is involved.

If these last few passages have been difficult, take the fact lightly and without blame. Of all the discoveries and inventions by which we live and die this totally improbable helix of credit is the most cunning, the most liable, the least comprehended and, next to high explosives, the most dangerous. I'll come out of the closet. I took out a mortgage to purchase a home. When I wished to pursue a startup opportunity which lacked cash flow, I refinanced that mortgage with a no-doc loan, chose an interest-only vehicle and fed my family on egads!

Like high explosives, debt can be quite useful. Interesting in , under the shadow of massive US debt to China to read such disgust at our being a creditor nation. Even if we build useless public works here in the good old USA, we shall have the tenements. A fair point that foreign loans are difficult to collateralize: Lending of this character, to local people, the bank knowing all of them personally, is not only the safest kind of lending for the bank; it is the ideal use of credit.

From the savings of the community, always accumulating in the safe as cash deposits, the bank acquires a surplus lending power. Having satisfied its own customers with credit at the window marked "Discounts and Collections", what will the bank do with the surplus credit? One would think that extra yield in foreign loans would compensate for the reduced safety. Garrett's real concern is not a Fort Wayne plumber's getting burned in defaulted Chilean bonds.

It is the postwar WWI international debt structure. All the European nations are rebuilding on American dollars. Britain has propped up the Pound, and Germany is clearly cracking under its Versailles obligations. Haircuts are coming and it seems likely that America will get shaved most deeply. You could fill a library shelf with my lack of understanding of WWI. I truly don't get it.

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This was the WWI version of the Marshall Plan, and it both saved many millions of lives and returned Europe to normalcy. Being a banker, Dawes structured aid as loans. Belgium was saved; did Germany default because of debt or onerous conditions of Versailles?

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This is available free on the LvMI site. In all seriousness, the four page section on the Gold Standard is well worth a read in full. The value of gold is arbitrary; so is the length of a yardstick. But just as it is necessary to sell cloth by the yard or coal by the ton, so it is necessary to have some arbitrary unit of value in which to price the yard of cloth and the ton of coal. It would be ideal to have something of absolutely invariable value in which to price them. But there is no absolutely invariable thing in the world. Great prose and keen insights.

But I hold opposition to his central thesis, videlicet: Third, the argument that prosperity is a product of credit, whereas from the beginning of economic thought it had been supposed that prosperity was from the increase and exchange of wealth, and credit was its product. Prosperity rests heavily on financial innovation, part of which is credit. Get capital to its best uses and risk in the best hands to deal with it.

It grieves me to pan a recommendation from such a person. But the integrity of Review Corner is sacrosanct. Three Stars. There is so much to say about this fascinating article, and so much of it requires even more thought than I've given it already. So for now, I'll just make this a de-facto Quote of the Day and suggest that everyone read the full article and its detailed explanation of how candidate Trump turned the criticisms of him back upon his accusers, and even seemed to willingly and repeatedly step into politically-incorrect messes, only to emerge from the other side stronger and more resolute.

None of this happened, of course. But why? Because what Trump's enemies failed to grasp was that he wasn't winning because of the crazy things he was saying, but because of the phony outrage and affected condescension it provoked.

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Many people empathized with Trump for enduring the contempt that he deliberately brought against himself. Trump kept playing the role of the antihero, and Clinton kept playing the role of the pearl-clutching fraud. Their bubble is sooo thick, and coated with so much patchouli oil and rainbow flags that they are having trouble finding their way out. Guilt by association, pure and simple. One commenter even pointed this out: it was a friendship, started before politics and presumably above politics, with the comment citing some public statements about how he didn't agree with everything.

He didn't get far Brady's obliviousness reeks of white privilege and dismissiveness; a MAGA trait if there ever was one. Kaepernick, Kaepernick. The name rings a bell. The President of Mexico seems to think he has the upper hand, much like Reagan did prior to meeting Gorbachev at Reykjavik. In accepting Nieto's cancellation of the meeting, Trump has merely called his bluff.

He certainly didn't arrange for Mexico to be skewered in a UN vote. I call it "holding his feet to the fire. In public, agreed with JK that Trump has taken a hard stance. I heard on the radio this week that one cabinet member Pence? This is doable, and has some merit on several fronts Sadly, in today's Mainly Hysterical media market, I don't see that happening. We have a right to build a fence, no one questions that. So, while we may debate its merits and debits, it's more than a bit beyond the pale to say that Mexico will pay for it.

One should be more circumspect about using the phrase "no one questions that Whatever one's thoughts on immigration, the wall will require a gooberload of eminent domain, it will be very injurious to private property, and it could be suggested as injurious to American's rights to emigrate. Not a South Park joke -- do we not have a right to leave? We also have the worst public schools in the developed world. In 1, American high schools, a third or more of the students don't graduate.

In , 66 percent of U. Our worst high schools are essentially prisons with poor security and lots of overhead. Usually these things are correlated with median income levels, but I see that as another symptom of the same cause - bad government. No doubt you're correct.

The affluent in the areas dominated by bad schools can buy their way into tony private schools. What fries my rice is that this is the root cause of inequality. All the same people who wish to "fix" inequality with hyper-progressive taxation represent a good Venn-match with the people protesting Sec. The referenced line starts around the 7-minute mark, but I found this entire RNC Convention speech to be quite interesting and foreshadowing of this election just passed.

Try the whole eleven minutes and see if you agree. Not even a week into his Presidency, Donald Trump seems to rack up accomplishments by the day rather than by the month or even year, by his predecessor. But there's more to the comparison than mere ambition or scope of vision. There's a palpable difference of style, and it clearly favors the man portrayed as "vulgar" and "misogynist" over the one lauded as "clean and articulate.

Then came more humor that got a big laugh from the car executives, when the president suggested they go around the table for introductions: "I'll start. I'm Donald Trump. Imagine the 44th president, often and aptly referred to as the Narcissist in Chief, being so self-effacing. In contrast:. Now who's guilty of excessive rationalizations? This is the tactic of a modern-day bully. President Trump was thought to be exactly that during the presidential primary campaign, calling his opponents "low energy," "little," and "lyin'.

