bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary cytogenetic study of Ctenopoma kingsleyae from Esa-Odo water reservoir, Osun State, Nigeria
Authors: Victor Ekundare Olugbemi , Omotayo Fagbuaro , Isaac Adeniran Idowu
Published: May 2024

Ctenopoma kingsleyae belongs to the family Anabantidae covers a wide geographic region. It has been morphologically described by a number of authors, yet it is lacking in adequate cytogenetic information, which is a setback to understanding its karyotypic evolution. This study, therefore, describes the karyotype of C. kingsleyae (n = 10) from Esa-Odo, Reservoir, Osun State, Nigeria. Metaphase chromosome spread was obtained from the gills of fish after intraperitoneal injection with 0.05% colchicines. Slides prepared were stained with Giemsa stain, images of metaphase spread were taken digitally and a karyogram was prepared. The study revealed a karyotypic formula of 2n = 48t with uniarmed chromosomes. This study has provided needful information on C. kingsleyae karyotype and will serve as the basis for further study on its evolution, genetic resource management and production.
Determination of nutritional composition, enzyme inhibitory activity and antioxidant activity of pretreated, dehydrated Amaranthus viridis L. Leaves
Authors: Jayanetti Madara , Arampath Palitha C. , Thambiliyagodage Charitha Jayaruk
Published: May 2024

Amaranthus viridis L., belongs to the family Amaranthaceae is a perennial edible plant, and traditionally used for medicinal treatments in South Asia. Despite the significant uses of the plant, availability of scientific data on plant's biological efficiency is lacking in the scientific domain. There is a higher potential and demand for dehydrated value-added products from the local and international market. Hence, the objective of the research was to determine the impact of pretreatments and dehydration on nutritional composition, phytochemical profile, antioxidant activity, and enzyme inhibitory activity of A.viridis leaves. Magnesium oxide 0.1% (w/v), sodium bicarbonate 0.1% (w/v) and potassium metabisulphite 0.5% (w/v) were selected as the best pretreatment based on the experiments. The pretreated leaves were steam blanched (5 min), followed by dehydration at 60 ± 1°C for 12 hours. Protein (21.90 ± 1.01%db), fat (3.70 ± 0.02%db), fiber (5.90 ± 0.05%db), ash (11.30 ± 0.12%db) and carbohydrate (49.24 ± 0.08%db) were determined. Data was statistically analyzed using one-way analysis of variance (ANOVA) test at a 95% confidence level (p < 0.05). A qualitative phytochemical analysis was conducted. The total phenolic content, 5.89 ± 0.30 mg in Gallic acid equivalents per 1g was determined in pretreated, dehydrated powder. FRAP, DPPH radical scavenging activity and ferrous ion chelating activity of the methanolic extract were 20.22 ± 0.45 mg Trolox equivalents, 1.68 ± 0.07 mg in Trolox equivalents and 3.83 ± 0.06 mg EDTA equivalents per 1g of pretreated dehydrated leaf powder, respectively. Methanolic extract (500 μg/mL) showed inhibitory activity of 25.30 ± 0.60% on 5-lipoxygenase, 30.80 ± 0.50% on alpha-amylase and 25.60 ± 0.40% on alpha-glucosidase. Inhibitory activity was not detected against lipase, acetylcholine esterase and butyrylcholinesterase enzymes. In conclusion, pretreated, dehydrated, A. viridis leaves are recommended as a health beneficial food ingredient.
Narrative review on the spectrum of diseases prevalent among substance-addicted populations and their interconnected health dynamics
Authors: Charuni T. M. J.
Published: May 2024

Substance addiction is a complex phenomenon characterized by the dysfunction of the brain's reward system and neuroplasticity, leading individuals to lose control over their behaviour. This review explores the diverse health implications of addiction, including its impact on liver diseases, cardiovascular conditions, respiratory issues, cancers, infectious diseases, gastrointestinal problems, and mental disorders. Heavy alcohol consumption, tobacco use, illicit drug abuse, and prescription drug misuse contribute significantly to these health burdens, affecting various organs and systems in the body. Respiratory issues arise from tobacco smoking, inhalation of illicit drugs, and volatile chemicals, causing chronic obstructive pulmonary disease, lung cancers, and bronchial asthma. Substance addiction is also linked to various cancers, particularly lung cancer from tobacco, oral cancers from tobacco and alcohol, and oesophageal cancers from alcohol and prescription drugs. Furthermore, addictive substances impair immunity, making individuals more susceptible to infectious diseases like pneumonia, tuberculosis, and HIV/AIDS, especially among injection drug users. The interconnected nature of substance addiction with mental health disorders, genetic factors, environmental influences, and social determinants underscores the need for comprehensive public health strategies. These strategies should encompass education, prevention programs, access to treatment and support services, harm reduction approaches, and destigmatization efforts to address substance addiction comprehensively and improve overall health outcomes for individuals and communities.
A rare case of pneumococcal keratitis in a patient with Herpes Zoster Ophthalmicus and compromised immune status
Authors: Dibyashree Dibyashree , Goyal Nisha , Yadav Rekha , Singh Narendra Pal , Swain Kalyani , Manchanda Vikas , Singh Poonam
Published: May 2024

