Year Book of Medicine 2019 Gurpreet S Wander
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdominal pain 107
Academia, acute 210
Accelerometer device 246
Acetylcysteine 11, 215
Acid-fast bacilli 161, 248
Acidosis 83
Acinetobacter 41, 42
Acquired immunodeficiency syndrome 160
Activated partial thromboplastin time 140
Acyclovir 170
Adalimumab 283, 298, 299
Addison's disease 77, 78
Adenosinergic dysfunction 262
Adrenal glands 187
Adrenal insufficiency 78
primary 78
Adult-onset Still's disease 300
Adverse cardiovascular events 33, 212
Adverse drug reactions 291
Adverse pregnancy outcomes 282
Aerodynamic diameter 51
Air pollution 44, 121
effects of 44
household 44
indoor 44
multiple sources of 44
Airway obstruction 45, 46
Airway pressure 62
Akkermansia muciniphila 96, 97
Alanine
aminotransferase 119, 129
transaminase 127
Albendazole 166, 250, 251
Albuminuria 95
Alcohol 130
consumption, effects of 119
Alendronate 105
Alirocumab 21, 22
group 21
Alkali therapy 231
Allograft pathology, Banff classification of 205
Allopurinol 198, 277
cardiovascular safety of 277
Alteplase 255
Ambulatory blood pressure
measurements and mortality 17
monitoring 17
American Gastroenterological Association 107, 108, 108t
institute guideline 107
American Society for Microbiology 143
American Society of Tropical Medicine and Hygiene 250
Amniotic fluid index 92
Amphotericin B 82
Ampicillin 172
Angiography 10, 11, 215
timing of 24
Angiotensin converting enzyme 7, 28, 198
Angiotensin receptor
blocker 28
neprilysin inhibitor 7, 27, 28, 34
Angiotensin-converting enzyme inhibitors 7, 28
Animal bite wound infection 144
Anti-acid therapy 58
use of 59f
Antiarrhythmic drug 8
therapy 8
Antibiotic 13, 64
overuse 65
prescription policies 66
prophylaxis, continuous low-dose 156
resistance 172
therapy, initial 13
Antibody 146
mediated
changes 206
rejection 205
Anti-carbamylated
peptide antibodies 293
protein antibodies 292
Anti-citrullinated
peptide antibodies 292
protein
antibodies 292
autoantibodies 292
Anticoagulant 260
choice cotherapy 130
Anticoagulation therapy, guideline-directed 8
Antiepileptic drugs 244246, 270
influence of 245
Antifibrotic drugs 37
Antihypertensive drugs 220
Antihypertensive medication, titration of 240
Anti-MDA5 antibody-associated myositis 287
Anti-neutrophil cytoplasmic antibody 280, 300
Anti-nuclear antibody 72
Antiplatelet therapy 24, 261
longer dual 22
triple 260
Anti-rabies vaccine 168
Antiretroviral therapy 174
three-drug 196
trial of 195
Antirheumatic drug
biological disease-modifying 299, 303
disease-modifying 30, 283, 284, 303
Anti-thyroid
antibodies 72
drugs 71
treatment 71, 72
Anti-tissue transglutaminase antibody 73
Antitubercular prophylaxis 303
Antiviral agents, direct acting 123
Aorta, abdominal 31
Aortic dissection, acute 224
Aortic stenosis
high-risk severe 26
severe 26
Apical ballooning syndrome 32
Apixaban 34, 131, 234
Apnea-hypopnea index 60
Appendicular skeletal mass 138
Arms, lymphedema of 165
Arrhythmias, risk of 4
Artemisinin-based combination therapy 148
Arteriovenous fistula 222
Arthralgias 31, 301
Arthritis 294
Arthropod-borne infection 143, 144
Ascariasis
lower 147
prevalence of 147t
Ascaris lumbricoides 147, 148
antigen 148
infection 147
prevalence 148
Aspartate aminotransferase, normal range for 129
Aspirin 1, 10, 109, 110, 244, 260, 261
Asthma
global initiative for 69
mild 68
Asymptomatic hyperuricemia 225
Atezolizumab 49, 50
group 49, 50
plus chemotherapy, first-line 49
Atherosclerosis
accelerated 77
multi-ethnic study of 19
Atherosclerotic cardiovascular disease 193
Atherosclerotic vascular disease 22
Atrial fibrillation 8, 9, 9fc, 28, 29, 33, 34, 7274, 131, 232, 233
Atypical organisms, testing for 151
Autoimmune
features 287
polyendocrine syndrome 77, 78
thyroid disease 78
Autonomic nervous system activity 60
Azathioprine 218, 219
B
Bacteria 169
actinobacteria 139
firmicutes 139
Bacterial infection 65, 300
Bacteroidetes 139
Balanoposthitis 81
Banff classification 205
core of 206t
Banff diagnostic categories 206t
Banff lesion score 205, 207, 208
Banff reference guide 208
Barbershops 208, 209
Bariatric surgery 99, 111
Barrett's esophagus 109, 110, 110t
Beta-agonist, long-acting 54
Beta-blockers 28, 198
Bifidobacterium 98
adolescentis 96, 97
Bile salt hydrolase 97
Biliary drainage, preoperative 113, 115
Biliary fistula 114t
Bilirubin, presence of elevated 113
Binocular visual acuity 188
Bioelectrical impedance 138
Biosimilar adalimumab 298, 299
Bipolar illness 187
Birmingham vasculitis activity score 280
Bismuth quadruple therapy 125
Bisoprolol 7
Bisphosphonates 105, 191
BK-virus nephropathy 208
Bleeding Academic Research Consortium 23
Blood 143
culture 144
eosinophil counts 55
gas analysis 211
glucose, self-monitoring of 92
pressure 31, 212, 213, 220, 221, 223, 240
benefits of controlling 212
efficacy of self-monitored 240
elevated 95
reduction, cluster-randomized trial of 208
self-monitoring of 241
standard 17
Bloodstream infection 143, 144, 222
catheter related 222
Body mass index 19, 85, 112, 193
Body, oscillatory movement of 254
Bone 143
fractures 7375
Boston carpal tunnel questionnaire 273
Brachial artery flow-mediated dilation 231
Brain 59
cysticerci in 250
derived neurotrophic factor 187, 236
features 262
somatosensory system 261
structure 59
volume 60
Breastfeeding 92
British Heart Foundation Study 1
Broken heart syndrome 32
Bronchitis, chronic 44
Brugia species 165
Budesonide 68
Butyrivibrio 98
C
Caffeine 214, 215
citrate administration 213, 215t
Calcineurin inhibitor toxicity 208
Calcitriol, amounts of 203
Calcium 89, 90
sensing receptors 79
supplements 192
upregulation 183, 184