The meaning implied when President Theodore Roosevelt Jr. In those days, "bully" was more apt to mean "superb" or "wonderful" and not the ruthless and insensitive lout it conjures today. President Trump seems determined to make many things Great Again - the more, and the faster, the better. The Dodo is well known as a long extinct specie of bird. The Baiji River Dolphin, far less famous, became extinct more recently. And astute readers have already detected the implied pattern in this post's headline.

While the fledgling administration of President Trump may have been the necessary catalyst, the real driving force behind the predicted demise of sanctuary cities in, first California, then the nation, is good ol' democracy :. Seventy-four percent! Hell, even same-sex marriage doesn't get that much popular support in the Golden State, with just 60 percent support. In fact, a greater majority of California Hispanics support ending sanctuary cities than the percentage of all Californians who approve of gay marriage. Eventually, some enterprising politicians will take advantage of these facts and defeat the sanctuary city "bitter clingers" at the polls.

Tiktok boy in the bubble

One last point: As a group, California Democrats are only 12 percent less "racist" than California Republicans. If there is to be any kind of a 'site' for the commemoration of this historic event that took place with all the tribes, the people of Standing Rock need to vote on where, what and cost before any 'shanty town is built. Reporting President Trump's moratorium on EPA social media communications, the always judicious Denver Post said "We're watching the dark cloud of Mordor extend over the federal service.

Make no mistake, the EPA is allied headquarters for the Climate-Industrial Complex and their anti-energy allies on the left. According to a report from the Republican majority of the U. Senate Committee on Environment and Public Works: EPA officials routinely corresponded via email with NRDC leaders with whom they also held meetings away from government property, thereby evading transparency requirements, since the start of the rule making process for the power plant regulations in March I'm not sure Humphrey's Executor was well decided.

In fact, I'm pretty certain it sucks. Regardless, I want to ask the hyoervetalists "Can you get on your company's Twitter account and send things out with which your CEO disagrees? The title is a wonderful Filipino phrase for when a young person says something betraying a lack of maturity. As I have some completely vegan "red meat" for the denier and lukewarmer community, I felt I might borrow it.

This is from , and Australia land of Caaaaaahbon Dioxode -- but I think you can update it mentally:. The previous president had Climate Change second only to Civil Rights as a priority issue. The new president has made an adjustment. Now it's somewhere lower than number 6. The rule of law was truly subverted on both of these to appease the environmentalist left. Such carve outs for progressive constituencies are one reason voters rejected Democrats in November, and the pipelines promise broader prosperity. The pipeline could move , barrels a day along the route from Alberta to Nebraska; up to , would come from North Dakota, where a glut of crude has to travel by rail to reach refineries built to process it.

The efficiencies will ripple across the oil and gas industry. Pretty awesome huh? Boy, we sure like the cut of that Trump fellow's jib. One danger here is President Trump's campaign promise to "renegotiate some of the terms" that included bromides about how "we'll build our own pipes, like we used to in the old days. TransCanada has said in past months that it's "fully committed" to Keystone XL, but the company may not be eager for another politician to direct its investment decisions.

Ah yes, the good old days when we built our own pipes. Wow -- America was really great back then. I'm going back to bed -- call me on my mobile if you need anything The WSJ Editorial Board has suggested that President Trump offers business a bargain: I'm going to lower your taxes and keep government regulators off your back; you're going to let me browbeat you and bias your investments toward domestic production.

As a great blue-eyed economist once said "That ain't love. But it will have to do until the real thing comes along. I'm actually hopeful that Trump is more saavy than all of the principled free-market advocates realize. Yes, he is distorting markets with his browbeating. But perhaps he is doing it as a countermeasure against foreign currency manipulation.

Perhaps President Trump is engaging in one of these. Among other things, the browbeating has the advantages that it can be done quickly, by executive action, and it is not an obvious countermeasure to something else. It just looks like unbridled populism. It is that, of course, but a principled executive knows how far to take it before backing off. I was going to comment on your optimism, but I would never have gone so far as Sister Dagny though the brave black and purple are not without talent On a serious note, optimism is good and I must admit that -- so far -- more of your rosy scenarios have materialized than my dark dystopian visions.

But it is Day Four; I hope you'll be willing to hold him accountable. And yes, he is well served by the compete insanity of his critics. Holy Cow, those people have left the rational plane. But they can be bonkers and he can still be wrong. Yes, I'll hold him accountable. I probably won't march on the capitol or cut off any parts of my anatomy, but I'll always be willing to condemn bad acts.

I haven't been following the Rox off-season moves but I did hear about the once great Royals reliever who's coming off some surgery or another. But a sports radio jock I know is predicting Rocktober already! She is obviously unfit to take the helm of such a well-oiled machine as the United States Department of Education. A major evaluation commissioned by the U.

Department of Education and conducted by two highly respected research institutions delivered a crushing verdict: The program failed and failed badly. The obvious explanation is that, like the Stimulus, it wasn't big enough. It was a tough weekend to be on Facebook. I guess I should salute my friends with their signs and knitted hats. I don't get it, but they dug it. And one must admit it was impressive both for turnout and paucity of complete destruction.

Yes, I've seen pictures of trash. But we have a patriarchy to clean up for them. I'll leave it to the even more pedantic to comment on grammar if they so choose. I don't see a fatal error in the original and wonder if they wish every tweet of theirs to be held to a similar standard.

But -- and brace yourself for a vigorous Trump defense -- what these people miss is the comparison to the status quo ante.

I want to answer almost every criticism of President Trump's appointments with "And the guys before were doing such a bang-up job So, last Thursday, everything was fine? Last month? Last year? It seems the no doubt highly educated, experienced, and undoubted grammar wiz whom DeVos seeks to replace shut down a large segment of educational facilities with false data. There is undisputed misfeasance and several signs of malfeasance. The department says the error "led to the undercounting of some borrowers who had not reduced their loan balances by at least one dollar.