Infectious keratitis is commonly encountered in the ophthalmology emergency department. Streptococcus pneumoniae causing bacterial keratitis is a cause of concern in developing countries, owing to its complication of irreversible corneal scarring. This is a rare case report of a 25-year-old immunocompromised patient who presented to the Ophthalmology Department in a tertiary care hospital in India with complaints of diminution of vision in the left eye with pain, redness and watering, along with a history of vesicular painful rashes involving the left side of the forehead, the tip of the nose and the supraciliary area. Gram-positive lanceolate diplococci and plenty of pus cells were seen on the Gram staining of the corneal abscess scrape. The clinical presentation of the patient led to a provisional clinical diagnosis of secondary bacterial infection in Herpes Zoster Opthalmicus (HZO), corneal abscess with herpetic keratitis. Quellung reaction yielded an 18C serotype of the isolated pneumococci. Prompt treatment was required to prevent rapidly progressive complications.
Pros and Cons of Air-Dried and Conventional Wet-Fixed Pap Smears: An Institutional Study
Authors: Mary A Queen , Das Subhashish , Sheela SR
Published: May 2024

Introduction:

Wet-fixed smear study routinely used to identify several pre-cancerous and cancerous tumours. By contrasting cellular preservation and staining quality in rehydration smears with wet-fixed smears, the current study aims to establish the effects of rehydration on air-dried smears.

Materials and Methods:

One hundred paired samples are compared. Wet fixing was done in the first place. Air-dried samples are rehydrated for 30 s with regular saline and then placed in 95% ethanol for 30 min. Both smears will undergo screening, evaluation and grading for numerous cytomorphological factors after Pap staining. The 2014 Bethesda system was used to report the cervical smear results.

Results:

When evaluated for numerous cellular properties, statistically significant similarities can be seen between two groups, one with wet-fixed smears and the other with rehydrated air-dried smears. The results of the cytological diagnosis comparison between the two groups can be shown in the agreement. Rehydrated air-dried smear interpretation and staining quality are significantly superior to traditional wet smears.

Conclusions:

Rehydration air-dried techniques can be used instead of traditional wet fixation methods and are as effective when used alone or with traditional wet-fixed smears.
Scoping Review of the Relationship between Salivary Cortisol and Depression
Authors: Saghiri Mohammad Ali , Desai Dhruvi , Vakhnovetsky Julia , Samadi Elham
Published: May 2024

Anxiety and depression are some of the most common mental disorders associated with a dysregulation of the hypothalamic-pituitary-adrenal axis (HPA) and elevated cortisol levels in the saliva. The aim of this scoping review was to synthesize all of the current information about the relationship between salivary cortisol and depression as well as address some of the shortcomings in prior research to explore its potential applications in diagnosing depression. In late July 2022, records from 2012-2022 were identified using Web of Science, PubMed, and Scopus. Unique abstracts were screened using the following criteria: (1) depression and saliva; (2) anxiety and saliva; (3) age and salivary cortisol and depression; (4) sex and salivary cortisol and depression. 4,869 records were identified across all three databases; resulting in 90 unique abstracts. 11 articles met all inclusion criteria. On balance, most studies associated the dysregulation of the HPA with depression and anxiety disorders, with a cofactor being the cortisol awakening response. Several studies also presented sex and age-related differences in salivary cortisol measures. However, there were several inconsistencies with some studies showing no age and/or sex-related differences. Furthermore, several studies also emphasized the importance of testing morning salivary cortisol as an effective method to diagnose depression and anxiety disorders. The oral microbiome may play a role in mental health disorders through changes in inflammation and cortisol levels in saliva. Our review contributes to the existing literature on the topic, highlighting gaps and strategizing the next steps.
Repurposing the Anti-Depression Drug Sertraline against Catheter-Associated Urinary Tract Infections
Authors: Poyil Muhammad Musthafa , Khan Mohammed Sarosh , Gowri Meiyazhagan
Published: May 2024

Introduction:

Catheter-associated urinary tract infections (CAUTIs) account for one-third of the nosocomial infections. As drug repurposing is an excellent method to develop new antimicrobials, the present study is a trial to repurpose the anti-depression drug sertraline against two of the major CAUTI causing, biofilm forming bacteria viz., Enterococcus faecalis and Escherichia coli.

Materials and Methods:

Agar diffusion and microdilution methods were used in repurposing sertraline against E. faecalis and E. coli, to find out the antibacterial activity and the minimal inhibitory concentration of the drug. The anti-biofilm activity of the drug was also studied.

Results:

Sertraline (concentrations given within brackets) produced growth inhibition zones against E. faecalis as: 23 mm (125 μg), 24 mm (150 μg) and 26 mm (200 μg) and against E. coli as: 14 mm (125 μg), 15 mm (150 μg) and 17 mm (200 μg), respectively. Against both of the pathogens, the minimal inhibitory concentration of the drug was found to be 75 μg/ml, and at this concentration, the drug prevented the colony formation by these bacteria on polystyrene surfaces. The drug reduced the biofilms of E. faecalis and E. coli by 62% and 69%, respectively.

