bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients’ Hospital Ratings Correlate with 30-Day Mortality and Readmission Rates following Hospitalization for Both Myocardial Infarction and Coronary Artery Bypass Graft Surgery
Authors: Lien Irvin Chi-Yang
Published: June 2024

Introduction:

Coronary heart disease is the leading cause of mortality and morbidity world-wide. Mortality and readmission rates following both myocardial infarction (MI) and coronary artery bypass graft surgery (CABG) have improved with advancements in medicine and standardization of treatment, however these improvements have plateaued in recent years. The purpose of this study was to investigate whether overall hospital ratings can indicate patterns of mortality rate and readmission rate following hospitalization for MI and CABG.

Methods:

Public data from the Centers for Medicare & Medicaid Services was utilized in the study. The 30-day risk standardized mortality rate (RSMR) and readmission rate (RR) following both MI and CABG for hospitals were matched with their overall hospital rating based off the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Hospitals were grouped based on their hospital ratings and their 30-day RSMR and RR were averaged within each group. A Pearson correlation was used to assess for correlation between hospital ratings and their 30-day RSMR and RR for both MI and CABG.

Results:

There was a strong negative correlation between hospital ratings and their averaged 30-day RSMR for both MI (R= -0.84; P < 0.0001) and CABG (R = -0.70; P < 0.0037). Similarly, there was a strong negative correlation between hospital ratings and their averaged 30-day RR for MI (R = -0.81; P < 0.0002) and CABG (R = -0.83; P < 0.0001). There was no significant difference between any group.

Discussion:

The correlation between hospital rating and the 30-day RSMR and RR following both MI and CABG suggest that hospital ratings may be one among many factors that can impact patient outcome for MI and CABG. However, this correlation is only present when the 30-day RSMR and RR are averaged. There are likely multiple confounding variables and improving hospital ratings alone would not be expected to significantly improve patient outcomes.

Conclusion:

Hospital ratings which incorporates patients’ perspective of good communications among hospital staff, timely staff responsiveness, quiet/clean hospital environment, and thorough discharge planning, may be factors that contribute to patients’ 30-day RSMR and RR for both MI and CABG.
Atherosclerotic Cardiovascular Disease Burden in Ghana: A Scoping Review
Authors: Agyekum Francis , Akumiah Florence
Published: June 2024

Background:

The global burden of atherosclerotic cardiovascular disease (ASCVD) is high. Documented data on the burden of ASCVD and its mortality in low- and middle-income countries are however limited particularly in Ghana. This study aims to identify the research gaps related to the ASCVD burden in Ghana to provide the recommendations to guide future research.

Materials and Methods:

We undertook a scoping review of ASCVD, comprehensively searching databases to identify all English-published articles on ASCVD and risk factors in Ghana from inception to 2021. Data on the study characteristics and key findings were independently extracted by two authors. We used a charting approach to synthesize and interpret the data.

Results:

We included 22 articles in this scoping review out of a total of 160 articles identified. There is a broad spectrum of conditions that are included under ASCVD. The most commonly included conditions were ischemic stroke, coronary artery disease, peripheral artery disease, and aortic disease.

Conclusion:

This scoping review has shown that ASCVD poses a considerable burden in the Ghanaian population, mostly driven by ischemic stroke. There is a need for an intensified effort by stakeholders, through research and policy, to identify and address the factors driving ASCVD to rise and prioritize prevention.
Premature Coronary Artery Disease in Young Indians
Authors: Vijaykumar Reddy J R , Patil Rahul S , Shetty Laxmi H , Manjunath C N
Published: June 2024

Background:

Cardiovascular diseases (CVDs) are on the rise globally. India, in spite of housing the youngest population, has now been termed the CVD capital of the world. Several independent studies have shown association between low levels of Vitamin D, insulin resistance, and low testosterone levels and coronary artery disease (CAD). However, the presence of this hormonal triad in premature CAD patients in India has not been studied. Therefore, we aimed to explore the role of this hormonal triad in CAD in young Indians.

Methods:

This was a prospective, case–control, study conducted at a tertiary care center in India. Premature CAD patients were enrolled as cases and healthy individuals were enrolled as controls. Demographic, behavioral, anthropometric and body composition, physiological, and biochemical parameters were recorded/assayed as per standard protocols.

Results:

A total of 644 individuals were enrolled in the study. Among them, 344 belonged to the case group and 300 to the control group. The mean age did not differ significantly between cases (32.1 ± 5.6 years) and controls (32.5 ± 5.0 years). Significantly lower levels of Vitamin D levels (P = 0.01) and serum insulin (P < 0.001) were observed in the case group compared to the control group. In males, no significant difference was observed between the two groups in terms of serum testosterone level (P = 0.075).

