bluuebunny/crossref_metadata_2025 huggingface dataset:
A male neonate failing to thrive with an endocrine disorder
Authors: Irewole-Ojo Folakemi Olutoyin , Olutola Esther Omowunmi , Olutekunbi Olanike Abosede , Lawal Mary Adetola , Fagbuyi Oluwaseun Yewande
Published: May 2024

Failure to thrive (FTT) is weight consistently below the 3rd to 5th percentile for age and sex, progressive decrease in weight to below the 3rd to 5th percentile, or a decrease in two major growth percentiles in a short period. The cause may be an identified medical condition, may be related to environmental factors, or may be multifactorial. Congenital adrenal hypoplasia (CAH), an endocrine disorder, is a rare cause of FTT in the newborn. We report a male neonate with FTT secondary to suspected CAH, salt-losing form. The case is reported to orient clinicians to have a high index of suspicion for any neonate who is failing to thrive. A 25-day-old male neonate presented with a history of poor weight gain. Weight at presentation was 2.8 kg, and birth weight was 3.7 kg (had lost 24% of birth weight). Mother is a 35-year-old Para 3 (3 Alive) woman who had a good appetite and was lactating well. Initial random blood sugar (RBS) was 117 mg/dL, but within minutes, she was observed to be unconscious, with a repeat RBS of 39 mg/dL. A thorough physical examination revealed a hyperpigmented male phallus with a stretched penile length of 4.8 cm and testicular volume of 2 cm3 using a standard orchidometer. Investigation results revealed hyponatremia, hyperkalemia, metabolic acidosis, with normal urea and creatinine levels. Full blood count parameters were essentially within the normal range. Serum cortisol, 17-hydroxyprogesterone, serum testosterone, and serum dehydroepiandrosterone-sulfate were not done. The patient was managed conservatively with dextrose-containing fluid and correction of electrolyte derangement. Weight was 2.7 kg on discharge. Weight on follow-up was 3.2 kg.
Prediabetes and its correlates in a suburban community in South-South Nigeria
Authors: Ejenobo Osaro E , Chike-Ezue Eunice , Eregie Aihanuwa , Edo Andrew
Published: May 2024

Background:

Prediabetes is a high-risk state for diabetes mellitus (DM) and is associated with the chronic complications of DM. There is paucity of data on prediabetes and its associated risk factors in Nigeria, particularly in the suburban setting. The aim of this study was to determine the prevalence of prediabetes and its associated risk factors in a suburban community in south-south Nigeria.

Materials and Methods:

This was a cross-sectional analytical study carried out among 382 adult residents in Mosogar, Delta State. An interviewer-administered questionnaire was used to obtain the socio-demographic and clinical information of the subjects. Anthropometric measurements and blood pressure were done according to standard protocols. Blood sample was collected for oral glucose tolerance test, fasting serum lipid profile, and glycated hemoglobin (HbA1c).

Results:

A total of 350 subjects (36.3% men and 63.7% women) completed the study. The mean (standard deviation) age of the participants was 46 (14.1) years. The prevalence of impaired fasting glucose, impaired glucose tolerance, and impaired HbA1c was 16.6%, 16.3%, and 19.2%, respectively. The overall prevalence of prediabetes and undiagnosed DM was 22.0% and 5.1%, respectively. On multivariate logistic regression, the significant predictors of prediabetes were increasing age, a family history of DM (adjusted odd’s ratio [AOR] 16.14, 95% confidence interval [CI] = 3.25–88.36), overweight (AOR 4.08, 95% CI = 1.72–9.63), obesity (AOR 5.63, 95% CI = 1.59–19.90), inadequate physical activity (AOR 5.28, 95% CI = 2.08–13.41) and elevated triglycerides (AOR 9.69, 95% CI = 1.77–53.18). Moderate alcohol intake was associated with a reduced risk for prediabetes (AOR 0.33, 95% CI = 0.12–0.92).

Conclusion:

There was a high prevalence of prediabetes in Mosogar community, Delta State. There is need for education of community members on dietary and lifestyle modifications aimed at reducing the risk of prediabetes and ultimately diabetes.
Antegrade revascularization of long-segment femoropopliteal chronic total occlusion
Authors: DAS DEBASISH , KUMAR ABHINAV , MAHANTA DIBYA SUNDAR , SINGH SASHIKANT , PRAMANIK SUBHAS
Published: May 2024

Although revascularization of a femoropopliteal (CTO) always remains challenging through a retrograde or contralateral crossover approach, we report a case of successful revascularization of a long-segment femoropopliteal CTO through antegrade femoral puncture which stands as the crux of the procedure. In routine peripheral intervention, long-segment femoropopliteal occlusion is usually approached from a contralateral femoral artery or ipsilateral brachial artery, antegrade revascularization of femoropopliteal CTO is not adapted by many in routine practice. Here, we describe the technique and the tips and tricks of antegrade puncture of common femoral artery. We will also discuss the literature review of antegrade technique versus retrograde and crossover technique for revascularization of femoropopliteal CTO which may be useful for budding young interventionists. Our case carries another important learning point about management of popliteal disease where revascularization with a stent is of concern due to high knee joint mobility.
A study on normal reference values of echocardiographic chamber dimensions in newborn infants from Eastern India – A pilot study
Authors: HALDER SWAPAN KUMAR , ROY SAMIR KUMAR , MUKHERJEE ANINDYA , KHANRA DIBBENDHU , DAS MALYABAN , SAMANTA BIAUS , SAHA SOUMYOJIT , MANDAL MANORANJAN
Published: May 2024

Introduction:

Echocardiography has been an integral part of neonatal care since the 1990s and the application of this technology is increasing ever since. It is already known that differences in weight, age, and race significantly affect the normal heart dimensions. Therefore, establishing the normative values for cardiac dimensions among Indian healthy newborn infants is of paramount importance. In this study, we report the normal reference values of echocardiographic chamber dimensions of newborn infants from Eastern India.