Conclusion:

When repurposed against E. faecalis and E. coli sertraline showed promising antibacterial, anti-biofilm and anti-adhesive activities, repurposing being one of the easiest ways to develop new drugs against bacterial pathogens, the authors suggest for further studies on repurposing sertraline for its clinical applications.
Andrology laboratory technique for analysis of semen in men with azoospermia
Authors: Japari Andrian , Moorthy Dharani , Rambhatla Amarnath
Published: May 2024

Discovery of spermatozoa during the 17th century led to developing technologies for semen analysis in the early 1900s, and then, standard techniques were implemented during the 20th century. Semen analysis has a pivotal role in the male infertility evaluation, and azoospermia is an important finding. Azoospermia is identified in 15% of infertile men. However, the accurate laboratory assessment of azoospermia poses certain technical challenges. Laboratories currently perform semen assessment with great variability; thus, a standard method should be used. Planning suitable management and determining the cause of infertility require a precise evaluation of azoospermia. This review aims to address the definition of azoospermia and highlight laboratory methods in the assessments of azoospermia. Basic methods such as centrifugation, repeat pellet analysis, and staining and advanced methods such as genetic testing and biomarkers have been discussed. These methods have helped in standardizing the protocol for accurate azoospermia assessments with less variability.
Type 2 diabetes mellitus and thyroid dysfunction, revisiting the intersections: A review article
Authors: Ezeani Ignatius Ugochukwu , Ogbonna Stanley U
Published: May 2024

There is an overwhelming evidence of the relationship between type 2 diabetes mellitus (T2DM) and thyroid dysfunction. The literature is robustly littered with data demonstrating the intersection of these two most common endocrine conditions. However, the extent of these intersections still remains complex, conflicting, and unclear. Therefore, we aimed to review the current literature on these intersections with an emphasis on interrelationship between thyroid dysfunction and T2DM. Several mechanisms have been postulated; some of which include but are not limited to blunting of the nocturnal thyroid-stimulating hormone (TSH) peak impairment of the TSH response to TRH from the hypothalamus, impairment of peripheral conversion from T4 to T3, increased hepatocyte plasma membrane concentrations of glucose transporter in the liver, which leads to an increased hepatic glucose output and abnormal glucose metabolism, to the perturbed genetic expression of a group of genes along with physiological abnormality. Insulin resistance has been shown to be associated with thyroid dysfunction (hyperthyroidism) in patients with T2DM. In other words, insulin resistance links both conditions. Several studies have evidenced an incontrovertible role of thyroid dysfunction as an intertwined cohort of T2DM. A plethora of guidelines have been exhaustively evaluated highlighting their key messages while synthesizing the relationship existing between them. The different treatment options available inexorably validate the importance of the intersection between these two endocrine conditions.
Hyperprolactinemia following traumatic myelopathy
Authors: Esan Arinola , Adeleye Jokotade O , Olukayode Lawal Abimbola , Badejo Oluwakemi A
Published: May 2024

Prolactin, an anterior pituitary gland hormone, is necessary for breast development in pregnancy and initiation of lactation. Prolactinomas constitute a pathological cause of elevated serum prolactin levels and are the most common type of pituitary adenomas. Excess prolactin could result from physiological causes that include pregnancy, lactation, sleep, and coitus. The usual presentation of hyperprolactinemia is galactorrhea. There are reports of elevated prolactin levels following other pathological causes such as chest wall lesions, chest wall trauma, and medications. We report the rare association of hyperprolactinemia with traumatic injury to the spinal cord in a Nigerian patient, and a brief review of the relevant literature.
Serum neurotransmitters level in response to acute restraint stress in perimenopausal female rats following L-arginine supplementation
Authors: Arikawe Adesina Paul , Oghene Okikiade , Olusanya Adedunni W , Olumide Odunayo , Dawodu Olayemi , Babafemi Pateince I , Jaja Smith I
Published: May 2024

Background:

Reproductive aging in females is a continuous process involving progressive follicular depletion that begins at birth and extends through the menopausal transition.

Objective:

This study aimed to assess neurotransmitter interplay in L-arginine-supplemented perimenopausal female rats subjected to an acute restraint stress paradigm.

Materials/Methods:

Fifty-four female Sprague–Dawley rats were divided into three groups: Control rats (injected with Corn oil 2.5 μL/g BW); VCD rats (injected with 4-vinylcyclohexene diepoxide 160 mg/kg BW diluted in Corn oil) both for 15 days; and Aging rats (210 days old) left to age naturally. Sixty days after VCD/corn oil administration and 240 days in Aging group, rats were further divided into two subgroups: distilled water and L-arginine supplemented (100 mg/kg BW) for additional 30 days. At 130 days in Control and VCD groups, and 270 days in Aging group on diestrus morning, animals were decapitated at two different time points (“before” and “after”) restraint stress. Trunk blood was collected into plain tubes; centrifuged to extract serum which was stored at –80°C for dopamine, noradrenaline, and serotonin measurements using specialized high-sensitive ELISA kits from LDN immunoassay company, Germany).

Results:

Before and after restraint stress, serum dopamine and noradrenaline levels were significantly lower (P < 0.05) in the perimenopausal groups compared to Control group, whereas serum serotonin was not significantly different amongst the three groups. L-arginine supplementation after stress significantly reduced (P < 0.05) serum dopamine in VCD rats and significantly increased (P < 0.05) it in Aging rats. On the other hand, L-arginine supplementation significantly lowered (P < 0.05) serum noradrenaline in Control rats and significantly increased (P < 0.05) it in VCD rats. Furthermore, after stress, L-arginine supplementation also significantly lowered (P < 0.05) serum serotonin in VCD and Aging rats compared to the Control rats.