Conclusion:

Higher fasting insulin levels may be a reliable indicator of premature CAD. Vitamin D levels may not reliably predict premature CAD because 70%–90% of Indians are deficient of Vitamin D. Testosterone levels in females, but not in males, may be a reliable predictor for the same. However, larger studies are required to validate these findings.
Spontaneous Coronary Artery Dissection Presenting as Massive Brain Stroke
Authors: Sharma Sanjay Kumar , Motiani Rajiv
Published: June 2024

Spontaneous coronary artery dissection (SCAD) presenting as stroke is indeed an extremely rare scenario. We hereby describe our experience of a case of SCAD in a 29-year-old man who presented with a massive brain stroke. Based on the neurological findings, the diagnosis of left hemiparesis, left upper motor neuron facial palsy, and acute right middle cerebral artery infarct was made. Coronary angiography displayed a large type B dissection along with heavy burden of thrombus and intimal hematoma in proximal to the mid-left anterior descending artery (LAD). SCAD of the LAD was managed with percutaneous coronary intervention using a provisional stenting approach with two overlapping drug-eluting stents. With this case, the author would like to outline vital clinical insights for clinicians managing such a challenging and perplexing patient cohort.
Reduction in Health-related Quality of Life during Coronavirus Disease 2019 Pandemic in Children with Congenital Heart Disease – Findings from Self and Proxy Report
Authors: Brudy Leon , Meyer Michael , Oberhoffer-Fritz Renate , Ewert Peter , Müller Jan
Published: June 2024

ABSTRACT

Objective:

The aim of this study was to determine how the coronavirus disease 2019 (COVID-19) pandemic affects the health-related quality of life (HRQoL) of children and adolescents with congenital heart disease (CHD), as well as how the parents perceive the HRQoL of their children.

Patients and Methods:

HRQoL was assessed by the KINDL® questionnaire during the COVID-19 pandemic and compared to recent questionnaire data of children of the Functional Outcome in children and adolescents with congenital heart disease (FOOTLOOSE) study. From May 27 to June 29, 2020, 160 children with various CHD (15.2 ± 2.5 years, 62 girls, age range: 10–18 years) completed this re-assessment of HRQoL.

Results:

HRQoL in children with CHD was significantly lower during the COVID-19 pandemic compared to before in total KINDL® score (by −2.1 ± 12.3, P = 0.030), and the subscales emotional well-being (by −5.4 ± 1.2, P < 0.001) and friends (by −4.5 ± 1.7, P = 0.009). Parents of children with CHD rate the HRQoL in total KINDL® score (mean difference: 3.9 ± 1.2, P = 0.002), and the subscales family (mean difference: 8.8 ± 1.7 standard estimate error [SEE], P < 0.001) and friends (mean difference: 7.6 ± 2.2 SEE, P < 0.001) even worse than their children. Only moderate degree of agreement was found between most of the sub-categorical HRQoL assessment of children with CHD and their parents.

Conclusions:

The COVID-19 pandemic had a negative impact on HRQoL in children and adolescents with CHD and their families. The psychological concerns of children with CHD and their families need special consideration by health-care providers during the COVID-19 pandemic.
Catheter-Directed Thrombolysis for Superior Vena Cava Syndrome in a Patient with Lung Adenocarcinoma
Authors: Laksono Sidhi , Kusharsamita Hillary
Published: June 2024

Superior vena cava syndrome (SVCS) is life-threatening for those with a history of malignancy. Here, we report a case of SVCS with a history of lung adenocarcinoma. Significant neck edema was observed during the physical examination. Venography revealed an occlusive thrombus of the right jugular vein. Catheter-directed thrombolysis (CDT) was performed with a 12-h infusion of alteplase at 1 mg/h. Over the next 20 h, the patient’s clinical condition significantly improved, and a venogram showed that the thrombus had totally resolved. In individuals with a history of cancer, the identification of signs and symptoms is very important for the diagnosis of SVCS. In patients with clinical SVCS symptoms, CDT can be effective and safe.
Assessment of Physical Inactivity Level, Work-related Stress, and Cardiovascular Disease Risk among Nigerian University Staff Members
Authors: Ogunyemi Suraj Adefabi , Awotidebe Taofeek Oluwole , Fasakin Olufesola Motunrayo , Ademoyegun Adekola Babatunde , Adebayo Rasaaq Ayodele , Abudu Funmilayo Rebecca , Akintomide Anthony Olubunmi , Odunlade Adekola John , Adesokan Oluwatobi Joseph , Adedoyin Rufus Adesoji
Published: June 2024

ABSTRACT

Background:

Sedentary behavior and mounting workload among university staff may increase risk of chronic diseases. However, information on the link between physical inactivity (PIA), work-related stress (WRS) and cardiovascular disease (CVD) risk is controversial. This study assessed and determined the association between PIA, WRS and CVD risk among university staff in Nigeria.

Methods:

This cross-sectional study involved 500 teaching and nonteaching staff of a Nigerian university using purposive sampling method. PIA level and WRS were assessed using the International Physical Activity Questionnaire and a modified International stress questionnaire, respectively. CVD risk was assessed using the Framingham Heart study questionnaire. Data was analyzed using descriptive and inferential statistics. Alpha level was set at P < 0.05.

Results:

The prevalence of PIA, WRS, and CVD risk were 37.6%, 33.3%, and 61.0%, respectively. Age and high income were significantly associated with PIA in both teaching and nonteaching staff (P < 0.05). In both the groups, older adults and female participants were almost thrice more likely odds ratio (OR) =2.85 (confidence interval [CI] =2.58–3.12) and OR = 2.98 (1.95–5.72) at CVD risk, respectively. Furthermore, individuals with WRS score ≥ 14 (OR = 2.14; CI = 1.14-4.29), and with obesity (OR = 4.20; CI = 2.58-6.25) were more than twice likely to present with CVD risk. The variability of the regression model for the prediction of CVD risk was 13.0% (R
2 = 0.130).