Callosal fibers 262
Canagliflozin 80
Cancer 93, 295
chemotherapy 295
related death 1
Candida albicans 81
Candida glabrata 81, 82
Candida vulvovaginitis 82
severe acute 82
uncomplicated 82
Candidiasis 78
Carbohydrate intolerance resulting 204
Carboplatin 49
Cardiac arrest 8
Cardiac catheterization 29
Cardiac disease 183, 184, 198
used for 198
Cardiac function 184
Cardiac magnetic resonance 32
Cardiac resynchronization therapy 16
Cardiac tamponade 29
Cardiogenic shock 13
Cardiological Society of India 27, 28
Cardiology 3
Cardiometabolic consequences 98
Cardiometabolic Syndrome 18
Cardiometabolic traits 18, 19
Cardiomyopathy
acute stress-induced 32
stress-induced 32
Cardiovascular abnormalities 71
incidence of 71
Cardiovascular comorbidities 194
Cardiovascular complication 114
Cardiovascular disease 35, 74, 84, 85, 212, 276, 277
end-stage of 184
lower risk of 1
Cardiovascular events 60, 193
Cardiovascular function 163
Cardiovascular health study 19
Cardiovascular risk 277
Cardiovascular symptoms 72
Cardiovascular system 29, 72
infection 143
Care
levels of 86
treatment, standard of 255
Carotid endarterectomy 260
Carpal tunnel
corticosteroid injection 273
syndrome 273
Carvedilol 7
Catheter ablation 8, 9
availability of 8
role of 9
Ceftriaxone 172
resistant Salmonella enterica serotype typhi 171, 172
Cell
atlas 237
lung cancer, small 50
transcriptomics, single 236, 238
Central nervous system infection 143, 144
Central somatosensory system 262
involvement of 261
Central venous catheter 223f
use of 222
Centrifugal pump group 20
Cerebral parenchymal cysticerci, multiple 251
Cerebrospinal fluid 144
Cerebrovascular events, acute non-disabling 261
Charlson comorbidity index 79
Charlson-Romano comorbidity index 198
Chemopreventive strategy 110, 111
aspects of 110t
Chemoradiotherapy 52, 53
Chemotherapy 126
platinum-based 50
Chest pain 10, 56
Chickenpox 176
vaccination 176
China Health and Retirement Longitudinal Study 201
Chinese Geriatric Population 201
Chi-square test 44
Chlamydia pneumoniae 150, 151
Chloramphenicol 172
Cholecystectomy 135137
Cholesterol 21
level 95
Chronic kidney disease 83, 212, 225, 230, 231
progression of 225
Cinacalcet 79
Cirrhosis 127
acute decompensation of 140
advanced 128
complications of 128
Cirrhotic patients, management of 129
Citrullinated peptide, anti-cyclic 72
Clarithromycin resistance 125, 126
Claustrophobia 67
Clavien-Dindo score 114
Clean intermittent self-catheterization 156, 157
Clinical prediction rules 247
Clinical relevent pancreatic fistula 114
Clopidogrel 24, 260, 261
dose of 261
Clostridioides difficile infection 132
Clostridium
difficile 160
species 97
Clotrimazole cream 82
Clotrimazole vaginal suppository 82
Coagulase-negative staphylococci 14, 42
Coagulation cascade, classical scheme of 233f
Coagulation enzymes 233f
Cognitive behavioral therapy 267
Community dwelling adults 89
Community-acquired pneumonia 150
Compensatory systemic vasoconstriction 61
Computed tomography 31, 38
angiography 5, 10, 11, 297
high-resolution 37, 38, 57
Concomitant inflammatory arthritis 274
Congenital malformation 282
Congestive heart failure 93
Conjunctivitis 144
Connective tissue diseases 285
Consecutive pancreatoduodenectomies 113
Conventional ventilation strategy 48
Cooperative international neuromuscular research group 264
Coronary angiography 12
Coronary artery
bypass graft 22
disease 1, 4, 5, 10, 11, 23, 73
Coronary computed tomography angiography 4, 10
Coronary heart disease 21, 74
Coronary revascularization procedures 21
Coronary syndrome, acute 1, 3, 2125
Corpus callosum 261
thickness 262
Cortical thickness 261, 262
Corticosteroid 126, 163, 251
inhaled 54, 55, 68
injection 274
cost-effectiveness of 273
Cortisol 187
Corynebacterium 42
Co-trimoxazole 172, 291
Cough, management of 37
Coupled model intercomparison project 51
Cox proportional hazards 58
C-reactive protein 31, 72, 297, 298, 300
Creatinine 12
Cryptogenic stroke 270, 271
ischemic 244
secondary prevention of 270
Cryptosporidiosis 160
Cushing's syndrome 76, 77
management of 76
Cyclin-dependent kinases 76
Cyclophosphamide 218, 219, 280, 289
Cyclospora 160
Cyclosporiasis 160
Cysticerci, evolution of 251
Cytokines, extracorporeal removal of 229
Cytomegalovirus 160
Cytotoxic T lymphocyte antigen-4 50
D
Dabigatran 131
Daily living, instrumental activities of 189
Dairy products 35
types of 35
Dapagliflozin 80
De novo glomerulopathy 208
Death
leading cause of 173
reduced risk of 264
Deep venous thrombosis, management of 131
Deflazacort 263
Delirium 199, 200
Dementia 73, 74, 93, 154f, 198
diagnosis of 198
risk of incident 199
Dengue
seronegative participants 145
serostatus, effects of 145
vaccine safety and efficacy 145
Denosumab 105
Dentate gyrus 187
Deoxyribonucleic acid 180
Dermatomyositis 286
Devices, cluster-randomized trial of 222
Diabetes 12, 71, 80, 91, 256
detection of 86
management of 86
preexisting 91
prevention of 86
risk factors to 100
Diabetes mellitus 77, 80, 93, 138, 257, 274, 276
complications of type 2 85t
treatment of type 2 93, 102
type 1 78, 91
type 2 80, 81, 83, 85, 86, 91, 9496, 98, 102, 189, 190, 256258
Diabetic foot 144
Diabetic nephropathy 12
Diarrhea 77, 122, 144, 164
Diastolic pressure, equalization of 29
Digoxin 7, 33
effects of 34
role of 34
Dimethyl fumarate 259
Dipeptidyl peptidase 4 inhibitors 102
Disability-adjusted life years, age-standardized 101, 101f
Disaccharides 121
Disease activity score 72
Disease-modifying
therapy 259
treatment 259
Diuretics 7, 84
Dizziness 126
Downstream invasive angiograms 10
Doxycycline 156
Drug
class ranking 103
eluting stents 22
therapies, use of 11
Dual antiplatelet therapy 23, 261