Conclusion:

L-arginine supplementation showed differential effects in an attempt to regulate neurotransmitters and this could be protective against hormonal fluctuations that occur during perimenopause.
Burdens of noncommunicable disease and communicable disease on a typical Nigerian diabetes mellitus patient with multiple comorbidities
Authors: Benjamin Timilehin A , Tobechukwu Ibe , Izu Chikwendu
Published: May 2024

Chronic diseases such as cardiovascular, respiratory, cancers, and diabetes are often regarded as noncommunicable diseases. The attendant challenges in their managements are rather demanding because of the huge cost implications in their diagnoses, treatments, and follow ups; the pressure, the physical and emotional exertions on patients’ relatives who constitute the primary-care providers; the poor prognoses and unfavorable case outcomes. Much more worrisome is the deleterious effects such disease conditions have on the immunity of patients. Non-communicable diseases break down patients’ walls of defenses and in the process pave way for myriads of communicable diseases. While most communicable diseases such as pneumonia, human immunodeficiency virus infections, tuberculosis, and coronavirus disease 2019 have a good prognosis in immunocompetent patients, concomitant presence with some of these noncommunicable diseases often produces poor or guarded prognosis. It is, therefore, imperative to ensure good public health advocacy on the menace of the threats posed by the duo of communicable and non-communicable diseases and the need for good health-seeking behaviors among patients. Besides, this case report will underscore the need for health insurance in developing countries. This case study aimed to highlight some of the burdens of non-communicable and communicable diseases on a typical Nigerian patient from the low socioeconomic class; his relatives and health care providers. He presented with history of cough, weight loss and diabetes mellitus at the Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria. Even though there was a good chance of surviving the illness, he succumbed due to multiple factors.
Unrepaired congenital heart diseases in adults – Detection rate and diagnostic errors
Authors: JAIN PRADEEP KUMAR , ATHWANI VIVEK KUMAR , KINARE AMIT B , KANAPARTHI SHRAVAN , MISHRA VIKAS A , SIDDIQUI SUHEL
Published: May 2024

Context:

There are very few data about the unrepaired congenital heart disease (CHD) in adults. There are high chances of errors in diagnosis of CHD in adult population due to various reasons. If proper diagnosis is made, many of these CHDs are amenable to surgery leading to improved quality of life.

Aims:

Primary objective of the study was to know the detection rate of unrepaired CHD in adults. We have also reported common errors done while making the diagnosis of CHD in adults.

Subjects and Methods:

This was a retrospective observational study conducted from March 2020 to September 2021. Patients more than 18 years old who came for transthoracic echocardiogram (TTE) for any reason were included, and the detection rate of unrepaired CHD was calculated. Simultaneously, we have also checked for any errors in reports done outside our center and classified them based on their effect on management.

Results:

During the study period, 6675 TTEs were done in the study population, out of which 89 (1.33%) were detected with unrepaired CHD. Acyanotic CHD was detected in 81 (91%), whereas the rest 8 (9%) had cyanotic CHD. Forty-one patients had echocardiography report done outside, out of which 25 (61%) had discrepancies. Discrepancies were more in complex CHD.

Conclusions:

Cardiologists or echocardiographers should follow systematic approach and place special emphasis on identifying congenital heart diseases. Many potential lesions are amenable to surgery and near-complete correction leading to improved duration and quality of life.
Prospective analysis of early outcomes of off-pump coronary artery bypass in high-risk patients and role of EuroSCORE-II
Authors: Patel Darshak , Patel Mrinal , Meharwal Z.S.
Published: May 2024

Background:

Off-pump coronary artery bypass (OPCABG) grafting has emerged as an effective alternative technique for allowing coronary revascularization without the use of cardiopulmonary bypass. OPCABG has been associated with decreased postoperative morbidity, shorter hospital stay, reduced cost, and reduced operative mortality in some studies.

Materials and Methods:

A total of 190 patients who underwent isolated coronary artery bypass graft surgery were evaluated with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk scoring system. Moreover, we also compared the discriminatory potentials between the EuroSCORE II with <5 and >5 scores.

Results:

EuroSCORE high-risk patients showed higher rates of blood transfusion (66.9%), intraaortic balloon pump insertion (12.6%), atrial fibrillation (21%), and renal failure (46.8%). There was one mortality in each EuroSCORE group.

Conclusion:

OPCABG can be accomplished safely in selected high-risk patients with acceptable morbidity and mortality without compromising complete revascularization. Severe renal failure needing dialysis, stroke, and deep sternal wound infection in the postoperative period carries high morbidity and mortality after OPCABG. There is no ideal risk prediction model for an individual patient but multidisciplinary approach and individual patient factors determine the operative risk.
Managing diffusely diseased coronary arteries – place of endarterectomy in today's scenario
Authors: Gadkari Ameya , Patel Darshak , Patel Mrinal , Patel Kartik , Doshi Chirag
Published: May 2024

Introduction:

Surgical management of diffuse coronary artery disease (CAD) requires aggressive techniques for complete revascularization. Coronary endarterectomy (CE) coupled with coronary artery bypass grafting (CABG) is a valuable technique for this subset. The aim is to evaluate the perioperative and early results following CE.

Materials and Methods:

Three hundred and eighty patients of diffuse CAD undergoing off-pump CABG were included in the study. CE was performed in 204 patients. The mean age of the patients was 62 ± 16.32 years. The male-to-female ratio was 1.43, and the mean SYNTAX score was 33.12 ± 6.42. The mean stay in the intensive care unit was 4.94 ± 2.72 for patients undergoing CABG with CE. The perioperative mortality was 4.9%. The patients were followed up at 3 months, and graft patency was assessed with computed tomography coronary angiography. The average graft patency was 86.725% for the grafts with CE. Patients with left anterior descending (LAD) CE had higher perioperative mortality (5%), overall survival (89.79% at 3 months), and graft patency rates (87%) were favorable. The outcome following single vessel CE was better than multivessel CE.