Conclusion:

The prevalence of PIA and work-related stress among Nigerian university staff is high and is associated with high CVD risk. Strategies in reducing PIA and WRS are essential for mitigating CVD risks among Nigerian University staff.
Patent Ductus Arteriosus with a Rare Hand Anomaly
Authors: Bhat Y Ramesh , Arthi P
Published: June 2024

Congenital heart defects are associated with various extracardiac malformations. Among them, association of congenital upper-limb malformations is common and frequently referred as heart–hand syndrome. Thumb malformations are most frequent among upper-limb malformations. The most common among them is Holt–Oram syndrome which consists of atrial septal defect with absent radius or thumb anomalies. Patent ductus arteriosus (PDA) with hand anomalies are quite rare. The authors present a peculiar hand deformity with PDA in a 2-month-old infant. The right hand revealed oligodactyly with syndactyly of the thumb and forefinger, the absence of carpal bones, few metacarpals, and phalangeal components.
Spectrum of Coronary Artery Disease in Seropositive Syphilis Patients in the Modern Era
Authors: Harsha Mullusoge Mariappa , Hegde Srinidhi , Mahadevaiah Ashwini , Krishnappa Santhosh , Sadananda Kanchanahalli Siddegowda , Nanjappa Manjunath Cholenahally
Published: June 2024

Context:

Cardiovascular manifestations of tertiary syphilis include aortitis, aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. There are few reported cases of coronary aneurysms and coronary dissection. However, in the modern era of antibiotics, classic manifestations are rarely seen. We intend to study the spectrum of coronary artery disease in seropositive syphilis patients undergoing cardiac catheterization.

Subjects and

Methods: Coronary angiogram of 150 patients seropositive for syphilis from March 2019 to April 2020 was reviewed. Seropositive for both Venereal Disease Research Laboratory and Treponema Pallidum Hemagglutination Assay tests were an essential inclusion criterion. Prevalence of left main stenosis, coronary ostial stenosis, aneurysms, dissections, and other features were studied and compared to standard prevalence in the general population undergoing coronary angiogram.

Results:

Mean age was 56 years and 109 (73%) were male. Thirty-three percent were smokers, 39% were diabetic, 45% hypertensive, and 5% had prior stroke. We noticed left main stenosis in 8%, isolated ostial left main stenosis in 1.3%, spontaneous coronary artery dissection in 0.7%, and coronary aneurysm and ectasia in 4%; a similar prevalence to the general population as compared with earlier trials.

Conclusion:

In the present study, there was no significant increase in aorto-ostial stenosis, coronary aneurysm, or coronary dissection in seropositive syphilis patients. The classic manifestations of tertiary syphilis are rare in the modern era. All syphilis patients should be treated with proper antibiotics, as a case of giant aneurysm post left main ostial stenting was noticed in an untreated patient.
Single-center Experience of Slow Thrombolysis in Stuck Mechanical Mitral Valve in India
Authors: Guleria Vivek Singh , Sharma Prafull , Keshavamurthy G , Bharadwaj Prashant , Datta Rajat
Published: June 2024

ABSTRACT

Introduction:

India is the rheumatic heart disease (RHD) capital of the world. It is home to 40% of all people of RHD. Many of these patients undergo valve replacement surgeries in our country. These patients present with prosthetic heart valve thrombosis (PHVT) as the international normalized ratio (INR) is not monitored due to several restraints. Many precious lives are lost due to the scarcity of cardiac surgery centers and the high mortality associated with redo procedures. Various international studies have proved the efficacy and low complication rate of slow thrombolysis with tissue plasminogen activator (tPA) compared to surgery in PHVT. Most Indian studies have used streptokinase for PHVT and data on tPA are lacking.

Materials and Methods:

Twenty-one patients with prosthetic mechanical mitral valve presenting with dyspnea, a high gradient across the prosthetic valve, and decreased leaflet motion were included in the study. As it is not always possible to differentiate pannus from a thrombus and association of some degree of thrombosis even in pannus, we offered thrombolysis as the first line of treatment to all patients. Slow thrombolysis with 25 mg of tPA over 6 h followed by unfractionated heparin for 18 h was given, and thereafter, patients were reassessed for thrombolytic success or complications if any. A total four sessions of thrombolysis were given, and thereafter, patients with failed thrombolysis were referred for valve replacement surgery.

Results:

Out of 21 patients, 67% were females. The mean age of patients was 54.33 ± 10.6 years. Fifty-seven percent of patients were in the New York Heart Association (NYHA) III/IV. Atrial fibrillation was present in 62% of patients. The mean time of interval from the time of valve surgery to the time of thrombosis was 80 ± 57 months and the mean INR was 1.43 ± 0.4. The total success rate was 71% in this study, 9% had complications, and 19% had failed thrombolysis and underwent redo mitral valve replacement. The mean dose of tPA was 56.58 mg in this study and a mortality rate of 4%. Age had no effect on the success of thrombolysis. The presence of sinus rhythm, NYHA class I/II status, EF more than 40%, and mean gradient <20 mmHg was associated with a higher likelihood of success.