Duchenne muscular dystrophy 263, 264, 266
care of 264
Durvalumab 52, 53
Dysglycemia 18
risk for 85
Dyslipidemia 18, 77, 84
Dysphagia 74
Dysphonia 74
Dysplasia, high-grade 109
Dyspnea 74
management of 37
Dysrhythmias, abnormal 71
Dystrophinopathies, X-linked 268
E
Echocardiography 6
Ejection fraction 6, 9, 16, 18, 184
reduced 9, 19, 183
Electrocardiogram 25
Electrocardiography 57
Electroimmunotransfer blot assay 250
Electrolytes 7
Electrophysiology 254
Elephantiasis 165
Eleusine coracana 86
Empagliflozin 80, 81, 86
Emtricitabine 195, 196
Enalapril 7
Enamel hypoplasia 77
End-expiratory pressure, positive 48, 61
Endocarditis
intravenous antibiotic treatment of 13
partial oral treatment of 13
Endoplasmic reticulum calcium ATPase 2A gene therapy 184
Endoscopic necrosectomy 117
direct 118
Endoscopic retrograde cholangiopancreatography 107, 108, 113, 135, 136
Endoscopic sinus aspirate 144
Endoscopic ultrasound 117
Endotracheal tube 67
Endovascular thrombectomy 249
Endovascular valve edge-to-edge repair study 15
Enteric fever 158, 172
fatality rate of 158
Enterobacter 41
Enterobacteriaceae 42
Enterococcus faecalis 13, 14
Enterotoxigenic Escherichia coli 163, 164
Enterovirus 170
Enzyme-linked immunosorbent assay 155
test 155
Eosinophilic inflammation 55
Epidemiological transition level 100
group 102
Epidermal growth factor receptor 76
Epididymo-orchitis 81
Epiglottitis 144
Epilepsy 245, 247
Epileptic seizures 266
Epithelial regeneration, representation of 123f
Erythrocyte sedimentation rate 31, 72, 297
Escherichia coli 41, 172, 173
Esomeprazole 109, 110
chemoprevention 109
Esophageal adenocarcinoma, incidence of 110
Esophagitis 131
Essential tremor 254
Estimated glomerular filtration rate 12, 83, 84, 216, 225, 227f, 231
Ethambutol 180, 181
Etomidate 77
Eubacterium rectale 97
European Medicines Agency 79
European Neuromuscular Centre 268
European Tuberculosis Reference Laboratory Network 181
Exacerbations, risk of 68
Exacerbator eosinophilic phenotype 55
Excessive alcohol 104
Exercise electrocardiogram 10
Extensive-stage small-cell lung cancer 49
Extracorporeal membrane oxygenation 47, 48
Extracorporeal therapies 228
Extrapulmonary tuberculosis 161
Extreme emotional stress 3
Extreme physical exertion 3
F
Face mask 67
Facioscapulohumeral dystrophy 268
Faecalibacterium prausnitzii97
Familial hypercholesterolemia 22
Fast ventricular rate 34
Fasting plasma glucose 92, 203
Fatality 158
Fatigue 279, 279
Fatty infiltration 128
Fatty liver 129
Febrile illness 158, 172
treating acute 156
Febuxostat 198, 277
cardiovascular safety of 277
therapy 225
Fermentable oligosaccharides 121
Fetal death 91
Fetal surveillance, intensified 92
Fever 31, 150, 300
causes of 300
low-grade 176
of unknown origin 152
Fibrin specificity, greater 255
Fibroblast growth factor levels 231
Fibrosing interstitial lung disease, types of chronic 37
Fibrosis 98
Fibrotic phase, chronic 30
Filariasis, triple therapy for 165
Fingolimod 258, 259
Flattened circadian biorhythm 187
Fludrocortisone 162, 163
Fluid overload, symptoms of 7
Fluoroquinole 172
Food and Drug Administration 83, 193, 226
Forced expiratory
time 45, 46, 46f
utility of 45
volume 40
abnormal 45
Forced vital capacity 44, 290
Formoterol 68
Fracture 74, 274
decreases, risk of 105
prevention of 90, 191
primary prevention of 89
reduces, risk of 104
risk 191
assessment tool 105
Frailty syndrome
pooled risk estimate of 202
risk of 202
Framingham Heart Study 19
Free pump, side-effect 20
French Aortic National Corevalve and Edwards 26
Fructan 120
Functional mitral regurgitation 15
Fungi 42
G
Gait impairments, risk factors for 185
Gallstone pancreatitis 136, 137
acute 135
Gastric emptying, delayed 114
Gastritis 131
Gastroenteritis
acute 135
moderate-to-severe 134
probiotic for children with 134
Gastroenterology 107
Gastrointestinal bleed 133
Gastrointestinal bleeding 131
risk for 132
Gastrointestinal malignancies 1
Gastrointestinal symptoms 84, 121
Gastrointestinal tract
bleeding, risk of upper 130
infections of 143, 161
Gene therapy 183, 184
Genetic diagnosis 178
Genetic sequencing, rapid advance of 268
Genital infection 80, 81f, 81t, 143
symptoms 81
Genital warts 81
Genitourinary symptoms, risk of 80
Genome-wide association study 190
Genotypic predictions 180
Geriatrics 178
Gestational age babies 204
Gestational diabetes 91
diagnosis of 92fc
mellitus 92, 189, 190, 203, 204
Gestational thrombocytopenia 195
Giant cell arteritis 30
Glatiramer acetate 259
Global burden of disease 163, 209
Global Initiative for Chronic Obstructive Lung Disease guidelines 55
Global Registry of Acute Coronary Events Score 25
Globus pallidus 262
Glomerular filtration 225
rate 157, 234
Glucagon-like peptide 1 97, 99
agonists 102
Glucocorticoid 104, 105, 186, 188, 280
induced osteoporosis 104
inhalation of 67
long-term 104
effects of 263
prolonged high-dose 290
receptor 187
antagonist 77
therapy 264
treated with 264
treatment 263, 264
usage, duration of 263
Glucocorticosteroids 219
Glucose monitoring system, continuous 91, 92
Glutamine 123
Gluten 120
Glycemia 103
higher 84
Glycemic control 92
Glycemic targets 91, 204
Glycosylated hemoglobin 91, 94
elevated 95
Gout 198
Gram-negative organisms 41
Granulomatosis 279, 280
Graves’ disease 74
Gray matter nuclei volume 262
Gut microbiome 96
analysis of 138
H
Haemophilus
influenzae 41
species 42
Hansen's disease 301
rheumatological manifestations of 301
Headache 176
Health
assessment questionnaire-disability index 298
burden of bacterial diarrheal pathogens 164
problems 201
professionals 203
service planning 168
Healthcare
system 179
team, integral part of 144
Heart failure 69, 9fc, 12, 15, 16, 19, 2428, 34, 73, 74, 183, 184