Conclusion:

In patients with diffuse CAD, CE is a safe technique with comparable mortality and lesser complication rate if performed adequately. Despite perioperative difficulties, early outcomes are favorable for CE to the LAD artery grafted with the left internal thoracic artery. Single vessel CE yielded a better result as compared to multivessel CE.
Serum lactate clearance as a predictor of outcome in infants' postcardiac surgery
Authors: Patel Hasmukh , Parikh Nirav , Ramkiran K. S. , Sadhwani Prakash , Patel Ramesh , Shah Pratik
Published: May 2024

Background and Aims:

Prediction of postoperative outcomes by conventional hemodynamic parameters and risk scoring systems immediately after pediatric cardiac surgery has not been found to be reliable. Trends in serum lactate value over time or serum lactate clearance were found to give better estimate. The present study aimed to find out the effect of serum lactate clearance on mortality after pediatric cardiac surgery.

Methods:

Out of the 150 pediatric cardiac surgical procedures performed during the study period, 131 patients meeting inclusion criteria were enrolled in the present study. The study population was observed for lactate levels immediately postoperatively (T0) and then every 4 h for the first 24 h (T1-T6) and lactate clearance was calculated. Patient's outcomes in view of mortality, duration of mechanical ventilation, and length of intensive care unit (ICU) stay were observed.

Results:

In our study, mortality was 9.23%. Median inter quartile range with Hodges-Lehmann median difference (95% confidence interval) lactate values were higher among nonsurvivors and statistically significant at T0 = (6.14 [3.43,7.34] vs. 2.50 [1.87,3.59]; 2.53 [1.02, 4.33], P ≤ 0.0001), T1 = (3.10 [2.81, 5.16] vs. 2.30 [1.73, 3.61];0.95 [0.13, 1.73], P = 0.032), T2 = (3.49 [3.03, 5.40] vs. 2.39 [1.66, 3.38];1.32 [0.48, 2.27], P = 0.004), T3 = (3.82 [2.99, 5.54] vs. 2.20 [1.58, 3.45]; 1.46 [0.50, 2.45], P = 0.003), T4 = (4.86 [3.35, 5.44] vs. 2.09 [1.42, 3.47]; 2.02 [1.09, 3.13], P ≤ 0.0001), T5 = (4.36 [3.80, 6.27] vs. 2 [1.32, 3.26]; 2.29 [1.41, 3.25], P ≤ 0.0001), and T6 = (4.12 [3.69, 5.83] vs. 1.82 [1.31, 3.15]; 2.34 [1.15, 3.21], P ≤ 0.0001). Nonsurvivors were having decreasing trend of lactate clearance which was statistically nonsignificant. Mechanical ventilation was prolonged in nonsurvivors compared to survivor (135 [202] h vs. 30 [77] h; P = 0.002); however, there was no significant difference in ICU stay (P = 0.764).

Conclusion:

Poor lactate clearance and high lactate level were associated with high mortality. Serial lactate levels and decreasing trend of lactate clearance in the early postoperative period is a good predictor of postoperative outcome in pediatric cardiac surgery.
Clinical features and treatment outcomes of cardiomyopathy in Indian patients
Authors: JAWAHIRANI ANIL R , JESWANI DEEPAK , KSHIRSAGAR DILIP , DHEDIYA RAJNISH M , JADHAV AMIT Y
Published: May 2024

Objective:

Cardiomyopathy is defined as a heterogeneous group of diseases of the myocardium, is a transient reversible, but potentially life-threatening condition. The natural history, management pattern, and outcome of cardiomyopathy are not clear in Indian scenario. This study was conducted to investigate the clinical features, prognostic predictors, and clinical outcomes of patients with cardiomyopathy.

Materials and Methods:

We retrospectively analyzed the data of 119 patients of cardiomyopathy admitted to tertiary care hospital from January 2016 to April 2019.

Results:

The mean age of analyzed patients was 55.08 ± 15.75 years. During admission, symptoms such as breathlessness (63.64%) and fever (40.17%) were reported more often than other symptoms. 38.66% of patients had dilated and stress cardiomyopathy while 15.97% had ischemic cardiomyopathy. Among the independent predictors of all cause death the respiratory failure, sepsis and renal dysfunction were identified. Reduced ejection fraction in 73%, moderate-to-severe mitral regurgitation in 20%, and global hypokinesia in 68.57% patients were observed. Of total admissions, 86% of patients recovered while 14% patients resulted in death.

Conclusion:

Our study shows that respiratory failure, sepsis, anemia, and renal failure are major contributing factors in poor prognosis, although most of the patients recovered from cardiomyopathy. Cardiomyopathy is the one of the important causes for heart failure with reduced ejection fraction.
Delayed perforation of the right ventricle by pacemaker/automated implantable cardioverter-defibrillator lead
Authors: KUMAR SARVESH , TEWARSON VIVEK , HAKIM MOHAMMAD ZEESHAN , KUMAR SHOBHIT , SINGH SUSHIL K
Published: May 2024

Introduction:

Cardiac perforation by pacemaker/automatic implantable cardioverter-defibrillator (AICD) lead can be a life-threatening emergency. Delayed cardiac perforation by pacemaker/AICD lead is defined as perforation occurring after a period of 1 month following pacemaker/AICD insertion. Delayed perforation is often difficult to identify at first and needs active intervention to prevent complications and death.

