bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Structure and Function of left atrial Appendage with Left atrial appendage Thrombus formation in patients with Rheumatic Heart Disease
Authors: NATARAJAN KARTHIK , MANSURI ZEESHAN , JOSHI DINESH , SHUKLA ANAND , SHARMA VISHAL , PANDEY VIMLESH , BHATIA SANJEEV , PATEL KRUTIKA
Published: May 2024

Context:

In patients with rheumatic heart disease (RHD), left atrial appendage (LAA) dilation and thrombus formation is widely known. LAA thrombus formation is a risk factor for stroke even in patients with sinus rhythm. The aim of this study was to determine an association between LAA structure and function with respect to thrombus formation and differences in LAA size and velocity between patients with sinus rhythm and those with atrial fibrillation (AF).

Materials and Methods:

We prospectively studied LAA structure and function in 120 patients with RHD by transthoracic echocardiography and/or transesophageal echocardiography by measuring left atrial (LA) dimension, LA area, LAAmax/min, LAA ejection fraction (EF), and LAA emptying velocity.

Results:

Four out of 48 patients with sinus rhythm had LAA thrombus. In 72 patients with AF, 32 had LAA thrombus. Patients with LAA thrombus had lower mean LAA EF and emptying velocity both variables P-value is same (P<0.0001 and P<0.0001) Patients with LAA thrombus had increased mean LAA max and LAA min as compared to LAA max and LAA min in patients without LAA thrombus (P 0.008 for mean LAA max and P<0.0001 for LAA min respectively). Patients with AF with LAA thrombus had greater LAAmax compared to that in patients with AF without LAA thrombus (P < 0.0001). Doppler demonstrated a recognizable sawtooth LAA outflow velocity pattern in 32 of 36 (88.9%) patients with LAA thrombus versus 32 of 84 (38.1%) patients without LAA thrombus.

Conclusions:

We conclude that LAA contractility is reduced in RHD with LAA thrombus, and loss of both contractility and LAA dilation is associated with increased risk of thrombus formation and hence the risk of stroke.
The impact of administering intraoperative dexamethasone versus placebo on major complications and mortality in patients undergoing cardiac surgery
Authors: Madkaiker Ashish , Mehta Tania , Manek Pratik , Doshi Chirag , Shah Pratik , Patel Sanjay
Published: May 2024

Background:

Inflammations resulting from cardiac surgical procedures have traditionally been controlled with corticosteroids such as dexamethasone. However, the use of these medications to attenuate the inflammatory responses from cardiac surgery remains contentious. The aim of this systematic review and meta-analysis was to evaluate the effect of administering dexamethasone intraoperatively on major complications and mortality compared to placebo interventions.

Study Design:

This was a systematic review and meta-analysis.

Methods:

The research was conducted on online databases such as PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Control Trials until August 5, 2022. The studies in the online databases were written between January 1, 2000, and August 1, 2022. The studies that were selected were scanned and analyzed based on an established eligibility criteria for the study.

Results:

Ten randomized and controlled trials were included in this systematic review and meta-analysis. The incidence of mortality was 2.2% (154 out of 7007 patients) in the dexamethasone group and 2.3% (164 out of 7038 patients) in the placebo group (odds ratio [OR],0.94; 95% confidence interval [CI], 0.75–1.01; P = 0.73; I
2 = 0%). Myocardial infarction incidence was 1.88% (88 out of 4685 patients) in the dexamethasone group and 2.12% (100 out of 4708 patients) in the placebo group (OR, 0.88; 95% CI, 0.66–1.18; P = 0.39; I
2 = 9%). The incidence of stroke for the dexamethasone group was 1.56% (70 out of 4488 patients) and 1.82% (82 out of 4511 patients) in the placebo group (OR, 0.86; 95%CI, 0.62–1.18; P = 0.34; I
2 = 0%). The prevalence of new onset atrial fibrillation was 32.3% (797 out of 2469 patients) for dexamethasone and 34.7% (859 out of 2478 patients) for placebo (OR, 0.90; 95%CI, 0.80–1.01; P = 0.08; I
2 = 0%). The incidence of renal failure was slightly higher in the placebo group with 1.58% (108 out of 6857 patients) compared to the dexamethasone group 0.97% (66 out of 6823 patients) (OR, 0.61; 95% CI, 0.45–0.83; P = 0.002; I
2 = 0%).

Conclusion:

According to this review, dexamethasone does not result in a significant decrease in incidences of mortality, myocardial infarction and stroke. However, the medication was associated with decreased incidences of renal failure and atrial fibrillation in a majority of the studies.
Acute and short-term outcomes of balloon aortic valvuloplasty in patients with significant aortic stenosis
Authors: PRAJAPATI JAYESH , SINGH PARMINDER , VYAS POOJA , PATEL IVA
Published: May 2024

Background:

The optimal treatment for congenital aortic stenosis (AS) remains in debate over the past three decades of practice with both balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy. BAV has been the palliative therapy with AS in most centers. The present study aimed to provide role and short-term outcomes of BAV in AS patients.

Methods:

We enrolled 58 patients aged ≤20 years of AS from July 2017 to November 2019. All patients were evaluated by echocardiography at 1, 3, and 6 months.