Conclusion:

In this study of PHVT in Indian patients, slow (6 h) infusion of low-dose (25 mg) tPA proves to be associated with a low complication rate, low mortality, and a promising success rate. This regimen can be offered to PHVT patients in our peripheral centers where cardiac surgical facilities are not readily available.
Barbarians at the Gate: Vascular Age as an Opportunity to Timely Prevent Atherosclerotic Cardiovascular Disease
Authors: Safarova Maya S , de Groot Eric , Moriarty Patrick M
Published: June 2024

The paradigms for precision cardiovascular medicine are undergoing continuous evolution and growth. With ongoing investigations of the role of genetic risk integrated into clinical assessment, current recommendations offer biomarker-and imaging-based risk-enhancing factors to individualize approach to each patient. Carotid intima-media thickness (CIMT) provides a reliable marker of vascular aging in young people, in whom plaque formation or calcification has not been established yet. When individualizing the treatment decision at the point-of-care, the population-based strategy may underperform in certain cohorts, especially younger individuals. Therefore, a comprehensive approach tailored toward the specific population is needed to provide further optimization of long-term care. Using the “vascular age” concept in shared decision-making may assist in better communicating the risk between the provider and the patient, furthering the focus on value-based care. This review is focused on the role of vascular age and CIMT as risk-enhancing imaging factors in identifying younger individuals at higher risk for atherosclerotic cardiovascular disease in the primary prevention setting to guide personalized prevention. Research is needed to evaluate whether early CIMT screening would affect uptake of risk-reducing interventions by the providers and patients as well as determine cost-effectiveness of the ultrasound-based surveillance intervals.
Clinical Presentation, Treatment, and In-hospital Outcomes of ST-Segment Elevation Myocardial Infarction
Authors: Das Chandra Kumar , Mishra Animesh , Kapoor Manish , Malviya Amit , Saha Swapan
Published: June 2024

Background:

India has a substantial burden of acute coronary syndromes, yet awareness regarding treatment and outcome of these conditions is limited. Thus, the present study aimed to document the characteristics, treatments, outcomes, and reasons for prehospital delay in patients with ST-segment elevation myocardial infarction (STEMI) admitted to a tertiary care hospital in North East India.

Materials and Methods:

A prospective, hospital-based, observational study was conducted at a tertiary care hospital in North East India between December 2016 and November 2017. All consecutive patients presenting with electrocardiographic evidence of STEMI were included in the study.

Results:

A total of 100 patients were assessed. Of these patients, 84 (84.0%) were male and 59 (59.0%) were urban residents. Smoking, hypertension, and dyslipidemia were the most common risk factors observed in 71 (71.0%), 55 (55.0%), and 43 (43.0%) patients, respectively. Anterior wall myocardial infarction was the most frequent type of STEMI observed in 59 (59.0%) patients. Only 54 (54.0%) patients reached the hospital within the window period. The average time to reach the hospital was 355 min. Thirty-three (33.0%) patients underwent thrombolysis, while 14 (14.0%) patients underwent primary percutaneous coronary intervention. Inhospital mortality occurred in 5 (5.0%) patients.

Conclusion:

Most patients were in the 60–69 years' age group, urban residents, and smokers. They received late medical care and received emergency therapies less often. In most cases, prehospital delay was due to patient inability to recognize symptoms at onset. Strategies to curb tobacco use, decrease prehospital delay, and improve urgent care could reduce morbidity and mortality in this patient subset.
Effect of White Blood Cell Indices and Glycemia on Inhospital Prognosis of ST-Segment Elevated Myocardial Infarction
Authors: Jadhav Dnyaneshwar V , Muley Dnyaneshwar , Deshmukh Shweta
Published: June 2024

Background:

Early risk stratification is recommended in daily clinical practice to predict adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Complete blood count and blood glucose analysis is routinely performed on admission. Hence, this study was undertaken to find out the predictive value of white blood cell (WBC) indices and glycemia to know adverse outcomes in STEMI.

Methods:

In an observational study conducted between December 2015 and October 2018 at a tertiary center, 400 patients with acute STEMI were included.

Results:

We had 400 patients of STEMI. In this study, mean total leukocyte count (TLC), total neutrophil count (TNC), neutrophil-to-lymphocyte ratio (NLR), and plasma glucose were higher in those with complications (13,449.8/mm3, 10,460.5/mm3, 5.20 and 180.8 mg%) than those without complications (11,318.3/mm3, 8581.9/mm3, 4.15, and 151.1 mg%) (P < 0.05). The cutoff point of TLC >13 × 1000 cells/mm3 had a sensitivity of 73.5% and specificity of 63% in predicting postmyocardial infarction mortality (area under the curve = 0.68,P< 0.001). Patients with acute hyperglycemia (≥140 mg%) had higher incidence of hypotension (31.12% vs. 17.64%,P< 0.05), left ventricular failure (32.14% v/s. 21.1%,P< 0.05), ventricular arrhythmias (13.26% vs. 6.86%,P< 0.05), and higher inhospital mortality (P = 0.0001). Multivariate analysis predicting inhospital mortality as dependent variable TLC >13 × 1000 cells/mm3, TNC >10.5 × 1000 cells/mms3, NLR ≥5.20, and plasma glucose >140 mg/dl were the variable found to be statistically significant (P < 0.05).

Conclusion:

The WBC indices (TLC, TNC, and NLR) and plasma glucose on admission are independent predictors of major cardiovascular events and inhospital mortality in STEMI.
Prognostic Significance of Baseline Plasma C-Reactive Protein Levels in Patients With Acute Coronary Syndromes
Authors: Raina Rohit , Gupta Mayushi
Published: June 2024

Objective:

The objective of this study is to assess baseline plasma C-reactive protein (CRP) levels in patients with acute coronary syndromes and their significance in prognosis.