chronic 7
stable 7
hospitalization for 95
management of 27
pharmacotherapy, evidence-based 6
studies 34
types of 18
Heart transplant 58
Heat shock protein 76
Helicobacter pylori 125
infection 125
Hemodynamic instability 25
Hemorrhage
post-pancreatectomy 114
risk of major 260
Hemostasis, rebalanced 141
Hepatic cirrhosis 140
Hepatic dysfunction 155
Hepatic encephalopathy 127
role in 128
Hepatitis
B surface antigen 127
seroclearance of 115, 116
B virus 116, 127, 160
infection 126
B, chronic 116
C virus 160
Hepatocellular carcinoma
causes for 124
risk of 123
Hepatocyte injury 99
Hepatology 107
Herpes virus 170
Hippocampus, cornu ammonis of 187
Human immunodeficiency virus 143, 159, 160, 169, 196
associated tuberculosis 173
infection 195
pregnant women with 195
Human monoclonal antibody 21
Hybrid therapy, reverse 125, 125t
Hydralazine 28
Hydrocortisone 162, 163
plus fludrocortisone 161
treatment of 163
Hydroxychloroquine 218, 219, 281, 282
Hydroxyvitamin D levels 202
Hyperbilirubinemia 114
Hypercalcemia, severity of 79
Hypercalcemic severity 80
Hypercortisolism 76
Hyperglycemia 204
Hyperparathyroidism, primary 79
Hypertension 17, 77, 205, 208210, 212, 240, 241, 276
complicating pregnancy 91
difficult to control 17
malignant 224
masked 18
position document 223
Hypertensive emergencies 223, 224
classification of 224
management of 223, 224
Hypertensive encephalopathy 224
Hyperthyroid 71, 72
Hyperthyroidism 71, 74
overt 71
subclinical 73, 74
Hyperuricemia 225
Hypoglycemia 91
Hypogonadism, primary 78
Hypokalemic periodic palsy 288
Hyponatremia 74, 75
mild 75
Hypoparathyroidism 77, 78
Hypopnea, categorizing 60
Hypotension 156
Hypothermia 150
Hypothyroidism 274, 293
Hypoxemia 48
refractory 47, 48
I
Ibandronate 105
Icterus 156
Idiopathic generalized epilepsy 252
Idiopathic inflammatory myositis 287
Idiopathic interstitial pneumonia 38
Idiopathic nephrotic syndrome 229
Idiopathic pulmonary fibrosis 37, 38, 58, 285
diagnosis of 37
treatment of 37
Immune checkpoint inhibitors 295
role of 50
Immunity, gift of 176
Immunoglobulin 168
E 147
G 147
Immunology 273
Immunosuppressants 126
Immunosuppression 300
Immunosuppressive therapy 286, 287
combined 219
Immunosuppressive treatment, combined 218, 219
Indian Chest Society 39
Indian National Association for Study of Liver 126
Infection 3, 77
incident 291
intra-abdominal 143
prevention of 148
spread of 176f
Infectious disease 143
diagnosis of 143
Infectious Diseases Society of America 143, 250, 251
Infective endocarditis 13, 14
Infective focus 144t
Inferior vena cava filters 12fc
Inflammation 3
noninfectious 300
Inflammatory arthritis 277, 296, 302
Inflammatory myositis 287
Influenza
episode of 3
infection, laboratory-confirmed 3
Inspired oxygen, fraction of 47
Insulin resistance 18
Insulinotropic polypeptide, glucose-dependent 97
Intensive care units 41, 62, 162, 210, 211, 227, 228
Interferon gamma release assay 303
International normalized ratio 140
International Parkinson and Movement Disorder Society 253
International Restless Legs Scale 262
Interstitial lung disease 37, 285287, 289
evaluation of 38fc
myositis-associated 286
Interstitial nephritis, drug-induced 208
Interstitial pneumonia
nonspecific 285, 287
usual 38, 285287
Intestinal metaplasia 109
Intestinal opportunistic infections 160
Intestinal parasites 160
Intestine 96
Intra-cluster correlation coefficient 204
Intravenous anesthetic drug, continuous 269
Intravenous antibiotic therapy 13
Intravenous cyclophosphamide 218, 219f, 289
Intravenous sodium
bicarbonate 11, 12
use of 211
chloride 12
Intravenous tenecteplase studies 256t
Invasive angiography 10
Invasive coronary angiography 24
Ionization 144
Ipilimumab 50
Irritable bowel syndrome
postinfectious 122
severity scoring system 122
symptom severity scale 122
Ischemia
hospitalization for 24
refractory 25
Ischemic attack, transient 260
Ischemic stroke 21
acute 256, 256t, 260
anterior circulation 250
minor 260
treatment of acute 255
Isolated tremor 254
Isoniazid 180, 181
Isosorbide dinitrate combination 28
Isosporiasis 160
Ivermectin 166
J
Joint Indian Chest Society 39
Joint infection 143
Jugular venous pressure 29
Juvenile idiopathic arthritis 300
systemic onset 300
K
Kaplan-Meier
analysis 219f
curve 16, 230f
method 210
Keratitis 144
Ketoconazole 77
Kidney
allograft pathology, Banff classification of 205
disease 214, 238
end-stage 93, 232, 234
pathogenesis 238
function, range of 83
injury
acute 12, 211, 213, 214, 216, 227, 234, 235
primary acute 215t
risk of acute 213
severe acute 228
organoids 236
stones, risk of 90
Klebsiella pneumoniae 41
Kussmaul's sign 29
L
Lactobacillus 96, 98
helveticus r0052 135
plantarum 135
rhamnosus r0011 134, 135
Lamivudine 196
Larger tidal volume 48
Laser desorption, matrix-assisted 144
Latent tuberculosis 303, 304
infection 303
Leflunomide 218, 219, 282
Left ventricular
assist device 28
dysfunction 15
ejection fraction 9, 19
end-diastolic pressure 61, 62
preload 61
systolic dysfunction 6
Legionella 151
pneumophila 150
serology 151
Legs, lymphedema of 165
Leprosy 302
arthritis, diagnosis of 302
Lesser disease severity 60
Leukocyte counts, increased 156
Levamisole 229, 230
Life-threatening circulatory 162
Limb girdle muscular dystrophy 267269
types of 268
Lipopolysaccharide 97
Lipoprotein
Cholesterol
level, elevated low-density 95
low-density 88
elevated low-density 95
Lisinopril 7
Liver
disease
causes of end-stage 137
model for end-stage 128
failure 140
function test 157
Long-acting muscarinic receptor antagonists 54
Loop diuretics 7
Lorcaserin 193, 194
Losartan 7
Loss of weight 188
Low birth weight 282
Low density lipoprotein 21