Results:

From the total of 58 patients, there were 38 male and 20 female patients. BAV could be successfully completed in 56 patients (96.5%). Pre-BAV mean left ventricle systolic pressure (LVSP) was 187.85 ± 53.75 mmHg and transaortic gradient (TAG) was 90.67 ± 42.77 mmHg. LVSP and TAG were reduced significantly (P = 0.0001) post procedure (133.85 ± 41.33 mmHg and 28.11 ± 23.22 mmHg, respectively). Echocardiographic parameters such as V max, aortic valve (AV) G max, and AV G mean were significantly decreased post procedure and AVA was increased significantly post procedure. Ten (17.86%) patients had developed significant (more than or equal to moderate) aortic regurgitation post procedure (17.24%). About 66% of our patients had no complication post procedure. At 1, 3, and 6-month follow–up, AV G max and G mean and V max increased but were not statistically significant.

Conclusion:

BAV via transarterial route in pediatric population with significant AS is safe, effective palliation with good immediate and midterm follow-up results with minimum complications. We did not face any major complications except for development of variable degrees of aortic regurgitation and access site complications.
Periprocedural and short-term outcomes of stenting of coarctation of the aorta in adults
Authors: Vijay Sudarshan Kumar , Jha Ashish , Tiwari Bhuwan Chandra , Singh Amresh Kumar , Jamwal Naveen
Published: May 2024

Background:

Coarctation of the aorta (CoA) is a rare congenital heart disease for which ballooning or surgery is recommended in the early stages of life, however, in adult patients, stenting has emerged as the treatment of choice. Data on various techniques and outcomes of stenting in CoA in Indian patients are scarcely available.

Materials and Methods:

Seven adult patients of CoA treated at our center with stenting between the years 2018 and 2022 were retrospectively studied. All patients were analyzed for their clinical presentation, coarctation segment anatomy, use of various techniques for stent deployment, perioprocedural outcomes, and 3-month echocardiography (ECHO)-based follow-up with the study of gradients and clinical features. The use of various hardware to facilitate stenting was studied, and predictors of successful stenting were also defined in the analysis.

Results:

The mean age of the coarctation patients was 19.1 ± 3.7 years with a male-to-female ratio of 3:4. The mean systolic blood pressure at baseline was 162.5 ± 12.6 mm of Hg and mean diastolic blood pressure of 95.7 ± 5.3 mm of Hg. The mean peak systolic gradient across the coarctation segment at baseline was 46 ± 8.2 mm of Hg. Combined antegrade and retrograde access was used for stenting of CoA in four patients (57%). Good-sized isthmus was present in only three patients (42%), and balloon predilatation was required in three patients (42%). The use of combined antegrade and retrograde route, good-sized isthmus, and adequate balloon predilatation were predictors of successful wire crossing and stent deployment across the coarctation segment. The mean ECHO-based follow-up gradient at 3 months was 9.2 ± 2.5 mm of Hg.

Conclusions:

Stenting for native CoA with the use of Cheatham-platinum stents in adult patients is a highly effective and safe therapy. Longer-term follow-up studies are required to show the exact incidence of stent fracture and aneurysm formation after stenting.
Clinical outcomes with the use of ticagrelor or clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction – A prospective observational study
Authors: Agarwal Bibek , Vijay Sudarshan Kumar , Singh Amresh Kumar , Jha Ashish , Tiwari Bhuwan Chandra , Jamwal Naveen
Published: May 2024

Background:

Thrombolytic therapy in the appropriate window period remains the most commonly used therapy in ST-elevation myocardial infarction patients, despite the advantage of primary percutaneous coronary intervention (PCI) over it. Use of newer more potent antiplatelets agents early after thrombolysis carries the chance of increasing bleeding complications, thus we planned to have a study to assess the safety and efficacy of ticagrelor as compared to clopidogrel in thrombolysed patients.

Materials and Methods:

This was a prospective observational study in Indian patients. A total of 142 patients were enrolled in the study with 76 in the ticagrelor group and 66 in the clopidogrel group. All patients received thrombolysis as the primary reperfusion strategy. Patients receiving either clopidogrel or ticagrelor after thrombolysis irrespective of the subsequent PCI status were followed up for any bleeding events (primary endpoints) as per thrombolysis in myocardial infarction (TIMI) definition and Bleeding Academic Research Consortium (BARC) definition. Major adverse cardiac events (MACE) including death from cardiovascular causes, myocardial infarction (MI), and stroke were also assessed as markers of efficacy and secondary endpoints.

Results:

Mean time from thrombolysis to study drug use was 18.9 ± 2.1 h in the ticagrelor group as compared to 14.8 ± 3.3 h in the clopidogrel group (P > 0.05). For major bleeding events (TIMI major), no statistically significant difference was observed between groups (2.6% in ticagrelor vs. 1.5% in clopidogrel) (P = 0.6). BARC 3–5 bleeding at 1-month follow-up was significantly higher in the ticagrelor group compared to the clopidogrel group (P = 0.04). At 1-month follow-up, BARC 1–2 or 3–5 bleeding events in the subjects who underwent PCI were higher in the ticagrelor group than the clopidogrel group (P = 0.03). Patients in the clopidogrel group have more major adverse cardiac events than the ticagrelor group especially driven by more fatal and nonfatal MI in the clopidogrel group (P = 0.04).