Materials and Methods:

The study was carried out at the department of internal medicine in a tertiary health care center. Fifty patients diagnosed with acute coronary syndromes (ACSs) (ST-elevation acute myocardial infarction (STEMI) or unstable angina (UA)/non-STEMI) were admitted and detailed history, clinical examination, and laboratory tests were done on each patient. All routine blood investigations were carried out along with electrocardiography and echocardiography in all patients. Plasma concentrations of CRP were measured with an ultra-sensitive latex immunoassay before reperfusion, 24 h after admission, and at discharge.

Results:

A total of 50 patients were taken. Thirty-eight cases were found to be male and the remaining 12 were female, of which 35 were STEMI and 15 were UA/NSTEMI. The maximum prevalence of ACS was observed in the age group of 41–50 years. Among all five presenting symptoms, chest pain was the most prevalent, followed by sweating, breathlessness, vomiting, and giddiness. The major risk factors in ACS include smoking being the most common followed by diabetes and dyslipidemia. In 16 patients, left ventricular failure was recorded, which was the most common complication followed by cardiogenic shock and atrioventricular block. ventricular tachycardia/ventricular fibrillation is recorded in five patients who died, 36 patients with complications, and three patients among 40 patients without complications where CRP levels are ≥0.6 mg/dl. Four patients out of 10 patients who showed CRP levels <0.6 mg/dl are known to have complications.

Conclusions:

It was concluded that the measurement of plasma CRP levels at the time of admission in patients with suspected coronary artery disease may be helpful in the identification of a group of patients with a high risk of cardiac complications.
Influence of Body Shape Index and Heart Rate Variability in Athletes as Assessed During Treadmill Exercise
Authors: Sharma Snigdha , Bokariya Pradeep , Kothari Ruchi , Srivastava Sujay
Published: June 2024

Background:

Heart rate variability (HRV) is emanating as one of the most effectual techniques for probing the intricate and ever-evolving changes in the oscillations of a healthy heart, allowing us to guard against any abrupt physical threat to homeostasis, such as that which occurs when a person exercises.

Aims and Objectives:

To study the influence of body shape index with HRV indices in athletic population during treadmill exercise in athletic population.

Materials and Methods:

It was a cross-sectional study carried out on 120 healthy subjects and 30 athletes in the age range 17-35 years. Short-term HRV (5 min) was extracted from ECG recordings obtained using Power lab system, AD instruments and was analyzed by LabChart software in accordance to the standards set forth by the Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology.

Results:

Out of 30 athletes, there were a total of 17 (56%) male subjects and 13(44%) female subjects. Out of 120 controls, male subjects were 50 (41.66%) and females were 70 (58.33%). The mean age of males was 21.06±3.02 and that of females was 22.50 ± 6.25. A statistically significant positive (r=0.56) correlation between BSI and HRV on treadmill exercise was observed.

Conclusion:

Examining HR variations offers a window to evaluate the condition and integrity of ANS. In this study, the extent to which the ANS contributed to obesity was assessed and the relationship of measure of cardiovascular risk, a newly established and pragmatic metric Body Shape Index (ABSI) with the HRV indicators in the athletic population was explored.
Factors Affecting Total Ischemic Time of Patients with ST-elevation Myocardial Infarction: A Cross-sectional Study from a Tertiary Care Hospital in Kerala, India
Authors: Avanthika KV , Kandathil Joyal J , Iype Mathew , Anish T S
Published: June 2024

Background:

Cardiovascular diseases have now become the leading cause of mortality in India. The mortality rate is observed to be higher in primary percutaneous coronary intervention (PPCI) patients with longer total ischemic time (TIT). The lack of awareness about the symptoms of acute coronary syndrome (ACS) delays the identification of this medical emergency and prolongs the TIT. The study of composition of TIT and the reasons for its prolongation will help to improve the outcome of ACS.

Objectives:

The objectives of this study were as follows: (1) to estimate the mean TIT and the proportion of patients with TIT <1 h (the golden hour), admitted to Government Medical College Thiruvananthapuram, with ST-elevation myocardial infarction (STEMI) who underwent PPCI and (2) to study the factors influencing the TIT as those in the (a) prehospital phase – the time from the onset of chest pain till arrival to the hospital where intervention is being carried out and (b) hospital phase – the time from the arrival at the hospital to the time of intervention.

Methodology:

The study assessed total ischemic time in STEMI patients who underwent PPCI, through a cross-sectional study investigating mean TIT, influencing factors, and proportion of Patients with TIT <1 h (the golden hour). The calculated sample size, 104, was met using a questionnaire and the case records. The data were entered in Excel and analyzed using SPSS.

Results:

No patients in the study population arrived within 1 h of symptom onset. The mean TIT was 363.10 min with standard deviation of 156.809 and the median TIT was 330.00 min (interquartile range is 225.00). Unlike other similar studies, there were no significant associations with age, gender, and social and educational status of the patient. Majority of the study population were not aware about the symptoms of ACS. Mode of transport, past history, family history, time of onset of symptoms, and time of arrival at the percutaneous coronary intervention (PCI) center were found to be significantly associated with TIT.

