bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperprolactinemia following traumatic myelopathy
Authors: Esan Arinola , Adeleye Jokotade O , Olukayode Lawal Abimbola , Badejo Oluwakemi A 
Published: May 2024

Abstract
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

Abstract

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

Abstract
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.