Conclusions:

Ticagrelor can be safely administered in postthrombolytic patients similar to clopidogrel albeit at the cost of slightly increased minor bleeding events in short-term follow-up.
A study on hospitalized patients of junctional rhythm with reference to the prevalence of different underlying etiologies
Authors: SINHA PULAKESH , MOULICK AVIJIT , MAJHI BHUBAN
Published: May 2024

Introduction:

Junctional rhythm (JR) is a rescue rhythm where the upstream impulse generators fail to pace the heart and atrioventricular (AV) junction takes up that function. The presentation is variable ranging from totally asymptomatic cases, where it is a manifestation of heightened vagal tone, to life-threatening bradycardia, resulting from some serious underlying pathologies. JR results from diverse causes such as sick sinus syndrome, acute myocardial infarction (AMI), dyselectrolytemia, drugs, and toxins. Understanding the etiologic factor has immense implication in the management as the prognosis is related mainly to the primary pathology rather than JR itself.

Subjects and Methods:

In this observational study, we evaluated 100 hospitalized patients of JR over a period of 1 year regarding their symptoms, signs, and underlying pathology.

Results:

Among 100 patients, 38 had a history of syncope and 42 had angina. Twenty-four patients had hyperkalemia (22 of them had renal dysfunction). Thirty patients had elevated troponin-T and/or CK-MB. The most common etiology was AMI responsible in 28% patients followed by hyperkalemia (24%), sick sinus syndrome (20%), and medication drug use (16%) as the principal causes of JR. Myocarditis, toxin, and hypothyroidism were uncommon association. Accelerated JR and junctional tachycardia were associated with AV nodal ablation and postsurgical patients, respectively.

Conclusion:

JR is a manifestation of several diverse etiopathologies, and elucidation of them is extremely important for the patient management. We estimated the prevalence of various underlying etiologies which should be considered during the management of such patients.
Evaluation of idiopathic dilated cardiomyopathy with cardiac magnetic resonance imaging
Authors: KHAN IMTIYAZ AHMAD , PARRY ARSHED HUSSAIN , PAUL IRSHAD , CHOH NASEER AHMAD , SHAHEEN FEROZE A. , SINGH MANJEET , KHAN KHURSHEED ASLAM
Published: May 2024

Purpose:

The present study was aimed to assess the prevalence, location, and patterns of late gadolinium enhancement (LGE) in idiopathic dilated cardiomyopathy (DCM) on cardiac magnetic resonance (CMR) imaging and to correlate the left ventricular (LV) functions obtained by cine CMR with the values obtained by echocardiography.

Methods:

This was a prospective single-center study covering a 2-year study period. The authors studied the prevalence, location, and patterns of LGE in idiopathic DCM on CMR and correlated the ventricular functions obtained by CMR with those obtained by echocardiography.

Results:

LGE was seen in 18/40 (45%) and was absent in 22/40 (55%) of patients. With regard to location, septal enhancement was the most common, seen in 8 (20%) followed by free-wall enhancement in 4 (10%) and a concomitant septal and free-wall enhancement in 6 (15%). In terms of pattern, midwall enhancement was observed in 10 (25%), subepicardial in 2 (5%), subendocardial in 4 (10%), and focal and transmural enhancement in 1 each. The maximum correlation for calculation of LV ejection fraction (EF) was obtained between CMR and two-dimensional echocardiography (P = 0.442).

Conclusion:

CMR is an accurate tool to determine the phenotype of DCM by identifying the presence, location, and pattern of LGE which has a prognostic value and is used to guide management. CMR is the most accurate assessment tool for the calculation of EF and other volumetric variables in DCM.
A descriptive study of socioclinical characteristics of young patients presenting for coronary angiography at Goa Medical College
Authors: DESAI MANJUNATH , VIEGAS MICHELLE , BORKER SHIRISH , KAMAT UMESH SUBHASH , CACODCAR JAGADISH A , PINTO STANISLAUS BOSCO
Published: May 2024

Background:

The magnitude of risk factor clustering for coronary artery disease (CAD), as well as the CAD, is increasing in developing countries, especially in the young.

Objectives:

The objective of this study was to study the sociodemographic, clinical, and angiographic profile of young patients (<45 years of age) presenting for coronary angiography at the Department of Cardiology, Goa Medical College, Bambolim.

Materials and Methods:

Ninety-four patients aged <45 years were interviewed using a semi-structured questionnaire between August 2018 and February 2019. The data were presented as proportions and means, and an appropriate test of statistical significance was applied toward drawing statistically sound conclusions.

Results:

There was a striking male preponderance with males contributing 97.9% of the patients. The proportion of patients with normal coronaries and single-, double-, and triple-vessel disease was, respectively, 21.3%, 56.8%, 18.9%, and 24.3%. Diabetes mellitus and use of tobacco were associated with CAD in a statistically significant manner (P < 0.05). Only around one-third of diabetics in the study group were subjected to fasting or random blood sugar estimation, and HbA1c was estimated in only 17%.

