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Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited condition causing left ventricular outflow tract (LVOT) obstruction, with a prevalence of 1 in 500. Widespread use of echocardiography has led to this disorder being increasingly diagnosed in pregnant women. Knowledge of HOCM is imperative for obstetricians. Pregnancy is generally well tolerated in HOCM but women who are symptomatic pre pregnancy or have significant LVOT obstruction can develop complications such as heart failure, arrhythmias and sudden cardiac death.
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Background: Women who have experienced pre-eclampsia (PE) may also face additional health problems in later life, as the condition is associated with an increased risk of death from 2-fold increased risk of long-term cardiovascular disease (CVD), hypertension, stroke, an approximate 5-12-fold increased risk of end-stage renal disease (ESRD), metabolic syndrome, and diabetes. Methods: Method was randomized controlled trial. Women with PE who delivered in PGIMER will be enrolled and will be allocated into experimental ad control group using a computer random table with allocation concealment. Enrolment will be done at the time of discharge; baseline assessment will be done 6 weeks and the intervention bundle will be implemented to the women in experimental group. The women in control group will receive routine care. Women in both the groups will be followed up at 6 months. Conclusions: This study aims to determine the effectiveness of “extended postpartum comprehensive health care bundle (EP CHC bundle)” on selected outcomes of women with preeclampsia at 6 months. The comprehensive health care bundle will be designed with the inputs from all stakeholders, has the potential to suit the dynamic nature of management of women with preeclampsia after delivery. CTRI registration number: CTRI/2021/04/032749 ON 12/4/2021
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Healthcare workers face specific challenges during infectious disease outbreak. Along with fear of getting infection, performing new, unfamiliar tasks in unfamiliar setting with new outfit (PPE) complicates their working. We explore perceptions and lived experiences of front-line nurses who cared for COVI9-19 confirmed patients in a tertiary hospital of North India eighteen in-depth, telephonic, semi structured interviews were conducted. Interviews were transcribed and analysed using Colaizzi’s phenomenological method. Nurses were challenged by risk of infection or fear of transmission, working in a new setting, unfamiliar clinical roles, heavy workloads, ineffective communication and discomforts of protective gear. Despite facing various challenges, nurses showed great strength and resilience. Good administrative support, PPE surveillance, developing nurses’ task force with distinct responsibilities, orientation, training and empowerment are suggested strategies to overcome the challenges and enhance the resilience. Nurses lived experiences will be helpful to healthcare organizations preparing for or responding to outbreaks or disaster.
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While nitrogen (N) uptake in rice has been extensively studied, the influence of root morphology on this process is not fully elucidated. This study explores the root morphological characteristics and N uptake of five diverse rice genotypes under different N sources, including novel slow-release nanoclay polymer/biopolymer composite (NCPC/NCBPC) fertilizers. A greenhouse experiment was conducted using five diverse rice genotypes (Swarna, Pusa Basmati-1, Pusa-44, MTU1010 and Nagina-22) with five N treatments (T1- control (without N fertilizer), T2- 100% RDF of N through urea, T3- 75% RDF of N through urea loaded NCPC, T4- 75% RDF of N through urea loaded NCBPC-I (NCBPC prepared with wheat flour), T5- 75% RDF of N through urea loaded NCBPC-II (NCBPC prepared with maida)). The results of the study revealed that maximum overall root growth was recorded under Pusa Basmati-1 followed by Swarna, MTU 1010, Nagina-22 and Pusa-44. Among the N treatment, maximum root growth and N uptake was recorded under NCPC treatment followed by NCBPC-II, NCBPC-I, urea and control. Thus, the study reveals significant variations in root traits among genotypes and N treatments, with notable improvements observed under NCPC and NCBPC based N treatments.
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Background: Chronic myeloid leukemia (CML) is relatively rare in pediatric and adolescent age groups. The purpose of this study was to evaluate the clinical, hematopathological, and biochemical parameters of CML in pediatric and adolescent age groups, along with an assessment of the treatment response with first-line tyrosine kinase inhibitors (TKI) and its correlation with the prognostic scoring systems of adults. Materials and Methods: A retrospective study of 44 Breakpoint Cluster Region-Abelson leukemia virus (BCR-ABL1)-positive pediatric and adolescent CML cases registered at our hospital was done. The clinical and laboratory parameters were evaluated using hospital software. The treatment response was monitored and scoring was performed using mathematical calculations. Results: The mean age was 11.6 (±4.7) years. The median hemoglobin was 8.4 g/dL and 63.6% of the cases showed white blood cell (WBC) counts >250,000/?L. The average follow-up was 21 months. A total of 97.7 and 78.1% cases achieved complete hematological response (CHR) and molecular response, respectively, during the treatment course. The maximum number of patients had low Sokal and European treatment and Outcomes Study (EUTOS) scores. Seventy-five per cent of the cases achieved CHR at 3 months, while 73.6 and 78.6% CML-Chronic phase (CP) cases with low Sokal and EUTOS scores achieved CHR at 3 months, respectively. Conclusion: This study revealed that the CML cases in pediatric and adolescent age groups are normally present with higher WBC counts at the time of diagnosis. The association of the prognostic scoring system with treatment response was statistically insignificant. However, a larger cohort study is needed to determine the treatment response of TKI in children and adolescent CML and its correlation with the prognostic scoring systems.
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Background: Blood culture is widely accepted as the gold standard investigation for the diagnosis of blood stream infections (BSI). The number of blood cultures collected has a considerable impact on the organism isolation. This study aims to optimize the number of blood cultures needed, for an optimal diagnostic yield in BacT/ALERT VIRTUO system mainly in a resource limited setting. Methods: All the blood cultures (BCs) obtained in BacT/Alert bottles per patient during a 24-h period were included as ‘one episode’ and categorized as single bottle, 1-set (2 aerobic bottles), 2 sets and 3 sets. BC bottles were incubated in the BacT/ALERT VIRTUO (bioMérieux) for a period of five days. Bottles flagged positive were subjected to Gram staining and culture plating. Colonies grown were identified by MALDI-TOF MS, VITEK MS, bioMérieux. Results: Cumulative positivity rate increased (21.7%, 41.4%, 56.1%, 60.6%) and pathogen isolation rate increased (10.3%, 21.8%, 30.4% and 33.8%) progressively when collected in single bottle, 1, 2 and 3 sets respectively. The pathogen detection rate for GNB and GPC were 45.1% and 42.6% respectively with one bottle and this got upsurged to 85.6% and 98.9% for GNB and 83.6% and 98.2% for GPC when collected in ?1 set and ?2 sets respectively. Conclusions: Two BC sets over a 24-h period can detect approximately 98% of the pathogens with a cumulative positivity rate of 60% and hence it is a justifiable alternative approach to the standard practice of 3-sets of BCs.
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Seed Production of rice fallow blackgram variety, ADT3 has limitations due to inherent issues of soil fertility, climate change and thermo sensitivity results in poor flowering, reduced pod setting and poor seed filling. Macro and micro nutrients application during critical stages of growth were tried to improve the seed yield and quality in rice fallow blackgram variety ADT3. The combined foliar spraying of 0.5% NPK (macro) and 0.2% chelated micro nutrients mixture (Fe 2.5%, Mn 1.0%, Zn 3.0%, Cu 1.0%, Mo 0.1% and B 0.5%), were sprayed on 15th (Vegetative phase), 30th (Reproductive phase), 45th ( Flowering and pod formation phase) days after germination improved the growth and seed parameters viz., plant height, number of branches, number of pods per plant, number of seeds per pod, filled seed % which resulted in increased seed yield in rice fallow blackgram variety, ADT3.Response of macro and micro nutrients through foliar mode revealed the lack of soil fertility resulting in poor uptake of macro and micro nutrients. Foliar application induced uniform flowering and synchronous maturity of pods with least shattering which would facilitate mechanical harvesting. Foliar application of macro and micro nutrients phenotypically altered the source-sink which greatly influenced the yield of seed, germination and seedling quality parameters
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Background: Stress is an inevitable and important part of being a student: It motivates and stimulates learning. However, intense stress can arouse feelings of fear, uselessness, anger, incompetence, and guilt. Aims and Objectives: The study aimed to assess stress levels, sources, and its associated determinants and hence appropriate measures can be taken in tackling them at the earliest stage. Materials and Methods: Before the study each subject was told about the purpose and nature of the study. They were also counseled about the maintenance of confidentiality, in addition to their informed consent. A cross-sectional questionnaire-based survey was given to the undergraduate medical students of Apollo Institute of Medical Sciences and Research, Murukambattu, Chittoor who were willing to participate in the study. The medical student stressor questionnaire was be used to assess the sources of stress. Results: Highest stressors domain was dominated by Domain I: Academic related stressor. For 1st and 4th year students, large amount of content to be learnt had the highest score. For 3rd year students, falling behind in reading schedule is said to be the major stress factor. For 2nd year students the major stress was getting poor marks. Severe stress was present in 4 out of 6 domains for 3rd year MBBS students. When we compared the stress levels in female and male students, the stress levels of all six domains were more in females as compared to males and P value of 4 out of 6 domains were statistically significant. Conclusion: Academic-related problems were the major stressors among medical students. Females had a significantly high level of stress. Year of study was the best predictor of a medical student’s stress level. The findings can help medical teachers understand more about stress among their students and guide the way to improvement in an academic context, which is important for student achievement.
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Circulating tumor clusters (CTC) disseminating from the primary tumor are responsible for secondary tumor formation where the conventional treatments such as chemotherapy and radiotherapy does not prevent the metastasis at locally advanced stage of breast cancer. In this study, a smart nanotheranostic system has been developed to track and eliminate the CTCs before it can colonize at a new site, which would reduce metastatic progression and increase the five-year survival rate of the breast cancer patients. Targeted multiresponsive (magnetic hyperthermia and pH) nanomicelles incorporated with NIR fluorescent superparamagnetic iron oxide nanoparticles were developed based on self-assembly for dual modal imaging and dual toxicity for spontaneous killing of CTCs in blood stream. A heterogenous tumor clusters model was developed to mimic the CTCs isolated from breast cancer patients. The nanotheranostic system was further evaluated for the targeting property, drug release kinetics, hyperthermia and cytotoxicity against developed CTC model in vitro. In vivo model in BALB/c mice equivalent to stage III and IV human metastatic breast cancer was developed to evaluate the biodistribution and therapeutic efficacy of micellar nanotheranostic system. Reduced CTCs in blood stream and low distant organ metastasis after treatment with the nanotheranostic system demonstrates its potential to capture and kill the CTCs that minimize the secondary tumor formation at distant sites.
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A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks
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Headache during pregnancy is a common complaint in the emergency room. In pregnancy, pituitary disorders include both hormone active and hormone inactive tumors. Apoplexy may be the first clinical presentation of an underlying pituitary tumor. Red flag signs of presenting symptoms, to be assessed for identifying life-threatening etiology. Various pathophysiological mechanisms have been passed for pituitary apoplexy in pregnancy. Magnetic resonance imaging of the brain is the gold standard investigation. The mainstay of management is the initiation of steroids. Transnasal transsphenoidal removal of the tumor is the definitive treatment that requires a multidisciplinary approach. The indications of surgery are the presence of symptoms due to compression and endocrine abnormalities; however, gestational period should be taken into consideration. We report a case of headache in antenatal women who presented to our emergency room diagnosed with pituitary apoplexy managed with steroids and early surgery, and discharged with good clinical outcome. We recommend a methodical approach to common symptoms that assist in diagnosing forgotten etiology.
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BACKGROUND: Congenital coronary artery anomalies are rare and are usually an incidental ?nding. The incidence of coronary anomalies was reported as 1.3% in a large number of patients undergoing coronary angiogram1. In this report we present a patient with a malignant right coronary artery (RCA) originating from left coronary sinus CASE REPORT:A 52 year old male came to cardiac OPD in view of ?tness for cataract surgery. He does not have any signi?cant cardiac history or symptoms. Coronary angiogram revealed Anomalous coronary artery arising from left coronary sinus with critical 99% lesion in the Mid RCA. The patient was taken up for Percutaneous transluminal coronary angioplasty and the Mid RCA lesion was addressed. CONCLUSION:The treatment plan for people with Malignant RCA should be based on an interdisciplinary decision made between the treating physician, patient, cardiovascular imaging experts, cardiologists and heart surgeons depending on symptoms, age, anatomic features of ACAOS and ischaemic testing.
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Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.
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Objective@#Dendritic cells (DCs) are administered as immunotherapeutic adjuvants after the completion of standard treatment in most settings. However, our Phase I trial indicated that one patient out of four, who received autologous tumor lysate-pulsed dendritic cell (TLDC) also received cisplatin chemotherapy and experienced complete regression of her lung lesion, continuing to be disease free till date. Hence, the objective of our current study is to evaluate the sustenance or augmentation of immune responses when autologous human papillomavirus positive cervical tumor lysate pulsed DC- are combined with cisplatin, using co-culture assays in vitro. @*Methods@#Before treatment, peripheral blood and punch biopsy samples were collected from 23 cervical cancer patients after obtaining an informed consent. DC functionality was confirmed through phenotypic and functional assays using autologous peripheral blood mononuclear cells as responders. For cisplatin experiments, the drug was added at 150, 200 (clinical dose equivalent), and 400 µM concentrations to DCs alone or DC-T cell co-cultures. Phenotypic assessment and functional characterization of DCs was done using flow cytometry. Cytokine enzyme-linked immunosorbent assay and interferon (IFN)-γ enzyme-linked immune absorbent spot assays were also performed. @*Results@#The functionality of TLDCs was not compromised upon cisplatin treatment in vitro even at the highest (400 μM) concentration. Even though cisplatin treatment reduced the secretion of IFN-γ and interleukin (IL)-12p40 in co-cultures stimulated with TLDCs, this effect was not significant (p>0.05). A doubling of IFN-γ secretion following cisplatin treatment was observed in at least one of three independent experiments. Additional experiments showed a reduction in both FOXP3+ regulatory T cells and IL-10 levels. @*Conclusion@#Our results provide evidence that cisplatin treatment may be given after autologous TLDC administration to maintain or improve a productive anti-tumor response in vaccinated patients.
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Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.
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Coronavirus disease 2019 (COVID-19) is inflicting a brutal blow on humankind, and no corner of the world has been exempted from its wrath. This study analyzes the chief control measures and the distinctive features of the responses implemented by Korea and the United States to contain COVID-19 with the goal of extracting lessons that can be applied globally. Even though both nations reported their index cases on the same day, Korea succeeded in flattening the curve, with 10 752 cases as of April 28, 2020, whereas the outbreak skyrocketed in the United States, which had more than 1 million cases at the same time. The prudent and timely execution of control strategies enabled Korea to tame the spread of the virus, whereas the United States paid a major price for its delay, although it is too early to render a conclusive verdict. Information pertaining to the number of people infected with the virus and measures instituted by the government to control the spread of COVID-19 was retrieved from the United States Centers for Disease Control and Prevention and the Korea Centers for Disease Control and Prevention websites and press releases. Drawing lessons from both nations, it is evident that the resolution to the COVID-19 pandemic lies in the prudent usage of available resources, proactive strategic planning, public participation, transparency in information sharing, abiding by the regulations that are put into place, and how well the plan of action is implemented.
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Objectives: Subclinical hypothyroidism (SCH) is a common disorder that is characterized by elevated thyroid-stimulating hormone levels in conjunction with free thyroxine concentrations within the normal reference range. Thyroid hormones are known to affect the heart and vasculature and, as a result, the impact of SCH on heart failure. Strong evidence points to a link between SCH and HF risk factors such as alterations in blood pressure, lipid levels, and atherosclerosis. Additionally, accumulating evidence indicates that SCH is associated with metabolic syndrome and heart failure. The present review proposes that SCH may be a potentially modifiable risk factor of heart failure and mortality. Methods: This is an observational study to determine the incidence of subclinical hypothyroidism in patients with heart failure and the cardiovascular risk profile among patients in a 750 bedded tertiary health care centre in south India, over a period from June 2018 to November 2018. Results: In our present study it was noticed that most of the patients were in the age group above 51-60 yrs (45.45 %). Our study data suggest that subclinical hypothyroidism with a TSH ≥10.0 mIU/L represents a potentially modifiable risk factor for HF in older adults but not subclinical hypothyroidism with moderate TSH levels (TSH 4.5 to 9.9 mIU/L) and subclinical hyperthyroidism. Conclusion: Subclinical hypothyroidism are more prone to associated with heart failure as an asymptomatic which is essential to be identified and treated for a better outcome as its association is proven statistically in our study.
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Introduction: Human respiratory syncytial virus (HRSV) an RNA virus belonging to Pneumoviridae family, is an important cause of acute respiratory infections (ARIs) in young children. HRSV circulates as two subgroups A and B, which are further categorised into several genotypes. New genotypes may replace existing ones over successive epidemic seasons and multiple genotypes may cocirculate in the same community rendering it important to monitor them at the molecular level. The present study assessed the circulating genotypes of HRSV in Chennai. Materials and Methods: Two hundred and sixty-seven children with ARI were recruited during the study from April 2016 to March 2018 for detecting HRSV A and B by real-time reverse transcription-polymerase chain reaction. Phylogeny and selection pressure analysis were done. Results: Fifty-seven of the 267 samples (21.3%) were positive for HRSV, of which 7.1% and 14.2% were HRSV A and B, respectively, indicating that HRSV B was the major subgroup circulating in Chennai. Peak activity of HRSV was observed during the monsoon and winter months. Phylogenetic analysis of 2nd hypervariable region (HVR) of attachment glycoprotein gene (G gene) revealed that the HRSV A strains belonged to ON1 and HRSV B strains belonged to BA9 genotypes. Several unique amino acid substitutions were observed among the study strains. The Shannon entropy plot revealed that the HRSV A strains from our study have a high potential for amino acid substitutions in the 2nd HVR of G gene. Conclusion: This study underlines the genetic diversity of HRSV and emphasises the need for continued molecular surveillance for infection management and prevention strategies.
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Background: Atherosclerosis has been described as a lipid driven inflammatory disorder of the arterial wall. Smoking is one of the most common modifiable risk factors for atherosclerosis and is the major epidemiological factor in increasing morbidity and mortality of chronic heart diseases (CHD). The objectives of this study were based on to estimate the status of lipid profile in both smokers and non-smokers and compare with each other, to predict the 10 years risk of cardiovascular risk based on Framingham score in smokers and non-smokers.Methods: This retrospective, case-control study was conducted among 50 smokers (cases) and 50 normal individuals (controls) attending to the department of medicine during the period between December 2016 and May 2018. The socio-demographic data and clinical history was obtained using a semi-structured questionnaire and then patients were subjected to blood investigations including estimation of lipid profile by CHOD/PAP method.Results: The mean age of the study participants was 34.7±2.9 years. The duration of smoking among the smokers was 5.4±2.9 years on an average. There was a significant increase in serum cholesterol levels (245.6±39.8 versus 155.8±15.2 mg/dl), serum triglycerides (217.3±42.2mg/dl versus 127.4±10.6), LDL (171.1±35.2 versus 85.7±15.1 mg/dl) and VLDL (43.5±10.5 versus 15.3±5.5mg/dl) among the smokers versus non-smokers. There was a significant (p<0.001) decrease in HDL levels among the smokers (30.8±3.4 mg/dl) when compared with the non-smokers (44.8±5.3 mg/dl). There was a highly significant difference between Framingham risk scores of smokers and non-smokers.Conclusions: The study established that the lipid profile was deranged towards atherogenesis among the smokers when compared to the non-smokers which was reflected in the significant increase in risk as calculated by Framingham risk score.
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nfluenza is a major public health concern. Information on theprevalence of influenza virus in respiratory tract infections inIndian children is very sparse. In the present study, 267 nasalswabs were collected from children with acute respiratoryinfections in Chennai, India, out of which 22 (8.2%) and 6 (2.3%)samples were positive for influenza A and B virus respectively.