Materials and Methods:

Patients presenting with and operated upon for delayed cardiac perforation following pacemaker/AICD insertion were included in this study. The study was conducted between April 2019 and April 2020.

Results:

Three patients reported with delayed cardiac perforation after pacemaker insertion. All patients had syncopal episodes, and detection could be easily done using chest X-ray and trans-thoracic echocardiography (TTE). Two patients had active fixation leads used for anchoring the lead in the right ventricle (RV). Two patients were female, while one was a male, and all had perforation through the RV apex. Lead reposition was done in two cases, thereby preventing the need for placing additional leads, while a new lead was required in the third case.

Conclusion:

Early identification of cardiac perforation can be done easily with chest X-ray and TTE, but a high index of suspicion should be kept in mind. Surgical or fluoroscopic intervention may be planned depending on the available expertise and patient condition.
Born-free congenitally absent pericardium
Authors: TEWARSON VIVEK , KUMAR SARVESH , HAKIM MOHAMMAD ZEESHAN , KUMAR SHOBHIT , SINGH SUSHIL KUMAR
Published: May 2024

Objectives:

Congenital absence of pericardium (CAP) is a very rare condition, with an incidence of <1 in 10,000 and occurs in isolation or associated with various congenital cardiac or systemic disorders. We describe the two cases of incidentally diagnosed left-sided congenitally absent pericardium and evaluate the presentation, diagnosis, and management with recent work done in this area. Atrial septal defects have been associated with the absence of pericardium similar to one of our case. We also found this entity associated with aortic coarctation which has not previously been described.

Materials and Methods:

Using our database, we retrospectively went through the details of patients operated in our center between January 2015 and December 2019 to identify the cases with CAP.

Results:

Out of 2193 cardiac surgeries, 478 patients got operated for congenital heart disease out of which 2 were found with pericardial defects intraoperatively. No surgical intervention for the pericardial defects was done. Both patients did well after surgery for their primary disease.

Conclusions:

Congenital defects of the pericardium are very rare. Although there are characteristic radiology findings, yet without a suspicion, these can be easily missed and are discovered during surgery. The associations with many cardiac conditions have been seen; however, association with aortic coarctation is extremely rare as we could not find any such association in literature.
Clinical presentation, risk factors, and coronary angiographic profile of very young adults (≤30 years) presenting with first acute myocardial infarction at a tertiary care center in Rajasthan, India
Authors: JOSHI PIYUSH , DAHIYA ARCHIT , THAKUR MANAS , SINHA RAMANAND PRASAD , WARDHAN HARSH
Published: May 2024

Introduction:

Acute coronary syndrome (ACS) in very young adults with age ≤30 years is rare. In India, the prevalence of acute myocardial infarction (AMI) in this population is <2%. ACS leads to significant effects on patient's psychology, morbidity, and increased financial burden when it occurs at this young age. Young patients with ACS on coronary angiography (CAG) show a relatively increased incidence of single-vessel disease and nonobstructive stenosis.

Materials and Methods:

This retrospective observational study was conducted at the Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. The medical records of very young adults (≤30 years of age) with first AMI between September 2019 to August 2021 were collected and analyzed.

Results:

Twenty-two very young adult patients aged ≤30 years were admitted with first AMI. Most of the patients were within the age group of 25–30 years. Mean patient age was 27.63 ± 2.03 years and 21 patients (95.4%) were men. Regarding the risk factors for coronary artery disease (CAD), smoking was the most common (54.5%) in young patients. Dyslipidemia and family history of premature CAD were present in 8 (36.3%) and 6 (27.2%) of patients. The most common symptom in patients was chest pain (90.9%). Obstructive CAD (vessel lumen stenosis ≥ 70%) was found in 18 (81.8%) patients.

Conclusion:

Very young adults presented with less extensive CAD as compared to elderly likely due to less atherosclerosis of the coronary arteries in them. The major modifiable risk factors in very young Indian population are smoking and dyslipidemia. Primary prevention by educating the public about the effects of smoking, unhealthy dietary habits, and sedentary lifestyle in early years of life may help to prevent the development of cardiac problems later in life.
End-of-life care in advanced heart failure during cardiology training in India
Authors: ALI MUZAFFAR , PADMANABHAN DEEPAK , BANAVALIKAR BHARATRAJ , RAJA RAJA R , GUPTA ANUNAY , KATHURIA SANJEEV
Published: May 2024

Background:

The incidence of heart failure (HF) is likely to increase in future in India. As a result, India's health-care system has to care for an increased number of patients with advanced HF (AHF) in future. The objectives of this survey were as follows: (a) to assess cardiology trainees' approach toward treating HF patients and end-of-life (EOL) care, and (b) to review cardiology training curricula and HF management guidelines regarding the approach to EOL care issues in AHF.

Methods:

We surveyed cardiology fellows undergoing training. The survey questions aimed to assess cardiology fellows' approach in treating patients with different severities of HF and at EOL. We reviewed the cardiology training curricula of various Indian institutions and HF management guidelines from Indian professional bodies.