Conclusion:

Public awareness of the early-onset CAD and its risk factors, proper laboratory workup of patients to identify clustering of risk factors, and further research to dwell in to the sex bias among the reported patients is required.
Cardiac resynchronization therapy left ventricular lead through middle cardiac vein
Authors: PANDE ARINDAM , KUMAR DILIP , MUKHERJEE SANJEEV S , PATRA SOUMYA , ROY RANA RATHORE , DEY SOMNATH , CHAKRABORTY RABIN
Published: May 2024

Purpose:

The benefits of cardiac resynchronization therapy (CRT) depend on multiple factors including patient selection and left ventricular (LV) lead position in the coronary sinus. The ideal position for stimulation is the posterolateral region of the left ventricle, since this is the site where maximum contractile delay is seen. But this ideal site of LV lead placement is not possible in many patients due to anatomical limitations. Our study evaluated the feasibility of the middle cardiac vein (MCV) as an alternative target for LV lead placement with short-term outcomes result in a small cohort of patients.

Methods:

This is a single-center experience over a span of 2 years where in patients with anatomical limitations, we positioned our LV leads through MCV. In this period, we had implanted a total of 76 CRTs in our institution, out of which 6 cases we used MCV. We utilized collateral circulation to reach as close possible to the lateral surface of the left ventricle. Right ventricular (RV) leads were positioned to either outflow tract or upper septum to enhance the electrical gap in between two ventricular leads.

Results:

We achieved satisfactory periprocedural end results in all the cases as evident by appropriate threshold/impedances of all the leads, lack of diaphragmatic stimulation, etc. There were no procedural complications. Optimum short- and midterm improvement of symptomatic class and LV ejection fraction was observed. None of the patients had any lead dislodgement, abnormal change in lead threshold parameters, or need for hospitalizations for heart failure in follow-ups.

Conclusion:

We conclude that when usual posterolateral or lateral target veins cannot be accessed for LV lead placement, as an alternative approach utilizing MCV collateral circulation to reach as close possible to the lateral surface may be considered in CRT. RV leads to be positioned at the outflow tract or upper septum in those cases.
Libman-Sacks endocarditis masquerading as suspected rat-bite fever
Authors: RAI ROHIT , SINGLA RAHUL , BANSAL NARENDRA OMPRAKASH
Published: May 2024

Libman-Sacks endocarditis is usually associated with systemic lupus erythematosus and malignancies. It usually presents between ages 40 and 70 years. Our case was a seven year old child who was initially suspected and treated on lines of rat bite fever endocarditis based on history of rat bite but on further investigations patient was diagnosed with libman sacks endocarditis. High index of suspicion should be there for Libman-Sacks endocarditis for early diagnosis and treatment in cases with positive family history.
Novel oral anticoagulant in treatment of left ventricular thrombus in acute coronary syndrome – A case series
Authors: DAHIYA ARCHIT , JOSHI PIYUSH , SINHA RAMANAND PRASAD , WARDHAN HARSH
Published: May 2024

Introduction:

Left ventricular (LV) thrombus is a known complication of myocardial infarction (MI) and it usually occurs in areas of poorly contracting LV muscle as a result of endocardial injury with associated inflammation. There is a high risk of embolization within 3 months among patients with MI complicated by mural thrombus and this risk is maximum during the first 1–2 weeks. We report a case series of five patients who presented with acute coronary syndrome with LV apical thrombus and treated with triple anti-thrombotic therapy of rivaroxaban, aspirin, and clopidogrel.

Case Series:

Our series involves 5 cases who developed LV apical thrombus after acute coronary syndrome. Four patients had anterior wall ST-elevation MI (STEMI) whereas 1 patient had inferior wall STEMI. One of the patients with anterior STEMI also had COVID pneumonitis. All of these patients received triple anti-thrombotic therapy consisting of tab Aspirin 75 mg OD, tab clopidogrel 75 mg OD, and tab rivaroxaban 20 mg OD for 3 months duration. Repeat ECHO after 3 months showed complete resolution of LV thrombus in all of our cases.

Discussion:

LV thrombus reported in STEMI patients is from 1.6% up to 39% in various studies. The incidence of LV thrombus is on decreasing trend as a result of modern revascularization strategies. The role of novel oral anticoagulants (NOACs) in treating LV thrombus is scant as compared to oral Vitamin K antagonists (VKAs) like warfarin. The current recommendation for anticoagulation in the presence of a LV thrombus after acute coronary syndrome is with VKAs for up to 6 months.

