ABSTRACT
Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.
ABSTRACT
Objectives: Recently, India has witnessed an increase in the number of public private partnerships (PPP) in various areas except nutrition. This paper explores barriers to private investment in improving nutrition outcomes in India, highlights success stories and recommends areas where PPP are more acceptable Methods: A need analysis was done based on secondary literature and data review. Primary interviews were then conducted with a representation of various stakeholders from the public, private sectors and civil society. Results: The public sector is more open to industry investment in improving services than in fortified food and supplements. It was perceived that the industry's capabilities in efficient logistics, training frontline staff and effective marketing would be useful for scaling public health nutrition programs such as the Integrated Child Development Services. Transparency was quoted as the key attribute for a successful PPP. The centralized kitchen model for school lunch programs is the only partnership operating at scale across 20 states in India. Some ongoing pilots in the use of mobile phones for training and social marketing and computerized distribution systems have the potential to scale. Conclusions: The ecosystem for PPP to address the high burden of undernutrition in India has begun to take shape. There are opportunities for the telecommunication industry, warehouse and logistics providers and advertising agencies to strengthen public health nutrition programs. Further, food and nutrition industry's expertise would be helpful in implementation research, and product development.
ABSTRACT
Aims and Objectives: We evaluated the incidence and implications of coronary artery disease (CAD) in patients above 40 years presenting for valve surgery. Materials and Methods: Between January 2009 and December 2010, coronary angiography (CAG) was performed in all such patients ( n = 140). Results: Coronaries were normal in 119 (Group I), and diseased in 21 (Group II). In Group II, 11 patients were < 50 years, 3 were between 51 and 60 years and 7 were > 61 years. In 8 of these, only valve replacement was performed. Coronary artery bypass grafting (CABG) and aortic valve replacement was performed in 10, CABG and mitral valve replacement in 2 and CABG with mitral and aortic valve replacement in one. The number of vessels grafted in these 13 patients was 1.54 ± 0.66. Hypertension and diabetes were significant ( P < 0.05) in this group. The mortality was significant in Group II (11 vs. 6, P < 0.05). Six patients died in Group II, 5 had severe aortic stenosis and severe left ventricular hypertrophy; the sixth patient had severe mitral stenosis and was in CHF. The predominant cause of death was congestive heart failure (CHF). Conclusions: Fifteen percentage of these patients had CAD. CAG should be performed routinely in these patients while presenting for valve surgery. Combined CABG and valve replacement carries high mortality (28.5%), especially in patients with aortic stenosis. The study suggests that the cardio-protective measures should be applied more rigorously in this subset of patients.