Results:

Ninety-nine fellows took part in the survey. 93%–100% reported that they were likely to prescribe recommended drug therapy and Cardiac resynchronization therapy-D implantation to all the patients. The number of likely responses for various EOL interventions was consistently lower when fellows had to rate interventions for themselves as patients. Sixty-four percent of fellows were unfamiliar or uncertain about the idea of hospice care. Eighty-four percent of fellows reported that their training was inadequate, or they were uncertain about the adequacy of their training regarding EOL care issues. None of the training curricula has mentioned “EOL care,” “palliative care,” or “hospice care,” and none of the HF management guidelines discussed such topics.

Conclusion:

There is an urgent need for sensitizing and training Indian cardiology fellows regarding different aspects of AHF and EOL care.
Impact of COVID 19 lockdown on post operative follow up of patients with valvular heart disease
Authors: SRIVASTVA NAVNEET KUMAR , SRIVASTAVA DHARMENDRA KUMAR , RAJPUT SUBHASH SINGH , TIWARI BHUWAN C.
Published: May 2024

Context:

In this COVID-19 pandemic, most of the healthcare infrastructure including healthcare officials has now been allocated toward COVID management. It is not even feasible for regular patients to visit hospital as they are susceptible to get infected.

Aim:

The aim is to study the impact of COVID-19 lockdown on the postoperative follow-up of patients with valvular heart diseases by international normalized ratio monitoring in a tertiary health care center.

Subjects and Methods:

This is an observational study on patients with prosthetic valve conducted at a tertiary healthcare center. Sixty postoperative patients were surveyed with a prevalidated questionnaire designed for them. The questionnaire included questions about the availability of testing centers, communication facility with doctors, and a list of complications such as skin color change, nose bleeds, abdominal fullness, dyspnea, fever, numbness, swelling of limbs, and headache.

Results:

The study comprised 60 patients with valve replacement surgery. 80% of patients faced difficulty in reaching the hospital during the lockdown; however, almost 86% of patients had telephonic conversation with the doctor. Almost 73% of patients did not have the testing facility in their locality. 34% of patients mentioned that they had history of prolonged fever, 14% presented with history of fullness of abdomen, 10% presented with episode of headache and unconsciousness, and 9% noticed a change in skin color.

Conclusions:

COVID-19 is still on rise, and there is a long way before herd immunity is developed or everyone is vaccinated. We need to find alternatives so that patient care is not affected. Point-of-care testing should be encouraged as it will reduce hospital visits and exposure to hospital-acquired infections.
Short dual right coronary artery without obstructive coronary artery disease causing obligatory coronary ischemia
Authors: DAS DEBASISH , ACHARYA DEBASIS , DAS TUTAN , GUPTA JAIDEEP DAS , PRAMANIK SUBHAS
Published: May 2024

We present an extremely rare case series of two short dual right coronary arteries (RCAs), causing coronary ischemia without the presence of obstructive coronary artery disease. We describe here the presence of short dual RCA in a 55-year-old nondiabetic, nonhypertensive, and nondyslipidemic male presenting with effort angina New York Heart Association Class II for the last 6 months with strongly positive stress test and another 40-year-old athlete (Central Reserve Police Force Army) without conventional risk factors with effort angina Class II for the last 3 months also with strongly positive stress test. Dual RCA, otherwise known as double RCA, duplicate RCA, or split RCA is extremely rare to encounter in routine clinical practice. The patient had a significant effort angina; in spite of nonatherosclerotic coronaries, small dual RCA terminating much earlier than the intended area of supply was the reason behind coronary ischemia with strongly positive provocative stress test. Short normal dual RCA can be a cause of coronary ischemia although mentioned in the literature; there has been no case report in the world literature till now about short dual nonatherosclerotic RCA causing coronary ischemia. Our case is unique and first to describe short dual RCA terminating much earlier than the intended area of supply can attribute to demand ischemia in the intended area of supply without the presence of obstructive coronary artery disease. We treated the patient with nicorandil to improve myocardial microvascular flow in ischemic region with symptomatic improvement of the patient.
Recanalizing a right coronary artery chronic total occlusion with J chronic total occlusion score 3
Authors: Das Debasish , Banerjee Anindya , Kumar Abhinav , Singh Jogendra , Das Tutan , Singh Shashikant , Gupta Jaideep Das , Pramanik Subhas , Dixit Manaranjan
Published: May 2024

We represent a case of interesting right coronary artery chronic total occlusion (CTO) revascularization where traditional wire upgradation failed to cross the CTO. Downgrading it to a Miracle 3 wire, the lesion was successfully crossed. It was further dilated with the smallest balloon (NIC Nano 0.85 mm × 6 mm), followed by serial dilation with bigger size balloons. The present manuscript conveys a message that the rule of thumb of wire upgradation during CTO revascularization does not yield in success always, it is the downgradation of the wire which can also achieve success. CTO revascularization although it has some fixed principles, sometimes, a permutation and combination even giving a fair try with wire downgradation can achieve success.
Management of Amavata with Panchakarma treatment – A case report
Authors: Kabra Diksha Nitin , Bhatted Santosh Kumar
Published: May 2024