This is huge. It means that fewer than half of undergraduate borrowers at the average college are paying down their debt. Yeah, jk, it's government accounting. Whaddya expect? The other scandal is that the Obama Administration used the inflated Scorecard repayment data as a pretext to single out for-profit colleges for punitive regulation. The punishment was tucked into a rule finalized in October allowing borrowers who claim their college defrauded them to discharge their debt. But, had they practiced honest accounting: If the regulation were applied evenly, a large number of nonprofit and public institutions would fail to meet the standard.

But then the justification for the department's selective regulation of for-profits would vanish. The department finalized the regulation in October anyway, perhaps anticipating a Hillary Clinton victory that would allow the repayment inflation game to keep going. Yet now it's taking credit for discovering and fixing the Scorecard error that likely would have been uncovered by the new Trump Administration.

But Sec. I had not read this. Thanks for promoting the story about the cronyist attack on for-profit colleges, to the benefit and protection of the "large number of nonprofit and public institutions" that were covered up for. Several Sophisms are discussed, but the main thesis of the book is protectionism and distortionary economic regulation. If we should find in France a gold mine, it does not follow that it would be for our interest to work it.

Nay, it is certain that the enterprise would be neglected if each ounce of gold absorbed more of our labour than an ounce of gold purchased abroad with cloth. In this case we should do better to find our mines in our workshops. And what is true of gold is true of iron.

I blather on about "The Law" but I confess I did not know this book existed until a couple of weeks ago. The site which recommended it included a comment claiming that Bastiat is overrated as an Economic Theorist. True, he did not substantially advance theory; most of his ideas can be traced to earlier thinkers. But the ideas were obscure. And, as many of them can be counter-intuitive, it was important that they be dispersed and explained. Exposition is M. His greatest stylistic device was the reductio ad absurdum.

Suggesting that The Candlemakers' Guild propose to ban the Sun, or that trains require a discontinuous stop at every town to promote employment shows the flaws in more reasonable but similar restrictions. He details a fictional battle 20 years hence, when "Dexterities" suggest repeal: We think that already we hear the free Dexterities, assembled in the Salle Montesquieu, holding this language "Good people, you think yourselves richer because the use of one of your hands has been denied you; you take account only of the additional employment which that brings you.

But consider also the high prices which result from it, and the forced diminution of consumption. That measure has not made capital more abundant, and capital is the fund from which wages are paid" [ Fortunately, Sire, an association has been formed in defence of left-hand labour, and the Sinistristes will have no difficulty in demolishing all these generalities, suppositions, abstractions, reveries, and utopias.

While the bulk of the book could be laid at the feet of President Trump for his penchant for protectionism, the Right vs. Left Hand debate reminds me of repealing Obamacare. Yes, some segment will be harmed by reintroducing some liberty, It will be understood that I am speaking here of general effects, not of the temporary inconvenience which is always caused by the transition from a bad system to a good one. A momentary derangement accompanies necessarily all progress. This may be a reason for making the transition gently and gradually.

It is no reason for putting a stop systematically to all progress, still less for misunderstanding it. Shades of Russ Roberts, from whom I am learning to appreciate legitimate hardships for those truly displaced by trade. Like "The Law," it is a joy from cover to cover. One is tempted to highlight every paragraph. Where to stop? Is there a state apart from the people?

Archimedes might repeat every day of his life, "With a fulcrum and lever I can move the world;" but he never did move it, for want of a fulcrum and lever. The lever of the state is the nation; and nothing can be more foolish than to found so many hopes upon the state, which is simply to take for granted the existence of collective science and foresight, after having set out with the assumption of individual imbecility and improvidence.

Cinq stars. One of the things I like at the PowerLine blog is their side interests. Scott regularly posts on English football Everton, I think , John Hinderocker covers the beauty pageant cycle with an artists' eye, and of course Dr. Hawyard's personal accounts of his tours through the fever-crazed swamps of academia and collection of memes never disappoint. His latest entry is a fascinating take on Suzy Bogguss.

She sounds like a true American treasure. Don't know if this is JK's taste, but thought I would share. PL's a great site, but the WordPress plug-ins are amongst the worst in the industry they've recently taken to pinging my kindle with a fake virus attack warning I wonder if people complain enough to sites like that. I read them A LOT less for their aggressive scripting. I set it on high security and never accessed an important password protected site. That helped some. Now, with Win10 and a new Edge installation it does not see too bad. The other one, which surprises me more, is National Review.

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They are collecting money fro a ground-up rewrite and I am hoping it includes different funding or rules on ads. Greedy capitalists! Just looking at the bottom-line and not the suffering of their user community. As to Ms. Bogguss, you cannot go wrong doing an album of Merle Haggard tunes.

Loved what I heard. Certainly not to assault them. Nor am I filled with anxiety by the thought that people who work in my home might have different political views than mine. Nor has the jaw-dropping, mass-hypnosis level of selective partisan-driven outrage. I understand that a lot of people are worried, upset, even frightened over the prospect of a Trump presidency. They should be. But they should have been worried eight years ago, or at the very least, four years ago. He goes on to mark the low points of the last 8 years, especially the end of the 4th Ammendment Did I mention he - and all future presidents - now has the legal right to kill anyone on the planet, including American citizens, with no conviction, no charges, no semblance of due process at all.

Did I mention that? I have vowed not to question my pussy-hatted friends about their big march yesterday. It brought them much joy. I enjoyed the quote jg posted yesterday.

fjghjhfg.co.vu/13481.php And the reviews were generally good except from sources expectedly unsympathetic. People laughed at Kellyanne Conway's dress; I found it rather cute. We have to talk. I watched it on YouTube last night I was busy at work, not boycotting and I cannot think of a nice thing to say.

I lost all the goodwill and optimism I had accrued from some of his pleasing cabinet picks. It was bad in tone, style and substance. There was that one great line about taking power from Washington to give to the people. But the rest of his speech was how he was going to use his power to run the economy and the world.

And, I know his pugilism is held in high regard by his devotees, but it was uncalled for. The inauguration has been called our national quadrennial religious service. I watch it every four years and usually weep with pride. He sullied it by ripping into his political opponents, many of whom showed grace and courage by attending.