Conclusion:

This study assessed the major patient-related and system-related factors causing the prolongation in TIT. This will help us to formulate and implement the strategies to significantly shorten the delay in revascularization and improve the outcome of patients admitted with STEMI. For decreasing the patient-related delay, creating public awareness regarding the identification of ischemic symptoms and accessing immediate medical care is paramount The early diagnosis and referral from the first medical contact or non-PCI center and rapid triage at the PCI center improves the system-related delay and will improve the mortality rate and outcomes of the patients.
Hemiepiphysiodesis with Tension Band Plates versus Percutaneous Epiphysiodesis Transphyseal Screws: A Comparative Study
Authors: Heckel Natascha , von der Heydt Kevin , Burgkart Rainer , Bernius Peter , Herzenberg John E. , Burghardt Rolf D.
Published: June 2024

Objectives:

There are currently two major types of implants used to treat varus/valgus deformities in children: tension band plates (TBPs) and percutaneous epiphysiodesis transphyseal screws (PETS). While reports about TBP abound, there is a paucity of reports on PETS. In this preliminary report, we compared the clinical results for hemiepiphysiodesis using TBP to PETS.

Materials and Methods:

The retrospective single European center study included 44 patients with varus/valgus deformities who underwent guided growth between 2010 and 2016. Follow-ups occurred from implantation through implant removal or skeletal maturity. Limb alignment was assessed through full-length standing radiographs.

Results:

In the group treated with TBP, the average age at implantation was 11.3 years (range, 3.6–15.8 years). Plates were inserted for an average of 14.6 months (range, 3.0–42.0 months). The mechanical axis deviation (MAD) changed an average of 2.5 mm/month (range, 0.1–8.0 mm/month). In the PETS group, the mean age at implantation was 13.1 years (range, 10.9–15.8 years). Screws were inserted for an average of 10.0 months (range, 2.0–25.0 months). The change of MAD was 2.9 mm/month (range, 0.2–10.3 mm/month).

Conclusions:

PETS had a comparable correction effect with TBP. Besides the different implant types, the correction effect and the treatment time are influenced by the growth rate, the extent of the deformity, and the underlying disease. TBP is less likely to lose purchase than PETS, especially in younger children. PETS have a sufficient grip in adolescents, are less expensive, and can be inserted through smaller surgical incisions which provide better cosmetic outcomes. The ideal age for switching from TBP to PETS has yet to be determined.

Level of Evidence:

III.
Radiographic Assessment of Lower Limb Alignment in South African Children
Authors: Foxcroft William Donnavan , du Toit Jacques , Ferreira Nando , Thiart Mari , Saini Aaron , Burger Marilize
Published: June 2024

Context:

Radiographic measurements on full-length lower limb views are the standard for lower limb deformity analysis. The published measurements of Paley et al.[1] on lower limb alignment are the gold standard, but were derived from small adult samples. There are no radiographic measurements reported exclusively of South African children.

Aims:

The study aimed to establish the normal values of lower limb alignment and joint orientation angles in South African children between 5 and 18 years old, at specific age intervals and to compare these measurements to the values as derived from Paley et al.[1]

Settings and Design:

A cross-sectional radiographic study including all 5–18-year-old children who underwent full-length anteroposterior radiographs between 2012 and 2020 was conducted.

Subjects and Methods:

Radiographic measurements were done as described by Paley. Differences in measurements obtained and those reported by Paley et al.[1] were compared.

Results:

A total of 190 patients (110 male; 80 female) with a mean age of 10.0 ± 3.3 years were included. The medial neck-shaft angle (MNSA), mechanical and anatomical lateral distal femoral angle (LDFA) and lateral distal tibia angle (LDTA) remained consistent throughout the age groups. Significant differences between Paley’s published values and our cohort were observed for the median mechanical axis deviation (MAD), MNSA and medial proximal tibia angle(MPTA).[1]

Conclusion:

Significant differences were seen in the mean/median of our MAD, MNSA, and MPTA compared to Paley’s work. Other measured values are comparable with previously published adult and pediatric populations. Using the acquired data, we were able to develop set values that could be the norm for pediatric joint orientation angles in the South African population.
Angular Deformity after Temporary Epiphysiodesis for Leg Length Discrepancy
Authors: Abousamra Oussama , Antoniak Katherine S. , VandenBerg Curtis D. , Wren Tishya A. L.
Published: June 2024

Aims:

Temporary epiphysiodesis with tension band plating is used to manage leg length discrepancy. Temporary epiphysiodesis may offer surgical timing benefits over permanent drill epiphysiodesis, but a potential complication is secondary angular deformity. We aimed to describe angular deformity and associated factors after temporary epiphysiodesis.

Materials and Methods:

In this retrospective review of patients who underwent temporary epiphysiodesis of the distal femur and/or proximal tibia, mechanical axis deviation (MAD) was measured on preoperative and last follow-up radiographs. Changes in MAD and angular deformity were analyzed using nonparametric statistics. Angular deformity was defined as MAD >10 mm from neutral.

Results:

In our cohort of 12 patients (age at surgery 11.3 ± 2.0 years; postoperative follow-up 2.0 ± 0.9 years), the mean magnitude of MAD change was 14 ± 10 mm. Of five femoral only procedures, four limbs (80%) had lateral (valgus) direction of MAD change, while one had 1 mm varus change. Of two tibial only procedures, both had lateral direction of MAD change. Of five combined femoral and tibial procedures, one limb (20%) had no MAD change, and four limbs (80%) had medial (varus) MAD change. At the last follow-up, 50% (6/12) of limbs had MAD >10 mm from neutral, which they did not have before surgery.