Conclusion:

Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases.
Left ventricular systolic dysfunction following percutaneous closure of patent ductus arteriosus
Authors: GANESH BALASUBRAMANIYAN AMIRTHA , AASHISH ARUMUGAM , KARTHIKEYAN SELVARAJ , GIRIDHARAN SRINIVASAN , PRASATH PALAMALAI ARUN
Published: May 2024

Transcatheter closure has become the standard treatment for patent ductus arteriosus (PDA) with excellent short- and long-term results. Left ventricular systolic dysfunction after closure is a known phenomenon rather than a complication with varied incidence documented in literature. Here, we report our experience of six cases who developed left ventricle (LV) dysfunction following percutaneous closure of PDA. Age, PDA size indexed to body surface area and pulmonary hypertension were the parameters noted to be associated with poorer LV function after closure. The LV dysfunction was transient and asymptomatic in most with delayed recovery noted with increasing age.
Clinical, echocardiographic profile, and outcome of heart failure patients with preserved ejection fraction
Authors: JOHN MC , NARAYANAPILLAI JAYAPRASAD , MADHAVAN SURESH , JAYAPRAKASH VL , GEORGE RAJU
Published: May 2024

Context:

Approximately half of the patients with heart failure have preserved ejection fraction (HFpEF). Epidemiologic studies and randomized trials provide somewhat conflicting data regarding outcomes of HFpEF.

Aims:

The objective is to study the clinical and echocardiographic profile of patients admitted with HFpEF and estimate outcomes.

Settings and Design:

This is a prospective observational study on patients with new-onset HF requiring hospitalization and normal EF and evidence of diastolic dysfunction in echocardiography.

Subjects and Methods:

Risk factors for HFpEF, clinical features, and echocardiographic parameters were recorded. The primary outcome studied was mortality at 1 year and the secondary outcome was rehospitalization at 1 year.

Statistical Analysis Used:

Variables were analyzed using Student's t-test and Chi-square test. Univariate and multivariate analysis were done to find out predictors of outcomes.

Results:

A total of 104 patients admitted with the first episode of HF were found to have left ventricular ejection fraction ≥ 50% and diastolic dysfunction. Associated cardiac conditions were hypertension in 77.8%, diabetes in 38.5%, ischemic heart disease in 30.7%, and atrial fibrillation in 32.7%. In our study, 42 patients (40.1%) had rehospitalization within 1 year. The mortality rate at 1 year was 15.4% (16 patients). The parameters found to be significantly correlated with mortality in the univariate analysis included age, high BP, anemia, hyponatremia, low isovolumetric relaxation time, and higher E/e' ratio. Multivariate analysis showed advanced age, hyponatremia, and high E/e' to be independent predictors of mortality.

Conclusions:

Among hospitalized patients with new-onset HFpEF annual mortality rate is as high as 15.4%. Advanced age, hyponatremia, and high E/e' were found to be independent predictors of mortality.
Use of steroid therapy as a bridge to decision-making in patients with late rising pacing threshold after pacemaker implantation?
Authors: KUMAR BARUN , SONI SHISHIR , GORE PRANAY , DARBARI ANSHUMAN
Published: May 2024

The late rising pacing threshold is an alarming situation in which a possibility of lead dislodgement is usually considered first. This condition is usually picked up on routine follow-up interrogation; however, it can clinically manifest as syncope due to bradyarrhythmia. We report such a case in a 59-year-old male presenting to the emergency with syncope with a double chamber pacemaker in situ. He had a history of pacemaker implantation 16 years back and a pulse generator replacement (PGR) 6 years back with desirable parameters found immediately and up to 4 years after PGR. He was found to have a complete heart block on an electrocardiogram following the evaluation of presyncope and subsequently on his pacemaker interrogation high threshold was found which improved to acceptable levels after 4 weeks of steroid therapy.
Clinical presentation, management and in-hospital outcomes of Acute coronary syndrome patients in real world scenario in developing countries
Authors: SHARMA AKHIL KUMAR , GOEL DIWAKAR , CAHAUDHARY GAURAV , TIWARI ASHISH
Published: May 2024

Background:

With the introduction of a huge armamentarium of invasive and noninvasive therapeutic strategies, the mortality related to acute coronary syndrome (ACS) has decreased across the world over the past 20 years, but the mortality remains high among Indian patients due to limited resource settings. Even in India, there is significant difference in health infrastructure in different part of country. This study was performed to evaluate the presentation, management and outcomes of ACS patients admitted in a high volume tertiary center of north India. Enrolment of the study done prior to covid pandemic.

Materials and Methods:

3511 ACS patients >18 year of age were included for this prospective observational study. All patients were evaluated with detailed clinical history and examination, ECG, Troponin, and detailed echocardiography. Patients were treated as per current guideline recommendation which included primary percutaneous coronary intervention (PCI), pharmacoinvasive therapy, thrombolysis or medical management only. Data was analysed for age, sex, risk factors, type of ACS, treatment given and complications if any. Those patients who underwent invasive approach also evaluated for coronary anatomy pattern and variables.

Results:

Study population had younger mean age of 57.2 years, male preponderance (67%) and very high tobacco intake (46%). Out of all ACS patients 39% were STEMI (55% anterior wall myocardial infarction, 43% inferior wall myocardial infarction) and 61% were NSTEMI/USA. In STEMI subgroup, only 18% had primary PCI, while 42% received thrombolytic therapy as primary management. Nearly half of the patients who received thrombolytic therapy underwent pharmacoinvasive treatment (47.5%). A large number of late presenters (32% of all STEMI) did not receive any reperfusion therapy in index admission while few of them (6%) underwent invasive revascularization. Coronary anatomy evaluation showed multivessel disease in 53.1%. Left anterior descending artery was most common vessel involved (69.3%) among all ACS patients underwent coronary angiography. Most of the STEMI patients who underwent invasive route received PCI while very low rate for referral for CABG (2.1%). Major complications noted in study included left ventricular failure/cardiogenic shock (11.7%), advance AV blocks (8.2%), VT/VF (2.8%), Ventricular septal rupture (0.7%) and stent thrombosis (0.5%). In hospital mortality remained high (11.5%) mainly due to late presenters.