I don't have much regard for Trump's speeches, nor him in general. I loved the money quote of returning power to the great unwashed, and there was another about America as a symbol. I was unnerved by the whole 'America 1st' bit. Yes, one should strive and believe in it, but should one really have to say it so? This will be an interminable 4 years if you take him literally. I'm most interested in how Pompeo handles CIA and the general bog remediation. His latest tweet I'm considering a collection nof the good ones, since I know my FB feed will regularly feature the bad ones shows that he should not be taken literally, and that he - unlike those on the Left or in the media - genuinely cares about the great unwashed: "Great to meet one of my earliest and most dedicated supporters!

I am deeply humbled by the faith that millions of Americans have placed in me and our movement - and to those who did not support me, I ask for the chance to be your President too as we make America great again together. Trump, I guess, for his father's chemo. More than BHO ever gave his brother As I watched the address live on C-Span I found it inspiring. I had one regret - that while he said "America First" he didn't also say "when America prospers, the entire free world benefits.

Then I read the transcript, linked in my Inauguration Day "Otequay" and found that he did say as much, and almost in as many words:. We do not seek to impose our way of life on anyone, but rather to let it shine as an example for everyone to follow. Quite the libertarian campaign plank, no? At least the second paragraph. But the first paragraph is pure Rand - rational self-interest. Only an altruist should object. You said we have to talk.

I love to talk! You also said you cannot think of a nice thing to say, but then you called the line about taking power from Washington to give it to the people "great. The prevalence with amlodipine, Material: It is study of two middle aged females, hypertensive since 5 years and on regular treatment of Amlodipine 5mg twice daily. Based on the clinical evaluation of the soft-tissue response to scaling and the persistence of fibrotic component on the lingual aspect of mandibular incisors, gingivectomy was performed.

The patients were placed on periodic recall of 3 months for the ev aluation of the gingiv al hyperplasia. Observation: Intraoral examination revealed generalized pink gingiva with rolled gingival margins, lobulated papillae, and fibrous overgrowth throughout the maxilla and mandible, particularly on the labial and buccal side.

Histologically, the lesions were diagnosed as fibro-epithelial hyperplasia, and were indicative of amlodipine-induced gingival hyperplasia based on clinical and histological evidence. Conclusion: The reported cases are examples of a combined type of gingival enlargement—basically a drug-induced one, complicated by inflammatory changes due to plaque accumulation.

Treating physicians should have a clear understanding of the drugs that cause this phenomenon and know how to manage these c ases. Congenital heart disease with right sided aortic arch with anomalous orgin of left subclavian artery. Introduction : Congenital abnormalities of the aortic arch are sometimes diagnosed in imaging.

These abnormalities are identified accidentally during imaging for other studies but it is important to differentiate from life threatening forms. A right sided aortic arch could be diagnosed in about 0. Material: In this report, 29 year old medical officer had history of recurrent cough, cold, fever, non radiating chest pain in right 4th, 5th intercostal spaces from one week on joining.

In physical examination he had pulse and blood pressure was normal, no cyanosis or clubbing, in heart auscultation S1and S2 heard, no murmur heard. Chest xray showed widening of mediastinum with normal lung parenchyme and soft tissue shadows. Echocardiography was also within normal limit. CT thorax showed right sided aortic arch with anomalous orgin of left subclavian artery with indenation of oesophagus and rest of the images were within normal limits and finally patient advised pneumococcal vaccine to prevent recurrent infections and regular follow up.

Observation: In this rare case, patient presented with who had no signs and symptoms except cough, cold and chest pain. Finally was diagnosed with left brachiocephalic artery. The right sided aortic arch is an anomaly seen in different types. One of them is anomalous origin of left subclavian artery with oesophageal indentation. In this report echo and CT angiogram were used to diagnose. Conclusion: Many of congenital vascular anomalies may no obvious signs and symptoms and therefore exact history and physical examination could help in better diagnosis.

Imaging modalities can be used. Prevalence of CAD among degenerative aortic valve disease patients requiring catheterization. Methods - The medical records of consecutive DAVD patients who underwent catheterization test between January to August were retrospectively reviewed. There were 95 There is statistically significant age There is no difference between both groups in the occurence of HTN 20 Vs 42 p Detection of silent myocardial ischaemia in type 2 diabetes mellitus by exercise treadmill test.

Background: The present study was conducted to evaluate the utility of exercise treadmill test ETT to detect silent myocardial ischaemia due to asymptomatic coronary artery disease CAD in patients with type 2 diabetes mellitus T2DM. Those with a positive ETT were 45 years of age or older and had diabetes mellitus for 5 years or longer.

Introduction: Acute heart failure AHF is growing in prevalance and is a public health problem world wide.

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Acute heart failure is defined as a rapid onset or change in the symptoms and signs of heart failure, resulting in need for urgent therapy. Acute heart failure may be either acute de novo heart failure or acute exacerbation of chronic heart failure. Patients with AHF are characterised by elevated left ventricular filling pressures or low cardiac output resulting in pulmonary and systemic congestion. This volume overload state manifests clinically by worsening signs and symptoms of heart failure as dyspnea,jugular v enous distension and edema.

Aim: To study the clinical and etiological profile of patients with AHF. To study its outcome. Materials and methods: It is a prospective study. Up to the results derived from our study, we could conclude that the first episode of AHF is more deadly. Conclusion: This study provides information on demographics, characteristics and underlying conditions as well as etiology, investigations and treatment practices of AHF. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia. AVNRT occurs in the presence of a reentrant circuit involving two electro physiologically distinct limbs that connect to AV node, known as fast and slow pathways.

AVNRT is more common in 2nd to 4th decades of life, often in women. Material: A 56 year-old female, presented with complaints of multiple episodes of palpitations, headache. Palpitations are regular and fast with average duration of ten to fifteen minutes. P waves are embeded in the QRS complexes. Baseline intervals were recorded in cathlab. Baseline AH was 64 and HVms. On incremental atrial pacing,AV conduction and on ventricular pacing, VA conduction was present. RFA was delivered in slow pathway location with good junctional acceleration. Post RFA no tachycardia was inducible on baseline or with isoprenaline.