Low-osmolar contrast media 12
Lung
cancer, nonsmall-cell 53
function 44, 61
tests 44
injury 61, 62
mechanism of 62fc
protective ventilation strategies 48
transplantation 37
Lupus nephritis 218
Lymphatic filariasis 165
triple-drug treatment for 165
Lymphoproliferative disorder, post-transplant 208
M
Macrosomia, risk of 91
Magnetic resonance imaging 57
high-resolution 261
Malaise 176
Malnutrition, form of 193
Mass drug administration, strategy of 165
Mass spectrometry 144
Massive bleeding 118
Maternal glycemia 204
Maternal morbidity 203
Mean arterial pressure 224
Mean platelet count 194
Mechanical ventilation 37, 41, 61
Medical therapy 16
guideline-directed 6
Medtronic and balloon expandable device 27
Megasphaera 98
Melanoma differentiation antigen 287
Meninges, inflammation of 169
Meningitis 169
causes of 169f
common cause of 170
etiology of 170, 248
Metabolic academia, severe 210
Metabolic acidosis 231
alkali replacement for 230
severe 211
treatment of 230232
Metabolic and obstetrical complications 91
Metabolic disorder 71, 80
Metabolic syndrome 276
Metformin 83, 86, 96, 97, 97f, 103
hydrochloride 83
promotes 98
treatment, initiation of 84
Methotrexate 298
monotherapy 283
initial 283
stable dose of 298
Metoprolol succinate 7
Metyrapone 77
Miconazole
cream 82
vaginal suppository 82
Microfilaremia, three-drug regimen cleared 165
Microfilaria
clearance of 165
complete clearance of 166
Microfilarial clearance, rate of 166t
Microsporidiosis 160
Midbody, posterior 262
Mifepristone 77
Milestone-related disease 263
Mineralocorticoid receptor antagonist 7, 34
Minimal inhibitory concentration 172
Mini-mental state examination 186
Mitotane 77
Mitral regurgitation 15, 16
secondary 15
Mitral valve 16
Molecular diagnostics, use of 164
Monoclonal antibody 50
Monosaccharides 121
Moraxella 42
Mortality, reduction of 156
Mosquitoes, bite of 165
Mouse kidney, single-cell transcriptomics of 238
Movement Disorder Society 254
Muciniphila 97
Mucocutaneous candidiasis, chronic 77
Multicentric collaborative registry 266
Multidrug-resistant tuberculosis
disease 43
treatment of 42
Multiple organ dysfunction syndrome 155, 156
Multiple parenchymal, treatment of 251
Multiple sclerosis 259
progressive relapsing 259
relapsing-remitting 258, 259
treatment for 258
Muscle
infiltration of 128
mass depletion 128
Muscular dystrophies 268
Musculoskeletal ultrasound 294
Myalgias 31
Mycobacterium
leprae 302
lepromatosis 302
tuberculosis 180
Mycophenolate mofetil 218
Mycoplasma pneumoniae 150
Myelodysplastic syndrome 280
Myeloperoxidase 280
Myocardial infarction 10, 11, 23, 25, 95, 103, 224
acute 3, 21, 32
nonfatal 10
risk of acute 3
Myosteatosis 127, 128
N
N-acetyl cysteine 12
Nailing lupus nephritis 218
Nasal cannulae 67
Natalizumab 258, 259
National AIDS Control Organisation 160
National College of Chest Physicians guidelines for spirometry 39
National Health and Nutrition Examination Survey 119, 209
National Institutes of Health Clinical Center 178
National Institutes of Health Stroke Scale 244
score 250
Natriuretic peptides, values of 28
Nausea 149
Necrotizing pancreatitis 108
Neonatal intensive care unit 92, 214
Nephrology 205
Nephropathy 12, 84, 85
contrast-induced 12
Neurocysticercosis 251
diagnosis of 250
treatment of 250
Neurological disorder, common 262
Neurology 243
Neuromuscular respiratory diseases 67
Neuronal apoptosis 187
Neuropathy, management of 87
Neuropsychiatric disorders 186
Neuroradiologic disease activity 258, 259
Neutralizing acid 211
Neutropenia 50
New York Heart Association 9, 16
Night splints, cost-effectiveness of 273
Nintedanib 37
Nipah transmission, dynamics of 171
Nipah virus 170, 171
clinical manifestations of 171
disease 170
investigation of 170
Nitric oxide, inhaled 48
N-methyl-d-aspartate 187
Nonalcoholic fatty liver 99
disease 98, 99, 119, 130, 137
Nonalcoholic steatohepatitis 99
stages of 98
Non-bismuth-based quadruple therapy 125
Non-celiac gluten sensitivity 120, 121
Noncommunicable disease 101, 139, 209, 241
Noncoronary angiography 12
Non-diabetic population 34
Nondisabling stroke, minor 261
Nonendocrine organs, involvement of 77
Nonfatal stroke 21
Non-inferiority trial 22
Noninvasive testing 5
Non-ST-elevation
acute coronary syndrome 25
myocardial infarction 23
Nonsteroidal anti-inflammatory drugs 132
usage of 131
Nonstress test 92
Non-ST-segment elevation acute coronary syndrome 24
Non-vitamin K oral anticoagulants 131, 132
Norepinephrine 193
Nucleic acid amplification test 144
Nucleos(t)ide analogue 115, 116
Nucleotide polymorphisms, single 190
Nucleus accumbens 262
Nutritional supplements 164
O
Obesity 18, 193, 194, 276
abdominal 18
hypoventilation 67
Obesity-related comorbidities 111
risks of 113
Observational trials 48
Obstructive jaundice, causes of 113
Obstructive lung disease, global initiative for chronic 64
Obstructive pulmonary disease
acute exacerbation of chronic 63
chronic 44, 54, 55f, 63, 67
severe 93
Obstructive sleep apnea 60, 67
Ocular infections 143
Oculopharyngeal muscular dystrophy 268
Odynophagia 67
ODYSSEY trial 88
Oesophageal adenocarcinoma 109
Opportunistic infection, incidence of 159, 160
Optimal medical therapy 16
Oral acetylcysteine 11, 215
Oral anticoagulants
bleeding 131
direct 233f
Oral glucose tolerance test 92, 189, 190
Oral immunosuppressive agent 218
Oral ivermectin 154
Oral mycophenolate mofetil 218
Organ damage, target 18
Organ failure assessment score, sequential 162
Organ systems 71
Orthostatic hypotension 182, 183
Osteopenia 191
Osteoporosis 74, 77, 90, 191
treatment of 105
Osteoporotic fractures 89
Ovarian insufficiency 77
Overnight dexamethasone suppression test 187