Conclusion:

ACS management specially STEMI care is still needs a boost in north India. With primary PCI rate of only 18% and more than one third being late presenters not receiving any reperfusion therapy, there is urgent need of robust primary and referral health care system. As compared to other part of India, tobacco intake is alarmingly high (46%) and needs widespread health awareness in community of tobacco ill effects.
Effects of hemofiltration during cardiopulmonary bypass in children undergoing intracardiac repair for tetralogy of Fallot
Authors: SINGH RAHUL , NAYAK PRAVEEN , PATEL ARCHIT , BHUMANA SRIKANTH
Published: May 2024

Introduction:

This study was planned to compare postoperative hemodynamics, blood loss, platelet count, and coagulation parameters in patients undergoing intracardiac repair for tetralogy of Fallot with and without hemofiltration and, in addition, to determine whether hemofiltration during cardiopulmonary bypass (CPB) reduces cytokines in children undergoing intracardiac repair for tetralogy of Fallot.

Methods:

Thirty children suffering from tetralogy of Fallot were enrolled in the study and randomly divided into two groups: one group had hemofiltration from beginning of rewarming till weaning off CPB, whereas in the other group, hemofiltration was not used during CPB. In the hemofiltration group, samples were taken for the comparison of tumor necrosis factor-α, interleukin-6 (IL-6), and IL-8 levels, before and after hemofiltration. Platelet count, coagulation parameters, postoperative blood loss, extubation time, hemodynamic parameters were recorded for hemofiltration as well as non-hemofiltration group and analysed.

Results:

The extubation time in the hemofiltration group was 15.6 h (mean), whereas that in the control group was 28.6 h (mean), and the difference, when compared, was significant between the two groups (P = 0.05). The cumulative postoperative blood loss at 24 h was significantly less in the hemofiltration group compared to the control group, 97.4 ml (80–114 ml) versus 159 ml (100–210 ml), respectively, with P = 0.001. No other statistically significant difference could be appreciated in the parameters analyzed.

Conclusion:

There was a significant reduction in postoperative blood loss and extubation time in the hemofiltration group. There was no significant reduction in cytokines. No significant difference was observed in requirement of inotropic agents, hemodynamic status, and intensive care unit stay between the two groups. Small sample size and shorter ultrafiltration time during rewarming phase were limitations of the study.
Evaluation of the association between glycated hemoglobin levels and severity of coronary artery disease in nondiabetic patients
Authors: SINGH BALVEEN , AGARWAL DEEPESH , DAHIYA ARCHIT , SAXENA G. N.
Published: May 2024

Introduction:

Higher fasting blood glucose level plus raised glycated hemoglobin (HbA1c) levels is one of the major risk factors for cardiovascular (CV) events in nondiabetic population. HbA1c levels have low intra-individual variability especially in nondiabetic patients. Studies have shown that coronary artery disease (CAD) and HbA1c are predictors of CV mortality. In this study, we have evaluated the association between HbA1c and severity of CAD in nondiabetic patients.

Materials and Methods:

This is a hospital-based observational study done on 300 patients in Department of Medicine and Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur. Prior approval was taken before the start of study from the Institute Ethics Committee. Gensini score was used to estimate the CAD severity. This score is based on the sum of scores for all 3 coronary arteries to assess the entire extent of CAD. Data were analyzed and appropriate statistical tests were used. P < 0.05 were considered statistically significant.

Results:

This study showed that the majority of cases (59.33%) were seen in 51–70 years of age group. The maximum number of patients (66.66%) had 5.6–6.5 HbA1c level and 29.36 ± 19.50 Gensini score in our study. Mean Gensini score showed a linear relationship with HbA1c.

Conclusion:

HbA1c level has a prognostic value for predicting the severity of CAD among nondiabetic patients and can act as a useful marker in risk stratification of nondiabetic patients presenting with acute coronary syndrome and indicated for angiographic evaluation.
Risk factor profile, incidence, and relevance of Mehran risk score to predict contrast-induced nephropathy in patients undergoing percutaneous coronary intervention
Authors: KAKROO SHAHOOD AJAZ , KUMARI N RAMA , LATEEF MANAL ABDUL , ARCHANA REMALA
Published: May 2024

Background:

Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population.

Materials
and

Methods:

A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN.

Results:

The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (<0.001), heart failure (<0.001), anemia (0.001), and median eGFR (P < 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P= 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P < 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P< 0.001) in the very high-risk groups (MRS >16) when compared to the low-risk group (MRS < 5). Dialysis was required only in 2 (3.1%) patients (P < 0.022).