Conclusion : Reassurance and instruction as to performance of valsalva maneuver are sufficient for many patients. Rate limiting drugs at onset of an episode has been used for termination. Introduction: Accidental hypothermia is a fairly common phenomenon in temperate climates.

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But in a tropical country like India such cases are not routine and most of the reported cases are from the winter months. Here we report a case of accidental hypothermia with a giant Osborn wave in EKG in the warm and humid month of September. Case details: An 18 year old otherwise healthy male was brought to the medical emergency with drenched clothes and in an unconscious state. He was cold and clammy and recorded rectal temperature was C. Immediately rewarming therapy was started and the patient started improving and in the EKG the height of Osborn wave decreased as the body temperature rose.

Also the height of the Osborn wave corresponds to the severity of hypothermia. The impetus in this case is on the fact that accidental hypothermia is not that uncommon in tropical areas as well and even in hot and humid conditions like that of September one cannot rule out completely the possibility of hypothermia. Also emergency physicians should be aware of the typical EKG manifestations of hypothermia as the major cause of mortality is cardiac arrhythmia in such cases, and in order to treat such cases one should be able to pick up the subtle changes early.

Introduction: Hypertensive heart disease is the result of structural and functional adaptations leading to LVH due to chronically elevated afterload, sympathetic overstimulation and myocardial fibrosis. ECG, biochemical parameters and adverse effects were recorded initially and after 6 months of therapy.

The biochemical parameters taken were random blood sugar, urine routine and microscopic , serum creatinine, serum uric acid, serum potassium, serum bilirubin and lipid profile. It also caused a rise in serum creatinine, serum uric acid and HDL and a significant decrease in serum cholesterol, whereas the group taking AMLO showed only a rise in serum creatinine.

The study of prevalence of metabolic syndrome in patients with essential hypertension in Kosi zone. Introduction: The metabolic syndrome consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease CVD and diabetes mellitus DM.

The major features of the metabolic syndrome include central obesity, hypertriglyceridemia, low high-density lipoprotein HDL cholesterol, hyperglycemia and hypertension. Vascular disorders are central to this condition,so it is also known as cardiometabolic syndrome and hypertension plays a pivotal role. Results: The cases consisted of 60 patients of which 34 were women and 26 patients were men. Deranged HDL was the most common abnormality followed by abnormal fasting blood sugar, abnormal w aist circumference and abnormal triglycerides.

Conclusion: Metabolic syndrome is highly prevalent in patients with essential hypertension. In hypertensive subjects, metabolic syndrome amplifies cardiovascular risks associated with high blood pressure independent of the effect of several traditional risk factors. So it is essential to screen all the patients of essential hypertension for metabolic syndrome to reduce risk of metabolic syndrome and its associated complications. Introduction: High uric acid is a negative prognostic factor in patients with mild to severe heart failure. This study to show correlation between serum uric acid and Killip classification in patients of acute myocardial infarctio n.

Methods: This is a prospective case control study. We studied 50 patients with acute myocardial infarction and 50 controls. Results: There was a statistically significant higher level of serum uric acid concentration in patients of MI on day of admission as compared to controls. On all the days serum uric acid levels were higher in patients who were in higher Killip class. All the two patients who died after 3 days of hospital stay had serum uric acid level more than 7.

Conclusions: Serum uric acid levels are higher in patients of acute myocardial infarction correlated with Killip class. Combination of Killip class and serum uric acid level after acute myocardial infarction is a good predictor of mortality after AMI. Peripartum cardiomyopathy with subclinical hypothyroidism - A rare case presentation.

Introduction: Peripartum Cardiomyopathy PPCM is a type of dilated cardiomyopathy in women with no past history of cardiac disease and requires high index of suspicion for diagnosis. PPCM is diagnosis of exclusion. PPCM is defined as: Development of cardiac failure in the last month of pregnancy or within five months after deliv ery. Material: 21 years old female primipara came with complaints of cough, dyspnea and anasarca which developed 3 months after the delivery of her first child.

She was hypotensive 90 mmHg systolic blood pressure , with sinus tachycardia at bpm and diffuse rales on lung auscultation. The chest x-ray on admission showed with bilateral pleural effusion. Observation: ECG revealed diffuse T wave inversion. Conclusion: PPCM is a relatively rare disease, which can have devasting consequences and should be promptly identified and correctly treated. Early diagnosis is important and therefore women who develop symptoms of heart failure during pregnancy or shortly after should be investigated for this condition.

Effective treatment reduces mortality rates and increases the chance of complete recovery of ventricular systolic function. Since diabetes shares most of the risk factors with CAD such as age, dyslipidemia, hypertension, obesity, sedentary life style, stress. Therefore, diabetic patients are known to have two to four fold increased risk of CAD and two to three decades earlier in life.

Mostly diabetic patients do not present with typical chest pain of unstable angina or myocardial infarction MI , thus late presentation contributes to higher mortality in these patients. Hence early diagnosis and intervention is recommended to improve the morbidity and mortality in these patients. Materials: The design of the study is cross sectional analytical. The study is carried out on the employees of Tata Motors limited, Jamshedpur Plant.

The study is conducted during the period of May to December with the sample size of patients. All selected individuals will be subjected to a detailed questionnaire, medical examinations and anthropometric measurements. Blood samples are collected for blood sugar fasting and postprandial level, HbA1c, serum lipid profile estimation. Results are analyzed using appropriate statistical tools. Observations and conclusion: As the study is still under process so observations and conclusion will be discussed at the time of presentation.

Correlation between carotid intimal thickness in type 2 diabetes patients with silent ischemic heart disease. Introduction: A study to find out prevalence of silent coronary artery disease in type 2 diabetes patients using Electrocardiogram,Tread mill testing, 2D-Echocardiography and correlate various risk factors with carotid Intima Medi Thickness IMT using doppler ultrasonography to determine the usefulness of carotid intima media thickness in assessing generalised atherosclerosis and risk of getting Ischemic heart disease.