Methodology:

One hundred healthy newborn infants were included in this cross-sectional, observational, single hospital-based pilot study. A single experienced cardiologist performed the transthoracic echocardiographic studies on the participants in supine position in their respective bassinets. No sedation was used. The parameters were distributed according to body weight and in percentiles.

Results:

Participants were categorized according to their body weight into three groups: 2–2.4 kg, 2.5–2.9 kg, and 3–3.5 kg. Each group comprises 7, 50, and 43 newborns, respectively. The left ventricular end-diastolic dimension and left ventricular end-systolic dimension showed incremental trends across body weight.

Conclusion:

This study shows the difference of cardiac dimensions in Indian newborn infants from Western data. This is the first study presenting the normative reference ranges and percentiles of echocardiographic parameters in Indian newborn infants which needs confirmation with larger multicenter studies.
Postoperative outcomes in patients with post infarction ventricular septal defect – Institutional experience
Authors: Kakkar Deepti , Desai Devvrat
Published: May 2024

Context:

Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction with a reported incidence of 1% to 3% in the pre thrombolytic era and <0.5% post thrombolytic therapy. Risk of death is greatest immediately after myocardial defect and then gradually declines. Early surgical treatment is recommended; however, surgical repair is associated with a high rate of mortality.

Aim:

To investigate the immediate survival outcome and prognostic factors associated with surgical repair of postinfarction ventricular septal rupture at our institute over a 3-year period.

Materials and Methods:

From April 2012 to April 2015, 32 patients underwent surgical repair of post-infarction ventricular septal rupture at our institute. Patients were identified from the electronic medical records database and preoperative, intraoperative, and postoperative variables were retrieved. Multiple perioperative variables such as anthropometric data, demography, and clinical history and preoperative details such as echocardiographic indices, coronary angiography, and intraoperative variables were analyzed. The outcomes were compared between the survivors and nonsurvivors.

Results:

Overall, younger patients tolerated the disease and the surgery better than the older population (59.96 ± 10.67 vs. 69.11 ± 8.11; P = 0.02). Female sex, cardiogenic shock (n = 20, 86.95% vs. n = 2, 22.22%; P = 0.001), and emergency surgery were independently associated with higher risk of postoperative mortality. History of systemic hypertension was found to be significantly associated with poor postoperative outcomes (survivors n = 9, 39.1% vs. nonsurvivors n = 8, 88.9%; P = 0.017). In our series, the overall mortality was 28.1% (n = 9). Higher NYHA class at presentation, intra-aortic balloon pump requirement and low ejection fraction are all independently associated with poor outcomes. Longer interval between the myocardial infarct and surgical repair is associated with a lower risk of operative mortality. Preoperative renal dysfunction (61.77 ± 19.04 vs. 41.36 ± 21.15; P = 0.025) and postoperative renal dysfunction (65.26 ± 28.81 vs. 27.27 ± 9.04; P = 0.001) is one of the most important predictors of postoperative outcome. The duration of aortic cross-clamp and cardiopulmonary bypass was not associated with early mortality in this study (89.17 ± 42.70 vs. 97.11 ± 76.38; P = 0.775).

Conclusion:

Postinfarction VSD still remains one of the most challenging conditions to treat surgically with considerable early mortality. Although percutaneous device closure and left ventricular assist devices may be used as a method to stabilize the patient preoperatively and improve the chances of survival after surgery, it is currently not advocated as a definitive treatment option. All efforts should be made to predict and prevent postoperative renal dysfunction as it is the single-most important factor affecting both short- and long-term survival outcomes.
Fungal endocarditis
Authors: Radha Sistla , Afroz Tameem , Amaan Mohammed Umar , Swamy Mallindra
Published: May 2024

Endocarditis is inflammation of the innermost lining of the heart including the valves. It can be of infective or noninfective etiology. It is a relatively rare disease with high morbidity and mortality. There are a very few cases reported from India. Infective endocarditis due to fungal organisms accounts for 2%–4% of endocarditis. We report a case of Aspergillus endocarditis in a patient with chronic rheumatic heart disease, which was incidentally diagnosed during surgery. The patient was treated with mitral valve replacement and antifungal agents. One year after surgery, the patient has a good prosthetic valve function with no evidence of vegetations.
Clinical profile, risk stratification of patients with acute pulmonary embolism
Authors: PATEL KEYUR , BHATIA SANJEEV , BRAHMBHATT JIT , SHARMA VISHAL , MANSURI ZEESHAN , SHARMA KAMAL , JAIN SHARAD , PATEL KRUTIKA , PARMAR PINKESH , VASAVA DIGNESH
Published: May 2024

Context:

To study the demographics and clinical profile of patients with acute pulmonary embolism (PE) and impact of management as per risk stratification on outcome of patients with acute PE.

Materials and Methods:

Prospective observational study of demographics, clinical profile, risk stratification, management, and outcome of patients presenting with acute PE from August 2016 to July 2017.