Conclusions:

The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS >16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).
Management of chemotherapy adversity through Ayurveda: An experience
Authors: Deogade Meena Shamrao
Published: May 2024

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. Chemotherapy is the largely accepted treatment protocol for cancer, but it comes with an increased risk of infections and side effects. Ayurveda can be a promising adjunct therapy to minimize the adverse effects of chemoradiotherapy. A 65-year-old female who was a known case of double-vessel block suddenly developed severe abdominal pain and was treated symptomatically by a general physician. Her weight loss was consistent with multiple episodes of abdominal pain for a year after which she was diagnosed to have moderately differentiated adenocarcinoma of the cecum. The patient was managed with exploratory laparotomy (with right hemicolectomy with ileal transverse colon end-to-end anastomosis). The histopathology study reported it as a Modified Astler–Coller stage C2. Consequently, six cycles of Folfox (chemotherapy) were advised by the oncologist. Before starting the chemotherapy, Ayurveda treatment was started to combat the expected side effects of chemotherapy. The treatment protocol included Dhanyaka
phanta, Suvarnamalini
vasanta, Madiphala
rasayana, and Guduchyadi
ksheerapaka. The patient had no additional complaints during the chemotherapy and all the hematological parameters were within normal limits. The patient reported weight gain after completion of the chemotherapy. Expected side effects (hair loss, mouth sores, anorexia, diarrhea, and vomiting) were not reported during the treatment. Known side effects of chemotherapy like infection, easy bruising, bleeding, or fatigue were also not reported; therefore, the present study concludes that the side effects of chemotherapy may be controlled by Ayurveda adjunct therapy.
Ayurvedic management of Vipadika (~palmoplantar psoriasis): A case report
Authors: Pratibha  , Rath Sudipta Kumar , Surolia Manaswi Mukesh
Published: May 2024

In Ayurveda, skin disorders are included under a broad category of diseases, namely, Kushta. There are 18 types of Kushta described in Ayurveda. Out of which, Vipadika (~cracks in palms and soles) is one. It can be correlated with palmoplantar psoriasis. According to ancient seers of Ayurveda, Pani
pada
sphutana (~cracks in palms and soles), Tivra
vedana (~severe pain), Manda
kandu (~mild itching), and Saraga
pidika (~redness associated with eruptions) are the symptoms of Vipadika. In the present case report, a 62-year-old male patient complained of dryness and cracking of the left sole with roughness associated with itching on the plantar aspect of the left foot and severe pain during walking for two years. He was taking allopathic treatment for two years but had limited relief. The patient has difficulty in mobility and daily activities. A combination of Shuddha
gandhaka, Rasamanikya, and Chopachini
churna along with Kaishore
guggulu, Raktaprasadaka
hima, Panchatikta
ghrita, Panchasakara
churna, Arogyavardhini
vati, and Sarivadyasava as internal medicines and Haridra, Rasamanikya along with Yashtimadhu was prescribed as a local application. The patient was advised to follow Pathya and Apathya (~wholesome and unwholesome diet) during the treatment. Within three months of the treatment, the psoriatic lesions and associated signs and symptoms were healed effectively.
Adenocarcinoma of the lung treated with add-on Ayurveda treatment: A case report
Authors: Nimbalkar Ranjeet , Kolte Sanjay , Baheti Akshay Motilal , Haritwal Prerna , Nimbalkar Manasi R.
Published: May 2024

Studies conducted in 2020 predicted that 1,392,179 people in India suffer from cancer. The six most common sites are breast, lung, mouth, cervix, uterus, and tongue. Among these, lung cancers are reported to have the greatest fatality rate. In the present case, a 49-year-old male patient suffering from adenocarcinoma in the upper lobe of the left lung was managed with herbo-mineral Ayurvedic combinations along with conventional treatment. He had a history of right-sided chest pain after facing a fall from stairs. The chest X-ray showed a right-sided rib fracture. However, as an additional accidental finding, a 3-cm mass on the upper lobe of the left lung was also visible, which was found malignant after the detailed investigations. The patient was initially treated with conventional treatment and surgery, followed by chemotherapy. During chemotherapy, he had complaints of pain, numbness of hands and legs, nausea, anorexia, and severe weakness. Hence, concurrent Ayurvedic treatment was also started after the second cycle of chemotherapy (January 27, 2019), and after completing the modern treatment, Ayurveda treatment was continued till May 27, 2023, accounting for five years approximately. The combination therapy module provided complete symptom alleviation and marked improvement in the positron emission tomography scan that showed marked improvement and did not show any new abnormality in subsequent follow-ups. No recurrences were noticed for the last more than four years. The fact that all of the symptoms have alleviated and investigations show no abnormality is suggestive that the add-on Ayurveda treatment in this case of adenocarcinoma has aided the patient with a more than four year disease-free survival along with the good quality of life as determined by Karnofsky score (90/100).
Perioperative Nutritional Practices in Patients Undergoing Bariatric Surgery in India
Authors: Baig Sarfaraz Jalil , Priya Pallawi , Katakwar Abhishek , Bhasker Aparna Govil , Peters Atul N. C. , Remedios Carlyne , Siddiqui Deeba , Dey Kankona , Goel Madhu , Khaitan Manish , Lakdawala Mariam , Palaniappan Rajkumar , Goel Ramen , Wadhawan Randeep , Samaddar Ritika
Published: May 2024

Introduction:

Variations in cultural practices, diet, socioeconomic factors, genetics, and procedure selection have a potential impact on nutritional outcomes after bariatric surgery. There are no updated guidelines from India on clinical practice on the nutritional management of patients undergoing bariatric surgery. This is the first attempt to have a consensus on the subject.