Materials: Study was conducted among 50 type2 diabetes patients, who were subjected to stress with treadmill testing to identify silent Ishemic heart disease, among these patients few were identified as having silent Ischemic Heart disease IHD via treadmill testing followed by, Carotid Intima media thickness measurement was done in all these 50 patients and the result was compared with controls 15 nondiabetic control patients with no risk factors and 15 control patients w ho had evidence of IHD by ECG or 2D-electrocardiography.

Conclusion: Carotid intima thickness can serve as a surrogate marker in assessing the generalised atherosclerosis. Recent studies are showing that patients with higher Carotid Intima Media Thickness values have higher risk of getting Ishemic Heart Disease. Introduction: Atrial Myxomas are most common benign primary cardiac tumours. It arises most commonly from left atrium, more common in women around yrs of age and presentation varies from completely asymptomatic to dangerous myocardial infarction due to emboli from tumor mass.

Surgery is the treatment of choice with good prognosis. Case: A 35 yr old female patient presented to cardiology opd with complaints of shortness of breath since 1yr and 1 episode of syncopial attack 3 days back. Patient gives typical history of breathlessness in standing position along with palpitations and generalised weakness. On examination- her vitals are stable.

Systemic examination of CVS revealed systolic murmur and mid diastolic murmur tumour plop over apex, S1 is loud and there is inspiratory split in S2. On investigating the pt, her Blood counts, liver and renal function tests are normal. Hence the diagnosis of Atrial Myxoma is confirmed based on history, clinical features and non invasive diagnostic tests like 2D- Echocardiography and biopsy of the tissue sample. Eventually after stabilizing the patient, we did surgery of this patient and now her breathlessness has improved and her auscultatory findings completely improved. Discussion: Atrial Myxomas are most common of all cardiac tumors, most common site of origin is left atrium near fossa ovalis.

Its diagnostic mode of choice is echocardiography. Although chararcteristically benign It can embolize to coronary arteries and presents with acute myocardial infarction, cerebral infarction. Some times myxomas present with severe left ventricle dysfunction thus leading to effort intolerance Surgical management is the treatment of choice with good prognosis. Recurrence of myxoma is very rare.

Objective - To assess the clinical and biochemical profile of malaria. Material and method- The study includes cases of malaria selected from medicine indoor wards. History of present illness, BP,Pulse rate, respiratory rate,temperature, blood sugar, systemic examination. Serum creatinine, blood urea, urine input and output charting, Peripheral blood smear for malarial parasite. Card test, Blood sugar, USG of whole abdomen. Maximum no. Maximum pts presented with fever via p. Conclusions — The incidence is higher in males than in females.

The peak incidence was seen in 2nd and 3rd decade. Anaemia was more common Mortality came out to be 2. A rare occurrence of unresponsiveness due to brady arrhythmia secondary to cardiac tamponade. Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease.

The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Patients with tamponade have signs reflecting varying degrees of reduced cardiac output and shock which include tachypnea, diaphoresis, cool extremities, peripheral cyanosis, depressed sensorium, and rarely yawning.

Cardiac tamponade presenting as loss of consciousness is rare entity and almost never explained in literatures. We encountered a patient with features suggestive of UTI with sepsis and AKI in due course in the hospital had bradycardia and loss of consciousness when further evaluated was found to have massive pericardial effusion. A 70 years old female patient who is a diabetic and hypertensive, presented with history of fever, decreased urination since 15 days. Antihypertensive was changed over to cilnidipine from losartan in view of AKI.

On day 4 she developed bradycardia with HR of 50 beats per minute regular. Diagnosis of Sinus bradycardia -sick sinus syndrome versus cilnidipine induced. Cilnidipine was stopped accordingly. Cause of unresponsiveness was kept as syncope versus TIA. Pericardiocentesis was done; ml of thick purulent sticky discharge was drained.

Study of estimation of serum parathyroid hormone levels and its relation with severity and duration of heart failure. Background: Congestive Heart Failure in a broader perspective is a systemic illness characterized by neuro-endocrine immune system dysregulation. This illness includes oxidative stress, release of proinflammatory cytokines, a catabolic state and secondary hyperparathyroidism based on urinary and fecal wasting of calcium and magnesium.

Abnormal elevations of serum PTH leads to excessive intracellular calcium accumulation in cardiomyocytes leading to myocyte necrosis, replacement fibrosis and contributes to progressive heart failure. Aims and objectives: To establish the relation of serum Parathyroid hormone levels with duration of heart failure. To establish the relation of serum Parathyroid hormone levels with severity of heart failure.

Methodology: The study was conducted on 50 patients diagnosed to have congestive cardiac failure on the basis of symptoms, clinical examination, NYHA grading and 2-D Echocardiography. Serum PTH and serum calcium were measured in the study population and its correlation with severity and duration of heart failure was analysed statistically. Serum calcium levels were also decreased as the severity and duration of heart failure increased. So serum PTH levels can be used as an individual prognostic marker to assess the sev erity of heart failure.

I ntroduction: A 24 year old male presented with the complaints of chest pain of 30 minutes duration which was retrosternal, sudden in onset and severe in intensity. Not a known case of hypertension or diabetes. Patient was a cigarette smoker and an occasional alcoholic. On examination, vitals were stable and GPE was normal.

ECG showed tall T- waves. The patient was admitted for observation and serial ECGs were taken, which were all normal with no changes suggestive of MI. During contemplation for the diagnosis, the patient had an episode of vomiting and suddenly started gasping for breath and became pulseless. The cardiac monitor showed polymorphic ventricular tachycardia, an immediate J DC cardioversion was done and 1 ampule of MgSO4 was injected and the patient went into sinus bradycardia. The patient was reverted back to sinus tachycardia of per minute PR with Inj.

An Emergency cardiologist opinion was taken and a bedside 2DECHO was done where regional wall motion abnormality of anterior w all was noted. An immediate decision for thrombolysis was taken and streptokinase was given to the patient. Conclusion: The misleading factors which deviated us from the diagnosis of MI was the age of patient, normal cardiac enzymes and normal ECGs. Immediate cardiov ersion and thrombolysis sav ed the patient. MI in the age group Cardiac cirrhosis: a rare manifestation of idiopathic pulmonary arterial hypertension.