Oxidative stress 257
Oxygen 66
delivery device 67
saturation 48
normal 66
therapy 66
P
P2Y12 inhibitor 24
Pain
abdomen 122, 156
scale 72
PAN arteritis 30
Pancreas, inflammatory condition of 107
Pancreatic fluid collections 117
Pancreaticoduodenectomy 113, 115
Pancreatitis
acute 29, 107
management of acute 107, 108t
radiographic evidence of 108
Pantoprazole 132
Paracentesis 141
Parathormone 79
Parathyroid hormone 79
Parathyroidectomy 79
Parkinson's disease 256, 257
risk of developing 258
Paroxysmal nocturnal dyspnea 29
Patent foramen ovale 270, 271
Pedal edema 29
Pelvic inflammatory disease 81
Peptic ulcer 131
Peptide tyrosine-tyrosine 98
Percutaneous coronary intervention 22, 23
primary 24
Percutaneous mitral valve 15
Percutaneous transhepatic biliary drainage 113
Periampullary neoplasm 113
Pericardial calcification 29
Pericardial knock 29
Pericardiectomy, surgical 29
Pericarditis, constrictive 29
Pericardium, thickened 29
Perinatal morbidity 203
Peripheral capillary oxygen saturation 66
Peripheral neuropathy 85
Peripheral sensory
impairment 186
loss 185
prognosis of 185
Peripheral T cells 50
Peripheral vascular disease 85
Peritubular capillaritis 205
Pharmacological therapy 99
Pharyngitis 67, 144
Phenotypic drug-susceptibility profiles, complete 180
Physical counter-maneuvers 182
Pioglitazone 86, 99
Pirfenidone 37
Pituitary, size of 187
Pituitary-directed therapies 77
Placebo 191, 193
controlled 49
group 49, 162
Planned interim analysis 244
Plasma glucose 92
Plasmodium falciparum
mono-infection 148
treatment of 148, 149
Platelet counts during pregnancy 194
Pneumocystis
jirovecii pneumonia 291
pneumonia 290
Pneumonia 50, 144, 151f
atypical 151
hospital-acquired 150
interstitial 287
organizing 287
risk of 55
ventilator-associated 41, 48, 150
Pneumoperitoneum 118
Pneumophila 150
POET trial 14fc
Polyangiitis 279, 280
Polychondritis, relapsing 302
Polyhydramnios 91
Polymerase chain reaction analysis 170
Polymorphisms 285, 286
Polymyositis 286
Polyols 121
Population attributable risk 276
Positron emission tomography 31
Postcentral gyrus 262
bilateral 261
Post-coronary artery bypass grafting 1
Postmenopausal
osteoporosis, managing 191
women 89, 90
Post-processing technique 60
Postradiation therapy 29
Praziquantel 250, 251
Prednisolone 127, 291
Pregnancy 91, 148, 178
late enrolment in 197
recognition during 204
third trimester of 91
uncomplicated 194
valproate use in 253
Pregnant women 148
Prevotella 98
Prima facie 43
Pro-brain natriuretic peptide 28
Procalcitonin 64, 65, 300, 301
antibiotic consensus trial 65
assay results 65
diagnostic value of 300
Proinflammatory cytokines leading 187
Prophylaxis 157
group 157
postexposure 168
Prostacyclin 48
Protein
derivative, purified 303
kinase, activated 97
Proteinuria 227f
Proteobacteria 139
abundance of 138
Proteus mirabilis 152
Proton pump inhibitor 109, 110, 130, 132
cotherapy 130
Protozoa 169
Proximal limb-girdle distribution 268
Pseudocysts 117, 118
Pseudomonas aeruginosa 41, 42
Psychiatric comorbidity 266
Psychogenic nonepileptic
events 266, 267
seizures 266
Pteropus giganteus 171
Public health 125
england 153
Pulmonary arterial pressures 57
Pulmonary artery 31
Pulmonary capillary pressure 62
Pulmonary complication 114
Pulmonary edema, acute 224
Pulmonary embolism, acute 56
Pulmonary fibrosis 38fc
Pulmonary function tests 38, 39, 42, 43
Pulmonary hypertension 57
Pulmonary microvascular pressure, elevated 62
Pulmonary multidrug-resistant tuberculosis 42
Pulmonary tuberculosis 161
Pulmonary vascular resistance 62
Pulseless disease 30
Pump failure 20, 32
Putamen 262
Pyelonephritis 208
Pyrazinamide 181
Q
Quality of life 8, 43
R
Rabies 167
death 168
exposure 167
Radiofrequency 221
Radiotherapy 53
Raloxifene 105
Ramipril 7
Randomized controlled
study 218
trial 12, 34, 54, 273, 289
double-blind 227
Rashes, nonspecific 154
Real culprit induces symptoms 121
Refractory status epilepticus 269
Relapse-free survival 230f
Renal allograft pathology
Banff classification of 205
core of Banff classification of 206t
Renal denervation 221
catheter based 221
effects of 220
Renal disease
end-stage 234
prevention of end-stage 19
Renal dysfunction 155, 156
Renal failure
actual 114
acute 114, 224
end-stage 94
free days 48
Renal function 7
test 7
Renal injury, contrast-induced 11
Renal replacement therapy 211, 235
delayed 236f
early 236f
timing of 234235
Renal tubular acidosis 288
distal 288
Renin-angiotensin-aldosterone system 28
inhibitors 34
Reoperation rate 114
Representative concentration pathways 51
Reproductive age group 252
Respiratory diseases, chronic 44
Respiratory distress syndrome
acute 48, 61, 62, 155, 156
severe 47
Respiratory infections, upper and lower 143
Respiratory specimen collection 3
Respiratory tract infection, lower 64, 65
Restless legs syndrome 262, 262t
Restrictive cardiomyopathy 29
Retinopathy 85
Reversible disorder 200
Rheumatic diseases 282, 290, 300, 301, 303
multiple 291
Rheumatic disorders 295
Rheumatic immune-related adverse events, types of 295
Rheumatoid arthritis 73, 274, 276, 278, 279, 283285, 287, 292, 294, 298, 299, 302
active 298
development, prediction of 293
early 283
management of 299
therapy of 284
Rheumatoid factor 72, 292, 298, 302
Rheumatology 273
Rhythm control 8
Rickettsia akari 152
Rickettsial disease 152, 153
Rickettsial infection, incidence of 152
Rifampin 180, 181
Ringer's lactate 108
Risedronate 105
Ritonavir-boosted lopinavir 196
Rituximab 259, 280, 289, 290
lower for 259
Rivaroxaban 131, 243
group 244
Roseburia
intestinalis 97
inulinivorans 97
Routine hygienic wipes 81
Roux-en-Y gastric bypass 112
rpoB gene 181
S
Salmonella 159
enterica 172
organisms 172