Conclusions:

For patients with limb length discrepancy, temporary epiphysiodesis with tension band plating may increase the potential for angular deformity. This finding should be considered when this procedure is planned for patients close to skeletal maturity.
Growth and morbidity of exclusively breastfed and artificially fed babies in a tertiary care hospital in South India
Authors: Habeeb Azmi , Unni Jeeson C
Published: June 2024

Background:

Exclusive breastfeeding has been established as the most appropriate modality of feeding babies up to 6months of age. Myths and misinformation regarding breastfeeding exist aplenty in the community. There is a feeling that modern-day mothers are less inclined to exclusively breast feed their baby.

Aim:

The aim of this study was to analyze the feeding practices that are prevalent in our hospital and to compare growth and morbidity pattern between breast fed and artificially fed babies up to 6 months of age.

Materials and Methods:

After obtaining clearance from the Institutional Ethics Committee, a retrospective study was conducted wherein a questionnaire inquiring feeding and illnesses was submitted to parents of babies born in our hospital coming to our outpatient department at 6 months of age for vaccination. Weights at 6 weeks, 10 weeks, 14 weeks, and 6 months, were accessed from our hospital information system.

Results:

199 babies were studied. Though exclusively breast-fed infants had more weight than artificially fed babies at 6 weeks, 10 weeks, 14 weeks, and 6 months, the difference was not statistically significant. Morbidity of artificially fed infant was significantly more than in those who were exclusively breast fed and bottle feeding was associated with a statistically significant morbidity pattern.

Conclusion:

Artificial feeding and bottle feeding was associated with increased morbidity. Weights and weight gains between exclusive breast fed and artificially fed infants were not significantly different up to 6 months of age.
Self-Counselling
Authors: Nair Muttathu K. C. , Kumar Shyamal , Lukose Riya , Girish Chandrasekharan S. , Binod Deepa , Sreejith Sailaja
Published: June 2024

Self-counselling helps analyze oneself. It allows one to take control to evaluate and rediscover. With the increase in mental health conditions in the post-COVID era and with the limited availability of trained physicians to deal with it, self-counseling can be an effective method to help candidates with mild issues. The theoretical basis for self-counselling involves the basic processes of counselling. However, the pre-requisite for an effective self-counselling includes self-awareness, self-motivation, and self-screening. A successful self-counselling session needs finding strength in not just oneself but also the support system which may include the family and/ or friends.
A rare case of prolonged jaundice due to USP53 gene mutation
Authors: Ananda Kesavan T. M. , Sreejith Kumar K. C. , Thampi Geethu Ponnu
Published: June 2024

Cholestatic jaundice in infancy is an uncommon but potentially serious problem that indicates hepatobiliary dysfunction. Common causes of cholestatic jaundice includes biliary atresia, neonatal hepatitis, Intra uterine infection, hypothyroidism, tyrosinemia, galactosemia and choledochal cyst. We report a rare case of progressive cholestatic jaundice in infancy presented with severe hypercholanemia but with lack of evidence of hepatic inflammation and the child improved clinically and biochemically on Rifampicin.
Optimization of Idle Vibration Characteristics of Powertrain Mounting
System
Authors: Zheng Bao Bao , Guo Yiming , Xiao Lei , Zheng Di , Li Guohong , Shangguan Wen-Bin , Rakheja Subhash
Published: June 2024

To address the issue of engine jitter at idle conditions in a specific vehicle
model, an initial test of the inertial parameters of the powertrain mounting
system was conducted. Utilizing the Adams software, a system model was
constructed and subjected to modal analysis. The stiffness of the mounting
components was selected as the optimization variable. A deterministic
multi-objective optimization was performed on the system’s decoupling rate,
natural frequencies, and minimum dynamic reaction force, employing the
multi-island genetic algorithm. sensitivity analysis regarding the stiffness of
the mounts was conducted based on DOE method. The optimized stiffness values
were then re-entered into the Adams software. The results of the deterministic
optimization indicated a significant enhancement in the decoupling rate of the
powertrain mounting system in the primary direction of concern, a reduction in
the natural frequencies, and a decrease to 43.5% of the original scheme in the
minimum dynamic force transmitted to the vehicle body. A comparative analysis
was conducted on the acceleration amplitude–frequency curves before and after
optimization in the Z-direction under idle conditions, and the
dynamic reaction force amplitude–frequency curves in three dimensions, both
demonstrating a notable attenuation post-optimization. In addition, vibration
isolation tests were performed on the powertrain mounting system, comparing the
comprehensive isolation rates before and after optimization under idle
conditions, with the results fulfilling corporate standards. Finally, based on
the stiffness values post-deterministic optimization, robust optimization was
conducted employing the 6σ methodology. A robustness analysis of the powertrain
energy decoupling rate was performed utilizing the Monte Carlo simulation
method, effectively mitigating the tremor issue of the vehicle model under idle
conditions.
Anadolu İrfan Muhiti ve Aşık Şenlik Sanatına Yansıması
Authors: Asker Naile
Published: June 2024