Background: Cardiac cirrhosis is one of the rarest manifestation of pulmonary artery hypertension. The true prevalence of cardiac cirrhosis is difficult to estimate, since the disease typically remains subclinical and undiagnosed. The incidence of cardiac cirrhosis at autopsy has decreased significantly over the past several decades, may be due to lower rates of uncorrected rheumatic heart disease and constrictive pericardial disease. Case presentation: A 60 yr old female presented to OPD with recurrent episodes of abdominal distention, pedal edema, and breathlessness from 2 yrs. On examination, raised JVP, parasternal heave, loud P2, tricuspid regurgitation, shifting dullness with dilated vessels over abdomen, right upper quadrant tenderness with pulsatile liver.

She has a past history of idiopathic pulmonary hypertension and repeated heart failure for 15yrs. Investigation: ECG, chest xray showed right ventricular hypertrophy. USG abdomen showed liver cirrhosis, ascites. Confirmed on CT abdomen. Ascitic fluid analysis showed SAAG 1. Conclusions: Diagnosing cardiac cirrhosis clinically is difficult, previous research has suggested that it should be based upon the triad of right-sided heart failure, hepatomegaly and ascites with high protein content and high serum ascites albumin gradient, however it should be noted that histology plays an important role in the definitive diagnosis.

Cardiac cirrhosis remains a rare but important cause of cirrhosis. The role of ECG in localizing the culprit vessel occlusion in acute ST segment elevation myocardial infarction with angiographic correlate. Introduction: Electrocardiogram ECG remains a crucial tool in the identification and management of acute myocardial infarction.

A detailed analysis of patterns of STsegment elevation may influence decisions regarding the perfusion therapy. Patients with ST elevation from ECG was evaluated to identify culprit v essel and later correlated with coronary angiogram. Observations: Amongst patients, 63 patients had anterior wall and 49 patients had inferior wall MI. Conclusions: The admission ECG in patients with ST elevation in AMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

Effects of diabetes mellitus and ischemic heart disease on the progression from asymptomatic left ventricular dysfunction to symptomatic heart failure. Background: Emerging data suggest that diabetes mellitus is a risk factor for the progression of established heart failure only in those patients with ischemic cardiomyopathy whether diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular to symptomatic heart failure in patients with left ventricular dysfunction of an ischemic cause is not known.

We used adjusted survival analysis to examine the effects of ischemic heart disease and diabetes mellitus on 3 prespecified study end points: 1 development of heart failure HF symptoms, 2 HF hospoitalization and death or development of symptoms. Native triple valve endocarditis caused by staphylococcus aureus as complication of post abortal sepsis - A successfully treated case. In the modern era IE presents acutely rather than as a chronic disease. IE due to Staph. Aureus can be more severe than IE due to other organisms, including more frequent association with severe sepsis, neurological events and multi organ failure and higher mortality.

Majority of the IE cases occur on a single valve and multiple valve involvement is rare. As the number of valves involved increases, the chance that the patient develops complications like congestive heart failure, acute renal failure, occurence of embolic events and splenic abscess increases.

Here we report a case of multivalve endocarditis due to MSSA. Case - Here we report a case of 25 yr old female, nil premorbid who presented to us with history of fever for 2 weeks not responding to conventional antibiotics. She had history of recent spontaneous 2nd trimester abortion and signs of heart failure and signs of infective endocarditis. Labs were suggestive of sepsis with multiple organ dysfunctions. She was emperically started on teicoplanin and pipercillin tazobactum. Echocardiography revealed features suggestive rheumatic heart disease- mitral stenosis with vegetations involving 3 native valves.

She developed new onset left hemiparesis with slurring of speech during hospital stay. Subsequently MRI brain was done which showed multiple early sub acute infarcts. Blood culture reports showed MSSA. She was changed over to cloxacillin and vancomycin as per snsitivity. She improved significantly evident from disppearance of regurgitant murmers and resolution of pulmonary edema. She was discharged with cloxacillin and diuretics and antiplatelets. Conclusion- This case emphasizes that despite the presence of multiple risk factors like multivalve involvement and multi organ dysfunction, patient outcome can be significantly improved if antibiotics are started at the earliest.

Candida albicans endocarditis in a hemophiliac patient with chronic kidney disease: A case report. Introduction- Hemophilia is an X-linked recessive clotting disorder. Chronic kidney disease is a rare complication in hemophilia. The need for a long term hemodialysis in such patients necessitates the use of indwelling central venous catheter for prolonged periods. Fungal endocarditis due to an indwelling catheter is rare, but it is the most sev ere form of endocarditis.

Methodology- A haemophiliac patient with chronic kidney disease was evaluated for his symptoms and the necessary inv estigations were performed and analysed. Observation- A 25 year old man, a known case of Hemophilia A with Chronic kidney disease, on maintenance hemodialysis twice a week came to the hospital with complaints of fever and persistent breathlessness since 3 days. The patient had an indwelling central venous catheter since 6 months for maintenance hemodialysis. The patient was febrile and was pale. On systemic examination, the patient had bilateral basal crepitations, an ejection systolic murmur in the tricuspid area and diminished heart sounds in all areas.

There w as no evidence of organomegaly. Laboratory data revealed Hb 4. RBS and liver function tests were normal. Blood cultures revealed a growth of candida albicans in two out of three subcultures. The patient was started on Amphotericin B and teicoplanin. Conclusion- Long standing indwelling catheter predisposes to fungal endocarditis. A rare case of fungal endocarditis in a haemophiliac patient with chronic kidney disease is reported here. Introduction: Elevated hs-CRP constitutes an independent predictor of advanced plaques in dyslipidemic subjects. Several prospective studies have demonstrated that hs-CRP is an independent predictor of future risk for cardiovascular events among patients with acute coronary syndromes.

Exclusion criteria: Recent history of surgery or trauma within the preceding 2 months. Patients on dialysis. Current acute illness including infectious diseases within past 1 week. Clinically suspected or a proven case of connective tissue disorder. Estrogen therapy. Superficial femoral artery thromosis secondary to hypereosinophilic syndrome. Intoduction- Hypereosinophilic syndrome is characterised by persistent marked eosinophilia in the absence of a primary cause of eosinophilia with evidence of eosinophil mediated end organ damage. Most characteristic cardiovascular abnormality in hypereosinophilic syndrome is endomyocardial fibrosis.

Development of peripheral arterial thrombosis is a rare manifestation of hypereosinophili c syndrome. Material- A 50 year old male came with complaint of pain in right lower limb. Patient had intermittent claudication. Patient did not have any other risk factors like diabetes mellitus, hypertension, dyslipidemia, sedentary life style. Other hematological and biochemical parameters were within normal limits. Peripheral arteriography showed thrombus in right superficial femoral artery.

Histopathological examination of thrombus showed presence of increased eosinophils in the thrombus suggesting increased eosinophils as a risk factor for peripheral v ascular disease. Observation- Arteriography of peripheral vasculature of a patient with hypereosinophilic syndrome showed thrombus containing eosinophils. Increased circulating eosinophils cause increased risk of thrombus formation in peripheral vasculature. Conclusion- Cardiovascular manifestations are the major cause of morbidity and mortality in hypereosinophilic syndrome.

This case reports peripheral vascular occlusion as one of the manifestation of hypereosinophilic syndrome. So hypereosinophilic syndrome should be considered as a risk factor for peripheral thrombus formation. Further research should be done regarding any need for prophylactic anticoagulation in a case of hypereosinophilic syndrome. Introduction : Left ventricular non-compaction is a rare cardiomyopathy caused by arrest of normal embryogenesis of the endocardium and myocardium in intrauterine life at weeks of gestation.

It is characterized by prominent left ventricular trabeculae and deep intertrabecular recesses. It may be familial or sporadic.

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Based on echocardiography, prevelance of left ventricular non compaction is 0. Clinical manifestations are variable ranging from no symptoms to heart failure, atrial and ventricular arrhythmias, systemic thromboembolism and sudden cardiac death. Echocadiography has been the diagnostic procedure of choice. He is not a known hypertensive, diabetic. He is an ocassional smoker and alcoholic. Working diagnosis of dilated cardiomyopathy w as done. Observation: His echocardiogram showed thickened left ventricular wall consisting of two layers - a thin compacted epicardial layer and markedly thickened endocardial layer with numerous prominent trabeculations and deep recesses.

Colour doppler displayed evidence of flow within deep intertrabecular recesses. Right ventricular wall is normal. Magnetic resonance imaging supported the diagnosis. He was treated conservatively and is in regular follow up. Conclusion: The above findings were consistent with isolated noncompaction of the left ventricle. Making the correct diagnosis is important because of the possible associations and need for longterm managment and screening of l iving relatives. Introduction: Acute coronary syndrome ACS is one of the leading cause of cardiovascular morbidity and mortality worldwide.

Many serum markers are under investigation to assess the severity of ACS. Few studies have shown positive correlation between these markers and severity of ACS. However such association is not established in literature on Indian patients. Methods: This is a prospective study on 86 hospitalized patients with ACS. Blood for hemogram and lipid levels was drawn at admission. The severity of ACS was assessed by Gensini score after performing coronary angiography. Data analysis and interpretation was done with SPSS Patients were divided into 3 groups mild, moderate and severe based on Gensini score.

When such a presentation occurs all focus is placed on not only the resolution of the presenting complaints but also on prevention of future mortality and morbidity. The case on presentation has been treated with utmost curiosity and interest due to the age group and absence of all other previous history. Case report: A single case study of a 20 yr old patient who presented to our hospital Basaveshwar Teaching and General Hospital with a tachyarrhythmia and loss of consciousness.

He was a young physically active male who had no previous history indicative of any pre-existing pathology. His clinical and laboratory profile were studied and related investigations were done. He was treated with Amiodrone and followed up with all necessary clincal examinations as w ell as investigations in the ICCU setting. The case served as an excellent example of a typical presentation of the pathology in a young adult as a tachyarrhythmia and was followed to its logical conclusion in the ICCU setup. Introduction: Leprosy is a chronic granulomatous infectious disease, which is caused by Mycobacterium leprae.

Although skin, nerves and musculoskeletal systems are amongst the common to be affected, it may be difficult to conclude the etiology on initial clinical assessment especially when patient presents with muti system involvement. Leprosy is an important global health concern; early diagnosis and a full course of treatment are critical for preventing lifelong neuropathy and disability. Material and observation: We report a case of 54 year old man who had erythematous skin lesions for more than 2 yr duration, subsequently developed features of sensory neuropathy of 3 months involving feet along with fatigue and weight loss.

Patient fulfilled criteria for Poly Arteritis Nodosa, but before further evaluation Skin biopsy taken revealed leprae bacilli. He was treated with short course of steroids and MDT following which he improv ed remarkably. Conclusions: In the modern era, in non endemic area it is likely that patient suffering from neuropathy may present to physician for evaluation of vasculitic etiology causing neuropathy. Our patient presented with neuropathy and skin lesions which were secondary to leprae reaction. Significant nerve destruction occurs during the reactive phase of both type 1 reactions and type 2 reactions.

Mycobaterium leprae itself can cause vasculitis, which can be confused with other causes of vasculitis inclucing ANCA vasculitis. Having good knowledge regarding un common causes of vasculitis will help to narrow down the differential diagnosis and will prevent unnecessary diagnostic workup. Background: Platelet inhibition may be necessary in post PCI period and there are only few studies on platelet aggregation comparison betw een males and females. Methods: We have studied 78 consecutive in- patients from NIMS cardiology department from august to who underwent PTCA, in the follow up period of 15 days we did platelet aggregation test for all the patients.

We calculated platelet inhibition by — platelet aggregation. Results: Out of 78 patients 19 are females 58 are males. Both the groups are matched in baseline characteristic of mean age 57 years, hypertension, diabetes, type of presentation stable or unstable weight, eGFR, type of stent, presence or absence of LV dysfunction, single or multi vessel disease.