Methods:

An expert committee was constituted which voted for three rounds on 20 statements/questions based on a Delphi method.

Results:

There was consensus regarding preoperative screening of hemoglobin, packed cell volume, albumin, iron, ferritin, Vitamin D, Vitamin B12, preoperative weight loss, postoperative prophylactic protein supplementations, therapeutic supplementation of iron, B12, and Vitamin D, postoperative testing, and frequency of follow-up visits. Experts did not agree on the routine preoperative testing of serum folate and thiamine. There was no consensus on lifelong supplementation with bariatric formulation, difference of supplementation dosages for Roux-en-Y gastric bypass and one anastomosis gastric bypass, or postponement of surgery pending correction of nutritional deficiencies.

Conclusion:

We need a better-quality regional data to formulate guidelines that can provide evidence-based guidance for the clinical practice.
Anterior abdominal wall desmoid tumors: Reconstructive considerations and challenges in an oncoplastic unit in a low- and middle-income country: A case report
Authors: Ajagbe Oluwasanmi Adekunle , Ugwu Ebere Osinachi , Idowu Olusola Kayode , Adigun Tinuola A. , Ayandipo Omobolaji O. , Olawoye Olayinka Adebanji
Published: May 2024

Desmoid tumors (DTs) are rare, locally aggressive tumors. When left untreated, DT can rapidly proliferate and occupy a significant portion of the anterior abdomen, making postresection reconstruction challenging. We present a 32-year-old female with a previous history of cesarean section and a 10-month history of two rapidly growing anterior abdominal wall (AAW) masses. There was no clinical or radiologic evidence of distant metastases. Abdominopelvic computed tomography scan showed no intra-abdominal extension. She had a wide local excision of the masses using an “abdominoplasty” technique and reconstruction of the extensive musculofascial defect with fascia lata grafts and polypropylene mesh. A histologic diagnosis of desmoid-type fibromatosis was made. The patient is scheduled for adjuvant radiotherapy and desires future pregnancies. This case report highlights the reconstructive considerations and challenges associated with surgical resection of huge AAW DT in an oncoplastic unit in a low- and middle-income country.
Antimicrobial resistance and stewardship: What do pharmacists know and practice in a major Nigerian tertiary health facility: A cross-sectional study
Authors: Roberts Alero Ann , Das Indu , Akodu Babatunde A. , Aderemi John Olatunde , Ajudua Sharon Chioma , Osuagwu Chioma S. , Fajolu Iretiolu B. , Akintan Patricia Eyanya , Olufohunsi Temilola Felicia , Oshun Phillip Olayiwola , Olugbake Olubusola , Soremekun Rebecca Oritsemaje , Joda Arinola , Oduyebo Oyinlola O.
Published: May 2024

Background:

Multidrug-resistant bacterial infections are still a global challenge and successful antimicrobial stewardship (AMS) requires multidisciplinary collaborative partnership. Studies have highlighted the knowledge and perceptions of pharmacists, but there is a paucity of data about practices of pharmacists in teaching hospitals in Nigeria. We set out to determine the knowledge and practices of pharmacists in a major tertiary health facility (THF) in Lagos, Nigeria, before starting an AMS intervention program.

Methods:

This cross-sectional survey used electronic forms to find out the knowledge and practices of pharmacists employed in a large tertiary health facility. Data were collected during a Commonwealth Partnerships for AMS program to support low- and middle-income countries to produce antimicrobial consumption surveillance data, quality improvement initiatives, and infection prevention and control (IPC) processes.

Results:

Two-thirds of respondents knew that antibiotics were effective against bacteria, and 48.6% knew the causes of antimicrobial resistance. Almost all (97.1%) agreed that AMS must be done, IPC is important, and they were confident to point out inappropriate prescribing. Three-quarters had advised colleagues or been involved in AMS activities; however, 62.9% had fully or mostly changed their practices based on information received, and 26.5% had participated in World Antibiotic Awareness Week.

Conclusion:

There are still gaps in knowledge and practices, which underscore the need to entrench regular training on the job. However, there is overall awareness of AMS and a desire for it to be carried out at all levels. Pharmacists are useful for choosing appropriate antibiotics and can play a vital role in AMS.
Effects of addition of fentanyl to lidocaine plus adrenaline during peribulbar anaesthesia for cataract surgery: A prospective study
Authors: Phillips Shete Kunle , Sanusi Arinola A. , Olusanya Bolutife A. , Sonaike Monisola T.
Published: May 2024

Background:

Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia.

Methods:

This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty-six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed.

Results:

The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant (P ≤ 0.001, respectively). The mean duration of globe akinesia and globe anaesthesia was longer in Group A as compared to Group B (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034).

Conclusion:

The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience.