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Objective: To assess QT interval abnormalities among children with breath-holding spells. Methods: This case control study included 204 children (104 cases of breath-holding spells and 100 healthy children) younger than 3 years. Breath-holding spells were evaluated for age of onset, type (pallid/cyanotic), triggering factors, frequency and presence of family history. Twelve- lead surface electrocardiogram (ECG) was analyzed for QT interval (QT), corrected QT interval (QTc), QT dispersion (QTD) and QTc dispersion (QTcD) in milliseconds. Results: The mean (SD) QT, QTc, QTD and QTcD interval in milliseconds were 320 (0.05), 420 (0.07), 61.15 (16.20), 102.3 (17.24), respectively for breath-holding spells as compared to control group [300 (0.02), 370 (0.03), 38.6(14.28), 78.6 (14.28), respectively] (P<0.001). Similarly, pallid breathholding spells had prolonged mean (SD) QT, QTc, QTD and QTcD interval in milliseconds [380 (0.04), 520 (0.08), 78.88 (10.78), 123.33 (10.28), respectively] as compared to cyanotic spells [310 (0.04), 400 (0.04), 57.44 (14.64), 97.90 (15.03), respectively] (P<0.001). The mean QTc interval was 590 (0.03) and 400 (0.04) milliseconds in prolonged and non-prolonged QTc group, respectively (P<0.001). Conclusion: Abnormal QT, QTc, QTD and QTcD were observed among children with breath-holding spells. ECG should be strongly considered, especially in pallid, frequent spells occurring at younger age and having positive family history, to identify long QT syndrome.
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The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.
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Objectives: In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods: This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results: In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n ¼ 113), while 6.9% were young men (n ¼ 254). Traditional risk factors such as hypertension (p ¼ 0.73), diabetes (p ¼ 0.61), and family history of premature CAD (p ¼ 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p ¼ 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions: Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women
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Background: Thyroid hormones have a crucial role in adapting the metabolic functions during stress and critical illness. Patients who are critically ill may have profound changes in thyroid hormone metabolism. Non-thyroidal Illness Syndrome (NTIS) is one among them, in which there is marked abnormality seen in the thyroid hormone levels. Hence this study is to understand the alterations of the thyroid function tests (TFTs) encountered in critically ill patients admitted in medical intensive care unit (MICU) without primary thyroid disease and to correlate with the severity of Acute Physiology and Chronic Health Evaluation (APACHE III) scoring. Methods: The study was conducted on 100 critically ill patients with no previous thyroid disorders, admitted in MICU in the Department of General Medicine in a tertiary care hospital between September 2017 and August 2019 who fulfilled the inclusion and exclusion criteria. Results: Out of 100 critically ill patients the abnormal thyroid function prevalence was seen in 78% patients. The most common abnormality seen in our study was low total triiodothyronine (TT3) (61%) followed by low free triiodothyronine (FT3) (36%), low total thyroxine (TT4) (29%), high thyroid-stimulating hormone (TSH) (18%), and low free thyroxine (FT4) (12%). Low TT3, TT4, and FT3 values had a significant correlation with increasing critical severity score of APACHE III with a p value which was statistically significant (p < 0.05). Conclusions: With increase in severity of critical illness assessed by APACHE III, TFT, that is, TT3, TT4, and FT3 levels were decreasing, suggestive of increasing non-thyroidal illness in critically ill patients.
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Objective: To evaluate the efficacy and tolerability of intravenousfosphenytoin in children with status epilepticus, and resultingserum total phenytoin levels.Methods: In this prospective study, 51 children aged less than 18years received intravenous loading dose of fosphenytoin (18-20mg/kg). Serum total phenytoin levels were estimated at 90 -100minutes. Outcomes studied were (i) seizure control and local and/or systemic adverse effects in next 24 hours and (ii) phenytoinlevels and its correlation with dose received, seizure control andadverse effects.Results: The actual dose of fosphenytoin received varied from15.1 to 25 mg/kg. Seizures were controlled in 45 (88%) childrenand, two required additional dose of 10 mg/kg. None of thechildren showed any local or systemic adverse effects. Serumtotal phenytoin levels were in the therapeutic range (10-20 μg/mL)in 12 (23.5%), sub-therapeutic in 16 (31.3%) and supra-therapeutic in 25 (49%) children. There was weak correlation ofthe phenytoin levels with dose of fosphenytoin received, seizurecontrol, or adverse effects.Conclusion: Intravenous fosphenytoin loading dose of 20 mg/kgis effective in controlling seizures in 88% of children with statusepilepticus, with a good safety profile. Seizure control and adverseeffects appear to be independent of serum total phenytoin levelsachieved.
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Myxomas are the most common type of primary cardiac tumor. They cause a variety of clinical manifestations depending on size and anatomical location. Sometimes, manifestations are atypical challenging differential diagnosis and the therapeutic approach. Left atrial myxomas are commonly missed clinically and often lead to grave consequences. We present here a series of 6 cases of left atrial myxomas with demographic and clinical characterization of the patients that were managed successfully.
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Background: We aimed to compare clinical profile of premature coronary artery disease (PCAD) in urban vs. rural Indian populations.Methods: This was a prospective cross-sectional observational multi-centre study. This study is a sub-study of the ongoing PCAD registry. Between the period April 2017 and April 2018, a total of 1061 patients <40 years with PCAD were studied. Urban (n=583) and rural (n=478) populations were statistically compared.Results: Mean age of the urban and rural populations were 34.50±4.15 years and 33.99±4.46 years, respectively. All cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidemia, obesity, diet and family history), except for alcoholism were more prevalent in urban subjects compared to rural subjects. However, higher prevalence of only hypertension (p=0.05) was statistically significant. Religion was significant between the two populations (p<0.001). Window period was also significant between the two populations (p<0.001). Very low density lipoprotein cholesterol (VLDL) (p=0.037) was significantly different between both populations.Conclusions: All conventional risk factors were more prevalent among urban populations than rural populations, however none of these differences except for hypertension was statistically significant.
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Introduction: Dengue is the most common arboviral diseaseworldwide and is usually endemic, but several epidemics havebeen recorded. Dengue fever is associated with electrolytedisturbances.Material and methods: This study was a cross sectional,descriptive and non interventional study conducted onpatients of Dengue fever, during the period of 18 monthsbetween October 2016 to March 2018 in a tertiary care centre.This study was conducted to find relation between electrolytedisturbances in patients with dengue fever.Results: The majority of the patients 136 (67.32%) weremales while 66 (32.67%) were female patients. The majorityof patients 84.65% were with Dengue fever and 14.35%patients were with Dengue hemorrhagic fever and 0.99%patients were with Dengue shock syndrome. Hyponatremiaand hypokalemia was the frequent electrolyte disturbancesfound in dengue patients. The mean value of serum sodiumwas 133.92mEq/L and of serum potassium was 3.62mEq/L.There exists a positive and significant correlation betweendifference in serum sodium (r = 0.38) and potassium levels(r = 0.41) with Dengue clinical syndrome (DF, DHF, andDSS) which implies that as the difference between the levelsincreases, greater are chances of the Dengue fever towardsDHF or DSS.Conclusions: Hyponatremia was the most frequent electrolytedisturbance and hyperkalemia was least common observed inpatients with Dengue viral infection. Mild hyponatremia andmild hypokalemia were more common among patients ofDengue fever whereas moderate and severe hyponatremia andhypokalemia were more common among Dengue hemorrhagicfever (DHF) and Dengue shock syndrome (DSS).
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Background: Heart diseases complicate >1% of all pregnancies and is the leading indirect cause of maternal deaths. Present study attempted determining the maternal and fetal outcome in pregnant women with heart disease using various relevant parameters.Methods: A total of 44 consecutive cases of heart disease with pregnancy that were admitted at the study centre from December 2013 to August 2015 were included and analyzed for outcome with respect to age, parity, associated comorbidities, nature of cardiac lesions, type of valvular involvement, NYHA functional class, type of anaesthesia used, mode of delivery, maternal outcome, fetal outcome, birth weight of babies and maternal and fetal mortality, if any.Results: Rheumatic heart disease 26 (59.1%) was the commonest lesion observed to be affecting pregnant patients, followed by congenital heart disease (10, 22.7%). Mitral valve (30, 68.2%) was found most commonly affected, followed by aortic valve (10, 22.7%). Regurgitant lesions (26, 59.09%) were commoner than stenotic ones (14, 31.81%). Four (9.1%) patients went into left ventricular failure and had to be admitted to ICU. Of these, one patient (2.3%) died.Conclusions: Maternal heart disease is one of the important causes of maternal mortality. The obstetrician needs to have strong suspicion of the entity right from the start, so as to improve upon the maternal as well as fetal outcomes.
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BACKGROUND: Although prevalence of MRSA strains is reported to be increasing, there are no studies of their prevalence in community-acquired primary pyodermas in western India. AIMS: This study aimed at determining the prevalence of MRSA infection in community-acquired primary pyodermas. METHODS: Open, prospective survey carried out in a tertiary care hospital in Mumbai. MATERIALS AND METHODS: Eighty-six patients with primary pyoderma, visiting the dermatology outpatient, were studied clinically and microbiologically. Sensitivity testing was done for vancomycin, sisomycin, gentamicin, framycetin, erythromycin, methicillin, cefazolin, cefuroxime, penicillin G and ciprofloxacin. Phage typing was done for MRSA positive strains. RESULTS: The culture positivity rate was 83.7%. Staphylococcus aureus was isolated in all cases except two. Barring one, all strains of Staphylococcus were sensitive to methicillin. CONCLUSIONS: Methicillin resistance is uncommon in community-acquired primary pyodermas in Mumbai. Treatment with antibacterials active against MRSA is probably unwarranted for community-acquired primary pyodermas.