paratyphi 158, 159
typhi 158, 159
typhimurium 172
Sapien prosthesis 27
Sarcopenia 127, 128
multifactorial pathogenesis of 203
Sarcoplasmic reticulum 184
Satellite derived baseline 51
Scabies 153, 154f
clinical features of 154
clinical presentation of 154
clinical symptoms of 154
diagnostic criteria 154
outbreaks 153
Scleroderma 287, 289, 290
lung disease, treatment of early diffuse 289
SCOT-HEART study 5
Scottish Computed Tomography of Heart Trial 4, 10, 11fc
Scrub typhus 155
Seizure 251
control of 244, 245
detection devices 246
role of 247
several types of 247
Sensorium 155, 199
Sepsis 114, 229, 234
management 162
Septic shock 155, 161, 162
SERCA2A
gene therapy 183, 185
transgene expression 185
Serotonin-reuptake inhibitor 193
Serratia 41
Serum
albumin, low 155
creatinine 12
levels 74
lipopolysaccharide 98
samples 152
thyrotropin 73
uric acid levels, lower 277
Weil-Felix titers 152
Shewanella 98
Shigella 163, 164
control of 164
Short-chain fatty acid 9698
Single Centre Prospective Cohort Study 295
Sinus rhythm 8, 9
maintenance of 8
normal 8, 9
Sinusitis 144
Sjögren's syndrome 287, 288
primary 288
Skeletal muscle 128
index 138
mass 137
Skin and soft tissue 143
Sleep apnea 59
Sleep duration and disturbances 200
Sleep duration and sleep disturbances 200
Sleeve gastrectomy 112
Smoking 95
Socio-demographical factors 200
Sodium
bicarbonate 11, 12, 215
administration 231f
therapy 210211
chloride 12
glucose 103
glucose co-transporter 80, 81, 97
inhibitors 80, 84
inhibitors, use of 102
Soft tissue infections 143
Soil-transmitted helminth transmitted 147
Solitary parenchymal cysticercosis 251
Solitary parenchymal granulomas 251
Somatosensory cortex 261
cortical thinning of primary 263
Sounds, normal 29
Sphincterotomy 137
Spirometry 39, 44, 46
interpretation of 40fc
normal 45
Spironolactone 7
Sputum 144
Stable angina 1, 4
Staphylococcus aureus 13, 14, 41, 42
Statins 198, 260
Status epilepticus 269
management of 270
severity score 269
ST-elevation myocardial infarction 13, 23, 24
Steroid
dependent nephrotic syndrome 229, 230
sensitive idiopathic nephrotic syndrome 229
side effects with 264
therapy 264
Steroidogenesis enzyme inhibitors 77
Streptococcus pneumoniae 41
Stress
and knee jerk response 133
role of 186, 188
treadmill test 5
Stroke 8, 34, 95, 224
prevention 243
risk of 4
secondary prevention of 260
Strongyloidiasis 160
Subarachnoid neurocysticercosi 251
Subclavian arteries 30
Suboptimal ventilation strategy 48
Sulfamethoxazole 290, 291
Sulfonylurea 86, 103
Supplemental oxygen, role of 37
Surgical complications, major 114
Surgical site infection 114
Sustained virologic response 124
Swollen joint counts 72
Symptomatology, spectrum of 122
Synergistic effect 261
Synovitis 293
Synthetic valve dehiscence, severe 27
Systemic autoimmune disease 289, 300
Systemic blood pressure 61
Systemic inflammation, signs of 150
Systemic inflammatory disease 276, 303
Systemic lupus erythematosus 218, 281, 300
Systemic sclerosis 289
Systolic blood pressure 19, 86, 87, 208, 212, 213, 224
T
Tachycardia 72
Tachypnea 156
Tacrolimus 219
Takayasu arteritis 30, 31, 296298, 300
clinical activity score 296
damage score 296
Takotsubo cardiomyopathy 32
Tender joint counts 72
Tenecteplase 255
use of 256
Tenofovir 195
alafenamide 127
disoproxil fumarate 127, 196
Tenosynovitis 293, 294
Teriparatide 105
Tetravalent dengue vaccine 145
Thalami 262
Therapeutic benefits 88
Thiazolidinedione 103
Thoracic aorta 31
descending 31
Thoracoscopic biopsy 38
Throat swab culture 144
Thrombocytopenia 48, 156, 194
Thromboelastography 140
parameters 140
Thromboelastometry, rotational 140
Thromboembolic events 34
Thromboembolic phenomenon 32
Thromboembolic pulmonary hypertension, chronic 56, 57
Thrombolysis 25
Thrombolytic agents 255
Thrombotic microangiopathy 205
Thyroid
diseases, prevalence of 73
hormone 71
Tidal volume strategies, low 48
Tissue
biopsy 144
parasite infections 143
plasminogen activator 255
Tonic-clonic seizures, bilateral 246
Topography encompasses 139
Toxic
adenoma 73
multinodular goiter 73
Trachea 45
Tracheal stenosis 67
Transbronchial lung biopsy 38
Transcatheter aortic valve replacement 26
procedure 27
Transcatheter mitral valve 15
repair 15
Transesophageal echocardiography 14
Transjugular liver biopsy 141
Transluminal coronary angioplasty, post-percutaneous 1
Traumatic brain injury 266
attribution 266
Tremor 254
classification of 253
disorders 253
syndromes 254
task force on 253
Triiodothyronine 74
Trimethoprim 290, 291
sulfamethoxazole, prophylactic effect of 290
Trivandrum Heart Failure Registry 28
Tubercular meningitis, diagnosis of 247, 248
Tuberculosis 29, 173
drugs 180
infection, reactivation of latent 303
laboratory, three tiers of networks of 174f
management of drug-resistant 42, 43
prevention 175
testing of 174
Tuberculous meningitis, rule for 247
Tubular injury, acute 205, 208
Tubulointerstitial nephritis 288
Tumor 50
necrosis factor 283
inhibitor 283
specific T cell immunity 49
tissues 53
Tunneled central venous catheters 222
Typhoid fever
incidence of 158
vaccination against 173
U
Undiagnosed diseases network 178, 179
Unstable angina 21, 23, 193
hospitalization for 21
Upper gastrointestinal tract bleeding 130
Upper limb
action tremor 254
disease progression milestones 264
milestones 263
Urethritis 81
Urinary frequency 182
Urinary tract infections 143, 144, 156
repeated 156
Urine sample 144
US Food and Drug Administration 65
V
Vaginal candidiasis, antifungal agents for 82t
Vaginal infection 81
Valproate 252
teratogenic effects of 252
use of 252
Valsartan 7
Valvular heart disease, severe 6
Varicella
clinical manifestations of 176
virus 170
zoster virus 176
Vascular disease 94
Vascular endothelial function 230
Vascular end-stage disease, prevention of 19
Vasculitis 280
Vasterbotten 258
Vehicular pollution 44
Venous thromboembolism 77
Venovenous hemofiltration, continuous 228
Ventilation 48
withdrawal of 61
Ventilator
days, number of 41
management 61
Ventricular arrhythmias 25
Ventricular assist devices 20
VERDICT trial 25fc
Vesicular rash 176
Vibration-controlled transient elastography 99
Vicinity and rural indians living 139
Viral infection 144
Viral meningitis 168, 169
sequelae of 168
Viral syndromes 143
Virologic response 124
Virologically confirmed dengue 146
Viruses 169
Visual impairment 188, 189
Vital capacity 40
Vitamin
D 89, 90, 203, 275
concentrations 202
deficiency 90, 202
serum levels 203
D supplementation 90, 274, 275
effects of 274
role of 275
K antagonists 233f
Vomiting 149
Voxel-based morphometry 60
Vulva infection 81
Vulvovaginal candidiasis, treatment for 82t
W
Walk test 42
Walled-off necrosis 117
Walled-off pancreatic necrosis 117, 118
Water, worth of 107
Wegener's granulomatosis 280
Weight loss 193
surgery 112
Weil-Felix test 152
serological titers of 152t
White coat hypertension 18
World Health Organization 180, 190, 204
Worldwide Acute Kidney Injury Epidemiology in Neonates, assessment of 214
Wuchereria bancrofti 165
Z
Zidovudine 196
Zoledronate 105, 191, 192
group 191
Zoonotic disease, neglected 167
Zoonotic transmission, direct 171
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Chapter Notes

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Cardiology
Section Editor: V K Bahl
Associate Editors: Gurpreet S Wander, Tiny Nair

Acute Myocardial Infarction after Laboratory-confirmed Influenza InfectionARTICLE 1

Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection.
N Engl J Med. 2018;378:345-53.

Abstract*

Background and Methods: Acute myocardial infarction (AMI) has been shown to be triggered by respiratory infections in smaller studies, which were not so well conducted. This association was looked at in a systematic manner in which laboratory-confirmed influenza and other respiratory infections were taken over a period and 7 days following respiratory specimen collection was considered as the risk period and the period 1 year before and after was taken as control.
Results: A total of 364 patients were admitted with AMI, which occurred within 1 year before or after a positive test of influenza. About 20 happened in the risk period and 344 in the control period. Thus, during the risk period, the incidence ratio was 6.05 as compared to control period. Following influenza B, influenza A, respiratory syncytial virus (RSV), and other viruses, the incidence ratios were 10.1, 5.1, 3.5, and 2.7, respectively.
Conclusion: Thus, acute respiratory infections can be precipitating factors for AMI. The risk is highest with influenza, but there are chances of risk involvement with RSV and other viruses causing respiratory infections.
“An ounce of prevention is worth a pound of cure”
―Benjamin Franklin
 
COMMENT
Infections are known to precipitate acute coronary events. In fact, what causes rupture of a stable atheromatous plaque is a matter of research and curiosity. The known factors are—extreme emotional stress, extreme physical exertion, early morning hours, infections and inflammation. It is known plaques which are having thin fibrous cap and thick lipid core rupture more often than those with thick fibrous cap. In fact, more acute coronary syndromes (ACS) are caused by nonobstructive plaques than by obstructive plaques. However, most ACS events occur without any obvious trigger preceding it. Amongst the known triggers influenza, pneumonia, bronchitis, and other chest infections have all been incriminated. Patients hospitalized for pneumococcal pneumonia have 7–8% risk of ACS. Similar increased risk is known with urinary tract infections and other bacteremias.
This particular study confirms the previously held notion and shows that risk of acute myocardial infarction (AMI) is increased six times during the first week after an episode of influenza as compared to the other periods. Other infections with noninfluenza respiratory viruses also increased the risk of AMI, though to a lesser extent. The mechanism of this increased risk is because of increase in circulating inflammatory cytokines such as interleukins 1, 6, and 8, and tumor necrosis factor-α which activate inflammatory cells in the plaque. In addition, acute infection causes a prothrombotic and a procoagulant state which can increase risk of coronary thrombosis. In addition, tachycardia, hypoxia, and cytokine release associated with the acute inflammation also precipitate AMI. So, we know that influenza can precipitate AMI. Lesson is we should not stop aspirin or statins if the patient is already taking these during an episode of influenza. This highlights the value of vaccination for influenza and pneumococcal vaccine for all those more than 65 years and also younger with coronary artery disease (CAD), especially those with left ventricular dysfunction. Infections not only precipitate acute coronary events but also worsen heart failure and increase the risk of arrhythmias and stroke. So, vaccination for influenza and pneumococci prevents acute complications in these patients. A meta-analysis of five randomized trials showed that cardiovascular events can be reduced by 36% with influenza vaccine and 17% with pneumococcal vaccine amongst adults. Most guidelines today suggest this as an additional secondary prevention method in patients of CAD along with aspirin and statins.