bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of idiopathic dilated cardiomyopathy with cardiac magnetic resonance imaging
Authors: KHAN IMTIYAZ AHMAD , PARRY ARSHED HUSSAIN , PAUL IRSHAD , CHOH NASEER AHMAD , SHAHEEN FEROZE A. , SINGH MANJEET , KHAN KHURSHEED ASLAM 
Published: May 2024

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion:
We conclude that when usual posterolateral or lateral target veins cannot be accessed for LV lead placement, as an alternative approach utilizing MCV collateral circulation to reach as close possible to the lateral surface may be considered in CRT. RV leads to be positioned at the outflow tract or upper septum in those cases.
Novel oral anticoagulant in treatment of left ventricular thrombus in acute coronary syndrome – A case series
Authors: DAHIYA ARCHIT , JOSHI PIYUSH , SINHA RAMANAND PRASAD , WARDHAN HARSH 
Published: May 2024

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

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

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

Conclusion:
Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases.
Clinical, echocardiographic profile, and outcome of heart failure patients with preserved ejection fraction
Authors: JOHN MC , NARAYANAPILLAI JAYAPRASAD , MADHAVAN SURESH , JAYAPRAKASH VL , GEORGE RAJU 
Published: May 2024

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

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

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

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

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

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

Conclusions:
Among hospitalized patients with new-onset HFpEF annual mortality rate is as high as 15.4%. Advanced age, hyponatremia, and high E/e' were found to be independent predictors of mortality.
Clinical presentation, management and in-hospital outcomes of Acute coronary syndrome patients in real world scenario in developing countries
Authors: SHARMA AKHIL KUMAR , GOEL DIWAKAR , CAHAUDHARY GAURAV , TIWARI ASHISH 
Published: May 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

Materials
and

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

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

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

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

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