Atrial Fibrillation Presenting with Acute Abdomen in an Elderly Patient - A Case Report

A 63 years old male patient was admitted with complaints of acute pain in abdomen and nausea since 1 day. He had no history of chest pain, palpitations, shortness of breath, orthopnoea, paroxysmal nocturnal dyspnoea. There was no history of constipation or obstipation, vomiting’s, haematuria, or oliguria. Patient had a past history of systemic hypertension, diabetes, IHD since last 8 years. He was non-smoker, non-alcoholic. On examination, he was mesomorphic, febrile, had pulse rate of 146 bpm, irregularly irregular, his blood pressure was 134 / 86 mmHg. He had bilateral pitting oedema feet and on abdominal examination, there was diffuse tenderness in all the quadrants of abdomen. Guarding or rigidity over the abdomen was absent.ECG was suggestive of atrial fibrillation with fast ventricular rate as shown in figure 1. Haemoglobin 12.8 gm per dL, WBC - 24,900 cells / cumm, CKMB - 6, Troponin I was negative, serum cholesterol - 95 mg / dL, serum triglycerides - 91 mg / dL, LDL - 63 mg / dL, VLDL - 18 mg / dL, HDL - 14 mg / dL, serum LDH - 382 U / L, CRP - raised, D - dimer was positive, CHA2DS2 - VASC score was 4 and HAS - BLED score was 3. In view of persistent acute pain in abdomen, he underwent CECT abdomen which was suggestive of hepatosplenomegaly with hyper dense liver with multiple splenic and renal infarcts as shown in figure 2. 2D ECHO findings were dilated cardiomyopathy with congestive cardiac failure (ischemic) with 40 % left ventricular ejection fraction. He underwent coronary angiography, which revealed ischemic heart disease.

Process of Developing the Online Certification Tests for Research Project Trainees and Assessing the Feasibility for Adaptation in Maternal and Child Health Projects.

An innovation launched by Datta Meghe Institute of Medical Sciences emphasized on promoting early child development through govt. Anganwadi centers under the project ‘Stepping Stones’. The innovation includes delivery of Enhanced Anganwadi Curriculum and Parenting Sessions through home visits by trained Anganwadi Workers with support from Community Health Workers. A system of computerized online and of training certification test was developed. This paper outlines the results of feasibility and acceptance of this system by Community Health Workers in maternal and child health programs.METHODSPre-tested questionnaire with questions on different aspects of certification test and responses with Likert-type scoring scale was provided to 30 randomly selected community health workers trained by DMIMS. Weighted means of total scores for agreement/disagreement for feasibility and acceptability questions was calculated.RESULTSAverage Weighted Mean of 4.07 demonstrated a strong agreement by all participants towards the feasibility and acceptability of this test. 47.67% candidates showed strong agreement.CONCLUSIONSSuch type of tests can be framed and utilized as, time saving screening, and certification test, for different types of community healthcare cadre.

Stimulating Home Environment for Early Childhood Development by Household Play Materials for Under 5 Rural Children in Forest Buffer Zone of Wardha District.

Home Environment of a child comprises of toys, books and stimulating play materials which are critical for promoting early development. Parents, family and atmosphere at home play a key role in stimulating child’s physical, cognitive and socio-emotional developments. This assessment was done in rural settings of forest buffer zone of Bor Tiger Sanctuary in Vidarbha to have a baseline picture about availability of play materials at households that promote child development and parent’s view about these play materials.METHODSThis was a cross-sectional survey which included assessment of 894 households in 45 villages from Seloo block of Wardha district. Survey tools included pretested questionnaire and home observation checklist which was administered at home visit and during interviews of parent-child dyads. Data was collected in android based ODK app and exported to server. Data imported from server was analysed using STATA-11.RESULTSAvailability of play materials as represented by Mean Item Availability Score (MIAS) was significantly associated with family structure, wealth index and parent’s education and occupation. Though 84.2% households had materials for moving around and outdoor play, only 26.9% households had materials for promoting coordinated gross-motor movements, 41.6% households had materials meant for stacking, constructing. Only 19.8% households had materials for learning shapes and colours, 29.8% households had picture books/charts, 32.4% households had materials for drawing and writing and only 11.3% children had materials promoting counting.CONCLUSIONSObvious gap can be seen in terms of paly materials available for under 5 children in rural and urban settings. Remote rural areas in this region need a well framed parenting program to sensitise parents about Early Child Development that can be blended with the existing ICDS program

Role of Ghrelin in regulation of growth hormone secretion by Ghrelin-Pituitary-GH axis linkage.

Background: Ghrelin is the endogenous ligand of the growth hormone (GH) secretagogue receptor and is the first hormone linking gastrointestinal-pituitary axis. Actions of ghrelin on GH secretion provide a strong force for envisioning that one of the major role of ghrelin could be the regulation of secretion of GH. Aims & Objective: To explore the intriguing dimensions on the possible physiological role of the Ghrelin /GHRP system. Materials and Methods: The search was performed in electronic databases (Medline, Embase, Cochrane, Google scholar) and by hand searching by 2 reviewers. Clinical trials (Randomised and non-randomised trials), review articles, systematic reviews, conference proceedings and meta-analysis were included in the study. Results: Ghrelin stimulates strong increase in circulating GH levels both in vitro and in vivo in a dose-dependent manner. Human or animal ghrelin was found to be significantly more potent than a synthetic GHS, hexarelin. The regulation of GH by Ghrelin is influenced by various other factors like autonomic nervous system, GHRH, IGF-1, anterior pituitary hormones, obesity, etc. Conclusion: Ghrelin is a specific endogenous ligand for the GHS receptor and suggests the existence of a GHS–GHS receptor signaling system in the regulation of GH secretion. Stomach-ghrelin - pituitary-GH axis links nutritional intake to regulation of GH secretion. However, the mechanism underlying the feedback actions of GH on the regulation of ghrelin remains unanswered. Under physiological conditions, ghrelin administered either centrally or peripherally, exerts a potent, time-dependent stimulation of pulsatile secretion of GH by ghrelin-pituitary-GH axis.