Rheumatoid Arthritis (RA) is an autoimmune systemic disease, resulting in functional decline, disability, and reduced quality of life particularly due to symptoms such as pain, fatigue, and morning stiffness. This manifestation is comparable to Amavata in Ayurveda. A 26-year-old female diagnosed with RA was treated with Ayurveda modalities including Valuka
swedana (~sudation therapy using sand), Virechana (~therapeutic purgation), Basti (~therapeutic enema), and Samshamana
snehapana (~type of internal oleation for palliative purpose). The patient was assessed both subjectively and objectively before and after completion of the treatment. Before treatment, the values of rheumatoid factor, C-reactive protein, and erythrocyte sedimentation rate were 358.4, 13.7, and 80, respectively, which were reduced to 153.1, 2.74, and 17, respectively, after one month of treatment. In addition, marked improvement in clinical signs and symptoms such as pain, stiffness, and swelling in joints was also observed. The present case report showcases the significant effect of Valuka
swedana, Virechana, Yoga
basti, and Snehapana in the management of Amavata.
Effect of Shodhana karma, Lekhana karma and Raktamokshana in the management of Luta vishajanya vrana: A case report
Authors: Ashraf Anisha S. , Gopikrishna B. J. , Rao Prasanna N.
Published: May 2024

Spider bites are commonly reported from many parts of the world. In classical literature, spider envenomation is coined as Luta
visha (~spider bite poisoning). A 20-year-old male patient approached to outpatient department with the chief complaint of a wound over the calf muscle region of the right lower limb associated with watery discharge, itching, pain, and burning sensation for the past six months. There was a mild rise in temperature. On evaluation, the symptoms were identified to be spider-bite poisoning. The patient was given classical Ayurveda therapeutic measures, which include Virechana (~therapeutic purgation), followed by Lekhana
karma (~therapeutic scrapping) over the site of the bite and Jalaukavacharana (~bloodletting using leech) for five days. At the time of discharge, Bilvadi
gutika (860 mg) twice daily for one month was advised. A remarkable improvement was observed in the condition of the patient within 14 days of treatment. The treatment approach, including Virechana, Lekhana
karma, and Raktamokshana, gave significant results with complete healing of Luta
vishajanya
vrana (~spider poison-induced ulcer) within the span of six months. After treatment, no recurrence of symptoms was observed when followed the patient up to two months.
Management of plaque psoriasis (~Ekakushta) through Ayurvedic approach: An experience
Authors: Mahulkar Darshan M. , Huddar Vitthal G. , Reetu
Published: May 2024

Psoriasis is one of a variety of illnesses brought on by the autoimmune response and is characterized by the rapid inflammatory proliferation of sick skin cells. Even though the illness was first identified several decades ago, the etiology and therapy appear to remain understudied. In Ayurveda, many herbs have proved efficacy in the treatment of psoriasis, but the disease’s complex etiology requires a multimodal therapeutic strategy. A 22-year-old male patient with persistent plaque psoriasis in the last three years presented with erythematous plaques over the back, chest, neck, legs, abdomen, scalp, and forehands. The Auspitz sign, Candle grease sign, and Koebner phenomenon were positive. The treatment plan was based on the Ayurvedic Samprapti (~pathophysiology) of Ekakushta (~plaque psoriasis). Virechana (~therapeutic purgation) along with Ayurvedic oral medicines and a wholesome dietary regimen were given. Within eight months of the treatment, the psoriatic lesions and associated signs and symptoms were healed effectively. No adverse events were reported during the course of therapy and no recurrence was noticed as of reporting the present case report. Altogether, multimodal Ayurveda treatment can be an effective and safe solution for plaque psoriasis.
Prevalence of syphilis and associated risk factors among human immunodeficiency virus-infected patients at the Lagos University Teaching Hospital Nigeria: A cross-sectional study
Authors: Oshun Philip Olayiwola , Sunmonu Omowunmi Bose
Published: May 2024

Background:

Worldwide, there was an estimated 7.1 million new cases of syphilis in 2020, and most of the infections were found in developing countries like Nigeria. The objective of the study was to determine the prevalence and risk factors for syphilis among human immunodeficiency virus (HIV)-infected patients in Lagos.

Methods:

A cross-sectional study was conducted in an HIV Clinic in Lagos, Nigeria, from April to June 2017 and 385 HIV-infected adult participants 18 years and above were recruited into the study. Structured questionnaires were used to collect data on sociodemographic and risk factors for syphilis. Blood samples were collected from all participants and tested for syphilis using rapid plasma reagin and Treponema pallidum hemagglutination assay test kits. Data were analyzed using SPSS (IBM) V. 20. Bivariate analysis was carried out using Chi-square, Fisher’s exact test, and Student’s t-test on sociodemographic and risk behavioral factors. Multivariable logistic regression analysis was performed with variables that were significantly associated with syphilis in bivariate analysis. A P < 0.05 was considered to be statistically significant.

Results:

Out of 388 HIV-infected patients recruited into the study, 262 (67.5%) were female. The mean age was 43.6 ± 10.1 years, and 137 (35.3%) of them were in the age group of 41–50 years. The prevalence of syphilis in HIV-infected patients was 1.8%. The prevalence of syphilis was significantly higher in males (4.8%) than females (0.4%). The prevalence of syphilis was higher in those with no education or primary school education, and multiple sexual partners were statistically significant in the bivariate analysis but not in the multivariate analysis. Male gender was the only independent risk factor for syphilis, with an odds ratio of 11.79 (95% confidence interval [1.26–106.5], P = 0.03) in multivariate analysis.

Conclusion:

The prevalence of syphilis in this study was lower than previous work done in other HIV-positive cohorts in Nigeria. Males were more affected significantly in this study. Routine screening and testing for syphilis should be integrated into HIV care, especially in males.