Results:

One hundred and fifty patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years, with 70% being males, were included in the study. There were 6 (4%) patients in high-risk group, 69 (46%) patients in intermediate-high subgroup, 39 (26%) patients in intermediate-low subgroup and 36 (24%) patients in low-risk group as per the ESC 2019 guidelines using sPESI score, shock/hypotension, right ventricle (RV) dysfunction and cardiac marker elevation. 72 patients (52%) had antecedent deep vein thrombosis (DVT) of which 60 patients has proximal, whereas 12 patients had distal DVT. One hundred and forty-seven patients (98%) had moderate-to-severe TR, 117 patients (78%) had evidence of right atrium/RV dysfunction and 27 patients (18%) had evidence of thrombus in the heart. Computed tomography pulmonary angiogram showed middle pulmonary artery thrombus/dilatation in 63 patients (42%), saddle thrombus in 18 patients (12%), partial thrombus in the left pulmonary artery (LPA) and right pulmonary artery (RPA) in 84 (56%) and 75 (50%) patients, respectively. Majority (86%) of patients with tenecteplase; 9 (10.3%) patients with streptokinase and 3 (3.4%) was thrmobolysed with alteplase.

Conclusion:

PE can present with unexplained dyspnea and atypical chest pain, among other signs and symptoms. Early diagnosis, risk stratification, and guideline-directed prompt management can lead to favorable outcome.
Safety and efficacy profile of an indigenous developed CHARAK DDDR 747R dual-chamber rate-responsive pacemaker
Authors: Sharma Yash Paul , Batta Akash , Mehrotra Saurabh , Panda Prashant , Sethi Surendra
Published: May 2024

Aim:

The purpose of this study was to assess the safety and performance of the domestically manufactured Charak DDDR 747R (Pacetronix Ltd, Indore, India) pacemaker device.

Materials and Methods:

This was a prospective, controlled, single-center study conducted between March 2016 and August 2017. Eligible patients were implanted with a Charak DDDR 747R pacemaker with parameters set as specified on the packaging material unless otherwise advised by the physician. Patients were evaluated before discharge and at the 18-month follow-up. Data such as patient age, gender, and medical history were collected to determine patient eligibility for study participation, monitoring of study progress, and data analysis.

Results:

A total of 35 patients were analyzed. Males comprised 45.7% and females comprised 54.3% of patients. The average pacing threshold was threshold (atrium) was 1.05 V and the average pacing threshold (ventricle) was 1.07 V. The average impedance (atrium) was 641.09 Ω and the average impedance (ventricle) was 719.31 Ω. No serious adverse events were documented during the follow-up. One death occurred; however, this was not device-related.

Conclusions:

As per study findings, the Charak DDDR 747R, an indigenous pacemaker, is safe and effective in the Indian population. Durable lead parameters were obtained during the study which remained stable over time referring the same. Future larger studies are needed to confirm the preliminary data obtained from our study.
Brugada syndrome presenting as atrial flutter with sick sinus syndrome
Authors: RAI ROHIT , SHAIKH SHAKIL S , BANSAL NARENDRA OMPRAKASH
Published: May 2024

An incidentally diagnosed patient with Brugada syndrome was found to have atrial flutter on baseline electrocardiogram. He was DC (Direct current) cardioverted which revealed sick sinus syndrome. The patient was implanted with VVIR(Ventricular rate modulated pacing) pacemaker. Underlying sinus node dysfunction can be present in cases of Brugada syndrome with atrial flutter. The patient may require pacemaker insertion postcardioversion.
Use of ivabradine in postoperative junctional ectopic tachycardia
Authors: SHARMA DHRUVA , SUBRAMANIAM GANAPATHY , SHARMA NEHA , SHARMA PREKSHA
Published: May 2024

Purpose:

When tachyarrhythmias originates from atrioventricular (AV) node, AV junction or bundle of His complex, they are termed “junctional ectopic tachycardia” (JET). Cardiac surgeries especially involving crux of the heart are mainly responsible for JET. Amiodarone and other pharmaco-therapeutic agents are tried as antiarrhythmics for the treatment of postoperative JET. Aim of this review was to discuss about role of ivabradine in the treatment of postoperative JET.

Materials and Methods:

A search was carried out for this review article on the basis of literature available including scientific databases of PubMed, Embase, Scopus, Google Scholar, using keywords “Ivabradine,” “Postoperative junctional ectopic tachycardia,” “Arrhythmias,” “Funny currents,” from October 2011 to October 2020.

Results:

After initial screening of 377 articles, 9 studies were included and discussed in detail in the present review article.

Conclusion:

Treatment of choice of postoperative JET is still not well established. Although there are very few case reports and case series that have been reported on the use of ivabradine in JET, yet it seems to offer a promising use.
Correlation between Troponin I, N-terminal pro–B-type natriuretic peptide, and left ventricular ejection fraction in acute coronary syndrome patients with mortality
Authors: PANSURIYA DARSHIT , KHADKE VRUSHALI , BAHULIKAR ARUN , PHALGUNE DEEPAK
Published: May 2024

Background:

Troponin I (Trop 1) and N-terminal pro–B-type natriuretic peptide (NT-ProBNP) can be a discerning marker for the patients presenting with symptoms of acute cardiac ischemia and risk of death. The present study was to find a correlation between NT-ProBNP, troponin 1, and left ventricular ejection fraction (LVEF) in acute coronary syndrome (ACS) patients with mortality.

Methods:

Ninety ACS patients >18 years of age were included for this prospective observational study. Each patient was subjected to detailed clinical history, clinical examination, Trop I, NT-ProBNP, and LVEF at the time of admission. The primary outcome measures were to study the correlation of NT-ProBNP and Trop I and LVEF at the time of admission with mortality, whereas the secondary outcome measure was to study LVEF after ACS up to 1 month. Medians of continuous variables of two groups and three groups were tested.

Results:

The median Trop 1 levels were 12.0, 378.0, and 2454.0 in patients of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), respectively (P = 0.001). The median NT-ProBNP levels were 1027.0, 1494.0, and 3728.5 in patients of UA, NSTEMI and STEMI, respectively (P = 0.002). The median Trop 1 levels were 5433.0, 627.5, and 92.0 in patients whose LVEF was <40%, 40%–50%, and >50%, respectively (P = 0.001). The median NT-ProBNP levels were 14,554.0, 2009.0, and 306.0 in patients whose LVEF was <40%, 40%–50%, and >50%, respectively (P = 0.001). The median Trop 1 levels were 11439.0 and 570.0 in patients who expired and survived, respectively (P = 0.001). The median NT-ProBNP levels were 21047.0 and 1869.5 in patients who expired and survived, respectively (P = 0.001). The median LVEF were 30.0 and 45.0 in patients who expired and survived, respectively (P = 0.001). Trop I showed a significant positive correlation (r = 0.636) with NT-ProBNP levels (P < 0.001).

Conclusion:

Trop I, NT-ProBNP, and LVEF at the time of admission are strong predictors of 1-month mortality in ACS.
Epidemiological study of acute pulmonary embolism in a tertiary care center
Authors: KADIYALA SRI RAMULU , RAZAK ABDUL , NAYAK KRISHNANANDA , RAMACHANDRAN PADMAKUMAR , SAMANTH JYOTHI , PAI M UMESH
Published: May 2024

Background:

Acute pulmonary embolism remains a significant cause of morbidity and mortality. This study aimed to determine the clinical profile, management, and outcomes of patients with acute pulmonary embolism.

Methods:

This was a retrospective, single-center, and observational study. All consecutive patients with proven diagnosis of pulmonary embolism and treated at a tertiary care center were included in the study based on inclusion and exclusion criteria.

Results:

From January 2012 to May 2018, a total of 304 patients diagnosed with pulmonary embolism were included in the study. Majority of the patients (n = 195; 64.14%) were male. Among included patients, 92 (30.66%) were smokers, and 81 (26.6%) were obese. Dyspnea (98.03%) was the most commonly observed symptom. Of patients who underwent bilateral lower limb venous Doppler, deep vein thrombosis was noted in 172 (56.57%). Electrocardiography confirmed the presence of sinus tachycardia and classical S1Q3T3 pattern in 284 (93.42%) and 79 (25.99%) patients, respectively. Chest X-ray showed dilated main and right pulmonary arteries in 170 (55.92%) patients. Right ventricular dysfunction as detected by echocardiography was observed in 241 (79.28%) patients. Thrombolytic therapy was administered in 158 (51.97%) patients (n = 86 (28.29%) were treated with tenecteplase; n = 72 (23.68%) were treated with streptokinase).

Conclusions:

This study gives an insight into the clinical profile of patients hospitalized with a confirmed diagnosis of acute pulmonary embolism along with treatment and diagnostic approaches adopted by the physician in the Indian scenario.
Evaluation of left ventricular function using speckle tracking echocardiography in patients with severe aortic stenosis with or without symptoms
Authors: YADAV RAHUL , TIWARI BHUWAN CHANDRA , JAMWAL NAVEEN , JHA ASHISH
Published: May 2024

Background:

Speckle tracking echocardiography (STE) may be useful in early detection of contractile dysfunction in severe aortic stenosis (AS) patients.

Aims and Objectives:

The present study aims to evaluate the global longitudinal strain (GLS), global circumferential strain (GCS), and strain rates in patients with severe AS and the role of STE in predicting the development of symptoms or left ventricular (LV) dysfunction in them.

Methods and Results:

This was a single-centered, prospective, observational study, done at a tertiary care hospital in north India. The study recruited 30 patients with severe AS and 10 healthy controls. Patients underwent two-dimensional echocardiography and STE at baseline and 6 months. Baseline characteristics were similar between the cases and controls. Majority of severe AS patients were symptomatic (n = 24; 80%). LV ejection fraction (LVEF) was similar between cases and controls at baseline and 6 months. Cases had a significantly worse GLS (−-19.3 ± 5.66 vs. -30.4 ± 3.63), GCS (−-29.6 ± 8.48 vs. −-33.6 ± 2.55), and strain rate parameters than the controls at baseline and had a significant decline in these parameters at 6 months. Among 6 asymptomatic patients, 3 developed symptoms and these patients had a significantly greater decline in GLS at 6 months as compared to asymptomatic patients.

Conclusions:

The present study revealed that patients with severe AS had an abnormal GLS and GCS to begin with, which was not picked by LVEF. Further, there was a significant worsening of these STE parameters at 6 months and those who had a greater decline were more likely to develop new symptoms.
Clinical profile, microbiological spectrum, echocardiographic features, and in-hospital outcomes of patients with definite infective endocarditis
Authors: BHOLE CHETAN , VISHWANATHAN SUNITHA , SINGH AMRESH KUMAR , VIJAY S. K.
Published: May 2024

Background and Objectives:

Infective endocarditis (IE) remains a serious clinical problem with a persistently high morbidity and mortality, despite the availability of improved diagnostic and treatment modalities in the developing world. We examined the microbiological spectrum, clinical profile, echocardiographic features, and in-hospital outcomes of patients with definitive IE.

Materials and Methods:

A total of 20 consecutive cases of definitive IE, admitted between March 2017 and August 2018, at a tertiary care cardiac center (Thiruvananthapuram Medical College, India) were included in the study and followed for 6 months. We compared the clinical profile, other features and outcomes of currently enrolled patients (Group-1) with 10 years back (2007) cohort (Group-2) of IE patients (n = 25) at the same institution.

Results:

The mean age of the Group-1 was 44.7 (±11.6) years, whereas those in Group-2 were 48.6 ± 12.9. The overall male to female sex ratio was 2.2: 1. The rheumatic heart disease (RHD) was the most common predisposing factor accounting for nearly 40% of all cases in both groups, congenital cardiac lesions accounting for 20% in both groups. The most common significant valve lesion was mitral regurgitation (45% vs. 40%P= 0.032). Fever was the most common complaint at the time of hospital admission in both groups (80% vs. 96%). The most common complication was congestive heart failure in both groups (60% vs. 56%). Blood cultures were positive only in 35% patients from Group-1 to 48% from Group-2 (P < 0.01). The mean vegetation size in Group-1 was 7.6 mm and in Group-2 was 10.8 mm (P = 0.04). Patients with large-sized vegetation had increased incidence of heart failure, and embolic phenomena and mortality. Among Group-1, 5 (25%) patients have undergone surgery compared to Group-2, where only 4 (16%) patients have undergone surgery. The overall in hospital mortality in Group-1 was 5 (25%). Out of them, two patients expired after surgery (surgical mortality 40%). In Group-2, mortality was 7 (28%). Out of them, three patients expired after surgery (surgical mortality 42.8%). The majority (53.3%) of patients were in New York Heart Association Class II at the time of discharge.

Conclusions:

The average age of patients presenting with IE in India has increased, while the male predominance is maintained. RHD continues to be the most common predisposing factor. The lower culture positivity rate and lower rates of surgery are worrisome in Indian patients. Despite significant advances in medical technology over the last decade, mortality rate remains the same.
Severe hypercalcemia mimicking as ST-segment elevation myocardial infarction
Authors: PRADEEP YADAV K L , TENDULKAR PRAKASH , KANT RAVI
Published: May 2024

The identification of ST-segment elevation on the electrocardiogram is an integral part of decision-making in patients who present with suspected ischemia. Unfortunately, ST-segment elevation is nonspecific and may be caused by noncardiac causes such as electrolyte abnormalities. We present a case of a 52-year-old male who presented with ST-segment elevation secondary to hypercalcemia in a patient with hypertension with osteoporotic vertebral collapse.
Real-world experience of clinical management with antiplatelet and lipid-lowering therapy in post acute coronary syndrome patients in Indian setting
Authors: HIREMATH M.S. , ROUTRAY S. N. , SHETTY SADANAND R. , JOHN JOHN F. , DAMLE ANIL , PRADHAN AKSHAYA , DHARMADHIKARI ANIRUDDHA , DESAI BHUPEN N. , ABHYANKAR MAHESH V. , REVANKAR SANTOSH
Published: May 2024

Objective:

The objective is to evaluate the pattern for use of triple-drug therapy (dual antiplatelet therapy [DAPT] and statin) in the management of patients with postacute coronary syndrome (ACS) and associated risk factors in Indian settings.

Materials and Methods:

This was a retrospective multi-centric (n = 63), real-world, cross-sectional study which included patients (aged ≥18 years) diagnosed with an ACS, post-ACS patients from 3 months to 3 years, and receiving DAPT and lipid-lowering agents for ACS. Demographics, baseline characteristics, risk factors, medical history, and therapy details were retrieved from medical charts. Descriptive and comparative analysis for qualitative and quantitative variable was performed.

Results:

A total of 1548 patients with a mean age of 57.4 years were included. Male preponderance was observed across all the age groups. A total of 973 patients were on triple-drug therapy, and the most common triple fixed-dose combination prescribed was rosuvastatin, clopidogrel, and aspirin, among all the groups (age-wise: 76.1%–88.6%; sex-wise: 78.5% and 79.2%; clinical status-wise: 75.7%–81.4%). The majority of patients with non-ST-segment elevation myocardial infarction (43.0%), ST-segment elevation myocardial infarction (42.7%), and unstable angina (40.8%) received triple-drug therapy for >6 to ≤12 months duration. Adverse effect observed in patients receiving triple-drug therapy were skin rash (n = 5), bleeding (n = 2), facial puffing (n = 2), and hematuria (n = 2). A total of 357 patients were undergone switch in DAPT therapy (prasugrel to clopidogrel or ticagrelor to clopidogrel).

Conclusion:

DAPT and statin were the standard of care in majority of ACS patients. Triple fixed-dose combination therapy of aspirin, clopidogrel, and rosuvastatin was the most preferred choice of physicians, for optimal management post-ACS patient in Indian setting.
Right coronary artery intervention through right radial access in a patient with aberrant right subclavian artery and anomalous origin of right coronary artery
Authors: KUMAR BARUN , SONI SHISHIR , SINGH ANUPAM
Published: May 2024

We report a case of primary angioplasty of right coronary artery (RCA) through right radial artery access in a patient with aberrant right subclavian artery (arteria lusoria) and anomalous origin of RCA. Major challenges in such cases are difficulty in hooking coronary ostia and getting enough support from the guide catheters. However, another challenge confronted in this patient was the anomalous origin of RCA from the left sinus. Herein, we discuss key aspects of management in this scenario. Arteria lusoria with anomalous RCA can be confronted during the transradial intervention. Use of an appropriate guide catheter to facilitate the procedure in this scenario can help interventionists to manage such a situation, and this can be a useful alternative in those patients with unfavorable transfemoral access along with this rare anomaly.
Invasive assessment of fluid therapy in hypotensive patients of postinferior wall myocardial infarction complicated by right ventricular infarction
Authors: VANKAR SAMEER GANPAT , SHARMA AKHIL KUMAR , DWIVEDI SUDDHANSHU KUMAR , CHAUDHARY GAURAV KUMAR , CHANDRA SHARAD , PRADHAN AKSHYAYA , VISHWAKARMA PRAVESH , BHANDARI MONIKA , SETHI RISHI
Published: May 2024

Background:

Management of such patients with inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) requires volume replacement along with the standard therapy. However, the optimum amount of fluid needed to maintain systolic blood pressure (SBP) ≥90 mmHg in such patients has not been reported yet. This study evaluates the role of graded fluid infusion in improving the hemodynamic parameters in patients of IWMI with RVMI in hypotension or shock and also optimizes the amount of fluid needed to maintain SBP ≥ 90 mmHg.

Materials and Methods:

In this single-center, prospective observational study, patients with first episode of acute coronary syndrome diagnosed as IWMI complicated by RVMI and SBP <90 mmHg were included. The hemodynamic parameters such as heart rate, SBP, cardiac output, cardiac index, and pulmonary capillary wedge pressure (PCWP) were measured at the baseline and after each 500 ml normal saline over 15 min until SBP ≥ 90 mmHg was attained. The primary objective was to study the change in cardiac output, cardiac index, and PCWP with response to fluid. The amount of fluid needed for ≥ 10 rise in cardiac output and to maintain SBP ≥ 90 mmHg was also evaluated. The secondary objectives were to study the need for inotropic support, complications such as inhospital mortality, acute pulmonary edema, and local site bleeding. Further, the predictors of early responders (<2 L of fluid) were also evaluated.

Results:

Among all 16 patients, 3 (18.7%) were excluded and the rest received graded fluid therapy. Invasively monitored and graded fluid therapy resulted a significant rise in cardiac output (2.1 ± 0.7 L/min vs. 3.7 ± 0.7 L/min), cardiac index (1.3 ± 0.3 L/min/m2
vs. 2.4 ± 0.76 L/min/m2), and PCWP (8.4 ± 3.0 mmHg vs. 17.6 ± 1.5 mmHg) in comparison to baseline parameters. On an average, 865 ± 462 mL fluid infusion was required for 10% improvement in CO from baseline. However, 2192 ± 560 mL fluid was needed for consistent maintenance of SBP ≥ 90 mmHg. The effect of fluid therapy was not significantly correlated with baseline clinical and hemodynamic parameters. There were no procedure- and therapy-related complications reported during the study.

Conclusions:

Early response to fluid therapy within 2 L of normal saline occurred independently of baseline hemodynamic parameters. However, more studies with larger number of patients would be needed to confirm the same.
A simple randomized prospective study comparing catheter-directed thrombolysis versus systemic thrombolysis in patients with massive and submassive pulmonary embolism
Authors: TATED SUYASH , JOSHI DINESH , SHUKLA ANAND , RAVAL PRATIK , NATRAJAN KARTHIK , KANABAR KEWAL , KUMAR SURENDER , PATEL JIGNESHKUMAR
Published: May 2024

Context:

Catheter-directed thrombolysis (CDT) is a novel mode of thrombolysis where thrombolytic agents are directed through catheter to a specific area of interest; hence, low-dose thrombolytic agent will be required to produce satisfactory thrombolysis results. This will subsequently decrease the bleeding complications. With this postulation, a study was conducted to compare the outcome of CDT versus systemic thrombolysis (ST) in patients with massive and submassive pulmonary embolism (PE).

Methods:

The present study prospectively included the cases of massive and submassive (high-risk) PE and randomly distributed 25 patients into two groups each: Group A underwent CDT, whereas Group B underwent ST. The outcomes of both the groups were studied including mortality and bleeding complications, and patients were followed up for 6 months. At the end of the study, data were analyzed, and outcomes of both the groups were compared.

Results:

Baseline characteristics were similar in both the groups. The success rate was 90.4% in Group A (CDT) and 75% in Group B (ST) among patients with massive PE (P = 0.95). The mortality rate was numerically higher in the ST group (12%) than in the CDT group (8%). Bleeding complications were higher in the ST group (20%) than in the CDT group (8%).

Conclusion:

CDT was found to be noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered viable alternative to ST in patients with high bleeding risk.
Management of Uttana vatarakta (limited cutaneous systemic sclerosis): An experience through Ayurveda management strategies
Authors: Sutaria Ekta , Rajput Devendrasingh , Anagha M.S , Pandya Darshna
Published: May 2024

Scleroderma (systemic sclerosis) is a group of rare diseases that involve the hardening and tightening of the skin and connective tissues. Diffuse cutaneous scleroderma and Limited Cutaneous Systemic Sclerosis (LcSSC) are the two major classifications of it. LcSSc usually affects the skin and further spreads to muscles and joints, but in about 10% cases, involvement of internal organs like gastrointestinal tract and manifestations like pulmonary hypertension is seen even after 10–15 years. The prevalence of the disease is 17.6/100,000 population. As far as the management of LcSSC in conventional medicine is concerned, other than symptomatic relief; immunosuppressive drugs are given, but long-term use of such medicines suppresses the immunity of the patient and hence the patient may get affected with opportunistic infections and causes severe complications. Hence, some alternatives in this direction are being explored from other systems of medicines for the betterment of patients. The direct description of the disease scleroderma is not available in Ayurvedic literature, but based on its presentation, it can be correlated with different stages of Vatarakta (~rheumatism due to blood tissue). A 20-year-old young male patient with presentation of limited scleroderma managed with Ayurveda therapy by Virechana (~therapeutic purgation) followed by Shamana (~palliative) therapy for one and half months and obtained encouraging results, inferring that Ayurveda therapeutic protocols can be successfully adopted in cases like LcSSC.
A review of infant apnea monitor design
Authors: Nwaneri Solomon , Ezenwa Beatrice , Osuntoki Akinniyi , Ezeaka Veronica , Ogunsola Folasade
Published: May 2024

Apnea detection is critical to the management of infant apnea. Effective monitoring and management of apnea using apnea monitors is known to reduce complications and possible fatalities in infants. There is a need to determine the critical design considerations in apnea monitors. This article reviews the design and development of infant apnea monitors. We conducted a targeted literature review from different databases, including PubMed, ScienceDirect, and Google Scholar. We reviewed articles published between January 1995 and February 2023. The search was done using combinations of key terms, namely, “apnea,” “apnea monitors,” and “apnea monitor design.” Articles that met the inclusion criteria were extracted and analyzed. The review investigated common physiological parameters, sensor types, and validation results of apnea monitors. The review revealed important design considerations adopted in the literature as well as the different sensor types and methods of apnea detection. It was found that thoracic impedance pneumography, thermistors, respiratory inductance plethysmography, pneumotachograph, and MEMS accelerometer are the most common sensor types used to design apnea monitors. The review revealed that most apnea monitors were designed to measure multiple physiological parameters. Device validation results varied from one device to another, with sensitivity and specificity metrics ranging between 80% and 96%. With the high burden of infant apnea in developing countries and its associated mortality and morbidity, the design of functional infant apnea monitors has become increasingly important to complement the expensive and complex polysomnography technique. Therefore, we must use appropriate sensors and design approaches for effective detection of infant apnea.
Correlates of iron deficiency among adult patients with sickle cell nephropathy at a tertiary health facility in Lagos, Nigeria: A cross-sectional study
Authors: Orolu Muyideen Olayemi , Mabayoje Monica Omolara , Braimoh Rotimi Williams , Bello Babawale Taslim , Amira Christina Oluwatoyin , Kushimo Oyewole Adebiyi , Anyanwu Roosevelt Amaobichukwu , Orolu Adebukola Khairat , Awofeso Opeyemi Mercy
Published: May 2024

Background:

Iron deficiency presents a muddled clinical picture in patients with sickle cell anemia (SCA). The picture is further complicated when these patients develop sickle cell nephropathy (SCN). This study aimed to identify the correlates of iron deficiency among adult patients with SCN in Lagos, Nigeria.

Methods:

This was a cross-sectional study conducted among adult patients with SCN who presented at the nephrology clinic of the tertiary health facility. Data on demographics, clinical history, laboratory investigations, and iron status were collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 28.

Results:

One hundred and nineteen adult patients with SCN were enrolled in the study. The mean age was 28.9 ± 9.5 years, and the majority were females. Iron deficiency was present in 36 (30.2%) subjects, while 7.6% had elevated iron status. Younger age and male sex were associated with iron deficiency state. Participants with an estimated glomerular filtration rate (eGFR) of ≥60 mL/min had a higher prevalence of iron deficiency (r = −0.28 P < 0.01/r = −0.32 P < 0.01). A logistic regression analysis showed no independent association between these factors and iron deficiency.

Conclusion:

This study showed that iron deficiency is common in adults with SCN, seen in one-third of participants. Therefore, although iron overload is frequently acknowledged as a significant issue in SCA, it should not be automatically assumed in cases where nephropathy is present. The study findings also highlight the need for routine screening for iron deficiency among SCN patients, especially among males, younger patients or those with an eGFR ≥60 mL/min, to optimize their management and improve their outcomes.
Assessment of knowledge and attitude toward influenza vaccinations within the adult population of Riyadh, Saudi Arabia
Authors: ElFeky Dalia S. , Ramadan Yomna K. , AlQurashi Rawabi S. , Alsarhan Alhanouf A. , Alkhodaidi Malak , Albalawi Malak
Published: May 2024

BACKGROUND:

The most cost-effective measure for preventing the infectious disease, influenza, is vaccination. The purpose of this research was to evaluate knowledge levels, familiarity, and attitude toward influenza and influenza vaccination of the Riyadh adult population.

MATERIALS AND METHODS:

A cross-sectional study was carried out in Riyadh and data was collected between December 2017 and March 2018. Five hundred participants were interviewed in person using a closed-ended questionnaire. Participants comprised the general population, students, and healthcare workers (HCWs), and were recruited from shopping malls, parks, Princess Nourah Bint Abdulrahman University, and King Abdullah Bin Abdulaziz University Hospital. A pilot study was conducted among 15 participants from the general population, students, and HCWs who gave verbal consent. Participants were asked if they comprehended the questionnaire and whether they felt comfortable participating. Descriptive statistics were used to describe the sample. Statistical significance was determined using t-test for quantitative variables and Chi-square test for qualitative variables.

RESULTS:

Most participants in all groups had poor knowledge. The least informed was the general population (8.8%), followed by the students (11.8%), and the most aware were the HCWs (18.5%). The social media (35%) was the main source of participants’ knowledge, followed by doctors and health educators in hospitals (33%). Only 15.6% of participants had been vaccinated this year. Even fewer (8.8%) stated that they took the vaccination every year. The most important reasons for getting vaccinated were the recommendations by the Ministry of Health or by their doctors (77.8% for each). The key barrier to vaccination was a lack of perceived benefit (the participants did not usually get influenza so they felt vaccination was unnecessary [66.2%]). About 34% of participants reported that they had the children in their families vaccinated. The main reason given was to protect their children from influenza complications (80.6%).

CONCLUSION:

Within the Riyadh adult population, there was both low compliance to take the influenza vaccinations owing to a lack of perceived benefit and insufficient knowledge of the risks of influenza.
Proteinuria and its associated factors in patients attending family medicine clinics in Dammam, Saudi Arabia
Authors: AlSinan Salma R. , Alsaigh Sukaynah A. , Al-Dawood Kasim M. , AbdelWahab Moataza M.
Published: May 2024

BACKGROUND:

Urinalysis is a simple, valuable, and low-cost tool for the detection of proteinuria, a significant risk factor for renal and cardiovascular diseases. The purpose of this study was to determine the rate of proteinuria and its associated risk factors in patients attending Family Medicine Clinics in Dammam, Saudi Arabia, as no study of that nature had previously been conducted.

MATERIALS AND METHODS:

In this register-based cross-sectional study, data including urinary protein and other urinalysis components ordered between January 2018 and January 2020 were collected from electronic medical records. In addition, data regarding nationality, gender, age, blood pressure, body mass index, serum human chorionic gonadotropin, fasting glucose, hemoglobin A1c (HbA1c), 25-hydroxy Vitamin D level, blood urea nitrogen (BUN), uric acid, creatinine, estimated glomerular filtration rate (eGFR), and lipid profile was also obtained. Proteinuria was classified as negative if no or trace protein was present, and positive if protein was ≥1+, and was considered overt proteinuria.

RESULTS:

In total, results of 2942 urinalysis tests were included. The mean age of the patients was 42.4 ± 14.5 years; majority of the patients were females (62.3%) and were Saudis (68.8%). The rate of proteinuria was 4.2%. Saudi nationality, female gender, age ≥ 40 years, high systolic blood pressure, high diastolic blood pressure, fasting glucose ≥126, HbA1c ≥6.5%, BUN >20 mg/dl, creatinine >1.3 mg/dl, low eGFR <60, and high low-density lipoproteins cholesterol were significantly associated with proteinuria based on bivariate analysis. Using a logistic regression model, a statistically significant association was observed between proteinuria and advancing age, the presence of urinary casts, elevated serum creatinine level, and Saudi nationality.

CONCLUSION:

The only variables that were independently associated with proteinuria using the logistic regression were the presence of casts in the urine, Saudi nationality, high creatinine level, and older age. These variables should be borne in mind by treating physicians.
Synthesis, Characterization, and Cytotoxicity Evaluation of Polyethylene Glycol-Coated Iron Oxide Nanoparticles for Radiotherapy Application
Authors: Anuje Madhuri , Pawaskar Padmaja N. , Khot Vishwajeet , Sivan Ajay , Jadhav Satish , Meshram Jagruti , Thombare Balu
Published: May 2024

Background:

Treatment methods for cancer that are widely being utilized affect both normal and cancerous cells. We report synthesis polyethylene glycol (PEG)-coated Fe3O4 nanoparticles (NPs) and its characteristic properties and appraise its potential as a promising radiation sensitizer candidate in radiotherapy that improves cancer treatment and reduces side effects of radiation.

Materials and methods:

PEG-coated Fe3O4 NPs were synthesized by chemical coprecipitation method and characterized by studying their size, structure, functional group, stability, magnetization, and cytotoxicity using different techniques. X-ray powder diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis results show that Fe3O4 NPs have been functionalized with PEG molecules during the course of synthesis.

Results

Synthesized NPs have good stability based on zeta-potential study. Dynamic light-scattering results reveal that PEG-coated Fe3O4 has a greater hydrodynamic size than bare Fe3O4. Transmission electron microscopy (TEM) micrograph exhibited that NPs are roughly spherical with size in range of 10–20 nm. Saturation magnetization value of PEG-coated and bare Fe3O4 also confirms coating and shows superparamagnetic behavior. Cytotoxicity evaluation study indicated that PEG-coated Fe3O4 is biocompatible on L929 and toxic on Michigan Cancer Foundation-7 (MCF-7) (breast cancer cells).

Conclusion:

These characterized properties of PEG-coated Fe3O4 NPs show that it could be used as a potential radiosensitizer candidate in radiotherapy to significantly improve cancer treatment and minimize painful side effects of radiation.