Türk halk edebiyatı Orta Çağ’da İslam dininin yaygınlaşması sonucunda irfani değerler kazanmaya başladı. 13. yüzyıldan başlayarak Horasan erenleri aracılığıyla Türkistan coğrafyasından Kafkaslara ve Anadolu’ya kadar gelen tasavvufi ve irfani akımlar edebiyat, kültür ve sanat alanında kendini belirgin olarak göstermekteydi. Ozan, bahşı veya âşık olarak adlandırılan sanatkârlar adeta bir hoşgörü elçisi olarak geleneksel sanatla İslami değerleri sentez etmekte ve geniş kitlelere terennüm etmekteydiler. Özellikle Alevi-Bektaşi tarikatları ve tekkeleri etrafında birleşen bu sanatkârlar 16. yüzyıldan başlayarak etkin bir şekilde Türk kültür ve sanat alanında, Türk âşık edebiyatının gelişiminde irfan yolculuklarını devam ettirmişlerdir. 19. yüzyıla kadar gelişim süreci yaşayan âşıklık geleneği bu dönemde sanat alanında en değerli eserlerini veren gelenek halini almıştı. Bu makalede Türk halk edebiyatının bir alanı olan Âşık edebiyatının irfani yönlerinin gelişim sürecine göz atılmış, süreç içerisinde bu alanın tespit edilen sanatsal özelliklerinden bahsedilmiştir. 19. yüzyıl sonu 20. yüzyıl başlarında yaşamış, kendi ekolü olan, Anadolu ve Azerbaycan sahası arasında köprü rolünü üstlenmiş Âşık Şenlik’in sanatı, dini-didaktik konulu şiirleri, bu şiirlerin Anadolu irfani muhiti içerisindeki yeri analiz edilmiştir.
White Racial Framing and White Supremacy Culture in STEM Education: Experiences of Students with Minoritized Identities of Sexuality and/or Gender
Authors: Forester Rachael , Miller Ryan A. , Friedensen Rachel , Vaccaro Annemarie , Kimball Ezekiel W.
Published: June 2024

Whiteness is prevalent in higher education and therefore permeates science, technology, engineering, and mathematics (STEM) fields. While research shows STEM’s long history of exclusion and marginalization in higher education (Ong et al., 2011), there has been limited research on the ways students with minoritized identities of sexuality and/or gender (MIOSG) in STEM interact with systems of dominance, such as whiteness. Using white supremacy culture (Okun, 2021; Okun Jones, 2001) and the white racial frame (Feagin, 2010) as sensitizing concepts, this paper explores how students with MIoSG are situated in relation to systems of whiteness and white racial dominance in STEM learning spaces. Our findings included three emergent categories: color-evasiveness, desiring diversity in STEM, and the simultaneous invisibility and hypervisibility of Black, Indigenous, and People of Color (BIPOC) in STEM. Findings illuminated the complex ways BIPOC and white students with MIoSG experienced and thought about whiteness and white supremacy in STEM. Data point to the need for intentional anti-racist research, policy, and practice in STEM learning spaces.
It Says STEM so it must Work for Everyone: Experiences, Beliefs, and Career Choices across the STEM Disciplines
Authors: Gossen Drew
Published: June 2024

The development of interest and aspirations to pursue STEM careers has been a focus of recent educational research and action. This study used Social Cognitive Career Theory as the framework to explore how types of learning experiences in and out of school prior to college affected undergraduates’ STEM beliefs and intent to pursue a career in a STEM field. A sample of 312 students at a large university were surveyed about the experiences in which they had participated, their perceptions of those experiences, and their self-efficacy, outcome expectations, and interests in science, mathematics, and engineering. The results indicated experiences that predicted beliefs across all STEM areas, but also some key experiences that differed depending on the subject. Experiences revolving around family and career-specific activities were important for science and engineering beliefs, the opportunity to build and create was important for mathematics and engineering beliefs, and varied instructional techniques were valuable for mathematics and science beliefs. This paper details the relationship between these experiences and STEM beliefs and career choices along with recommendations for educators looking to develop experiences to enhance STEM career pathways.
Rainbows, Presents, Zombies, and Frankenstein's Monster: Insights into Young Children's Attitudes towards Mathematics
Authors: Quane Kate
Published: June 2024

Understanding young children's attitudes towards mathematics provides insights into their lived mathematical experiences. It has long been recognized that attitudes towards mathematics have a profound influence on mathematical achievement. Despite the considerable amount of research into students' attitudes toward mathematics, limited research has been conducted into young children's attitudes toward mathematics. Using the modified Three-dimensional Model of Attitude affords the opportunity to describe children's attitudes more comprehensively, moving beyond the emotional dichotomy. This paper reports research conducted with Australian children aged between seven and eight years of age (N=106) using children's drawings, written descriptions, and interview responses. The three data sources resulted in rich narratives providing young children with multiple opportunities to voice what is important to them and their learning. Analysis indicated a range of attitudes, including negative attitudes towards mathematics. Further, a child who has a narrow vision of mathematics impacts their overall Attitude towards the subject.
Trends and Issues of Inquiry and Socio-Scientific Issue (SSI) Research in the Last 20 Years: A Bibliometric Analysis
Authors: Noris M , Sajidan Sajidan , Saputro Sulistyo , Yamtinah Sri
Published: June 2024

This study aims to look at research trends on inquiry and socioscientific in the last 2 decades from 2004 to 2023. The PRISMA method is a reference in determining inclusion and exclusion criteria, as many as 449 articles were synthesized using bibliometric analysis. The result synthesis refers to the distribution of articles per year, research themes, affiliations, countries, authors, and productive journals. The inquiry and socioscientific research trends will peak in 2022, affiliated with the University of Wisconsin-Madison and the University of Southampton. Productive country United states and United Kingdom. Best author Laursen S and Zeidler D.L. Productive journal CBE Life Science Education from United Kingdom and International Journal of Science Education from United States.