Dois anos de pandemia da COVID-19: implicações para as salas de hemodinâmica e suas práticas atuais / Two years into the COVID-19 pandemic: implications for the cardiac catheterization laboratory and its current practices

A COVID-19 continua a sobrecarregar os sistemas de saúde. No auge da pandemia, os serviços de hemodinâmica do mundo todo tiveram redução significativa no volume de procedimentos devido a vários motivos, incluindo redistribuição de recursos médicos, alocação dos cardiologistas intervencionistas em alas da COVID-19 e preocupações dos médicos e pacientes com a transmissão viral. Em especial, as intervenções para doença cardíaca estrutural tiveram queda importante ­ de mais de 90% do volume. Para enfrentar esses desafios, os sistemas de saúde empregaram novas medidas de segurança e protocolos, incluindo pré-teste com reação em cadeia da polimerase para COVID-19, Equipamentos de Proteção Individuais e exigência de vacinação para garantir a segurança de pacientes e trabalhadores da saúde. Embora tais medidas tenham abordado parcialmente as questões de segurança, o diagnóstico e o tratamento da injúria miocárdica aguda permaneceram desafiadores durante a pandemia. Enquanto os mecanismos fisiopatológicos que causam injúria miocárdica não estão completamente elucidados, a maioria dos estudos sugere que a COVID-19 seja uma doença pró-inflamatória, associada a um estado de hipercoagulabilidade. Os estudos randomizados em andamento avaliam a eficácia de regimes antitrombóticos mais agressivos na COVID-19. Além disso, a apresentação de síndrome coronariana aguda junto da COVID-19 é variável, mais provavelmente atípica, tardia e está associada a altas taxas de eventos cardiovasculares adversos e óbito. É necessário implementar protocolos para agilizar diagnóstico, triagem e tratamento de pacientes com síndrome coronariana aguda, e também minimizar o risco de transmissão viral para os funcionários do hospital. A intervenção coronariana percutânea robótica oferece uma solução em potencial para as diversas questões de segurança enfrentadas pelos cardiologistas intervencionistas na era da COVID-19. Porém, ela também se apresenta com seu conjunto de limitações.

COVID-19 continues to overwhelm healthcare systems. During the peak of the pandemic, cardiac catheterization labs across the world observed a significant decrease in procedure volumes due to several reasons, including reallocation of medical resources, deployment of interventional cardiologists to the COVID-19 wards, and physician and patient concerns about viral transmission. In particular, structural heart disease interventions experienced a significant reduction in volume by more than 90%. To address these challenges, healthcare systems employed new safety measures and protocols, including COVID-19 rapid polymerase chain reaction pretesting, Personal Protective Equipment, and vaccination mandates to ensure safety of patients and healthcare workers. Although these measures partly addressed safety concerns, diagnosis and management of acute myocardial injury remained challenging throughout the pandemic. While the pathophysiological mechanisms leading to myocardial injury is not fully elucidated, most studies have suggested COVID-19 is a pro-inflammatory disease associated with a hypercoagulable state. Ongoing randomized studies are evaluating the efficacy of more aggressive antithrombic regimens in COVID-19. In addition, the presentation of acute coronary syndrome with concomitant COVID-19 infection is variable, more likely atypical, delayed, and is associated with higher rates of adverse cardiovascular events and death. It was necessary to implement protocols to expedite diagnosis, triage and management of patients with acute coronary syndrome, while minimizing the risk of viral transmission to hospital staff. Robotic percutaneous coronary intervention may offer in the future a potential solution to many of the safety concerns faced by interventional cardiologists during the COVID-19 era; however, it has its own set of limitations.

Profile of neonatal mortality in special newborn care unit of tertiary care hospital

Background: In India presently around 8 million LBW infant are born each year. India accounts for 24% of global neonatal mortality. Improving NMR is an essential component of reducing U-5MR. The aim of this study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods:' This study was conducted at SNCU of Kamala Raja Hospital, Gwalior providing level III neonatal care. This is a retrospective hospital based observational study. Data from SNCU online database were taken for a period of 3 year from March 2016 to March 2019. Data obtained included sex, birth weight, Gestation age, morbidity profile, Diagnosis, and Mortality profile, Duration of stay and outcome. Categorical variables were tabulated and Statistical analysis was done.Results:' A total of 12,027 neonates were recruited, 63.07% were males and 36.92% were females. 54.87% were extramural, while 45.13% were intramural neonates. Prematurity was the most common morbidity 56.98% in the admitted neonates. Major contributors to the neonatal morbidity were Birth asphyxia (24.61%), others (21.60%), Respiratory Distress(14.06%), Sepsis(13.77%). The mortality rate in the present study is 25.45%. Major contributors for neonatal mortality includes Respiratory distress (37.76%), Birth Asphyxia (26.75%), Sepsis(13.91%). Mortality was more in out born babies 33.03% compared to inborn babies 22.03%.'Conclusions:' Improving antenatal care, more deliveries at institutions with SNCU facility, improved access to health facility, early identification of danger signs,'' timely referral of high risk cases, capacity building, can reduce neonatal mortality and its complications.

Calculation of dose volume parameters and indices in plan evaluation of HDR interstitial brachytherapy by MUPIT in carcinoma cervix

BACKGROUND: Evaluation of a HDR- interstitial brachytherapy plan is a challenging job. Owing to the complexities and diversity of the normalization and optimization techniques involved, a simple objective assessment of these plans is required. This can improve the radiation dose coverage of the tumour with decreased organ toxicity. AIM: To study and document the various dose volume indices and parameters required to evaluate a HDR interstitial brachytherapy plan by Volume normalization and graphical optimization using MUPIT (Martinez Universal Perineal Interstitial Template) in patients of carcinoma cervix. SETTINGS AND DESIGN: Single arm, retrospective study. METHODS AND MATERIALS: 35 patients of carcinoma cervix who received EBRT and HDR brachytherapy using MUPIT, were selected. The dose prescribed was 4 Gray/Fraction in four fractions (16Gy/4) treated twice daily, at least 6 hours apart. CTV and OARs were delineated on the axial CT image set. Volume normalization and graphical optimization was done for planning. Coverage Index (CI), Dose homogeneity index (DHI), Overdose index (OI), Dose non-uniformity ratio (DNR), Conformity Index (COIN) and dose volume parameters i.e. D2cc, D1cc, D0.1cc of rectum and bladder were evaluated. STATISTICAL ANALYSIS: SPSS version 16 was used. RESULTS AND CONCLUSION: CI was 0.95 ± 1.84 which means 95% of the target received 100% of the prescribed dose. The mean COIN was 0.841 ± 0.06 and DHI was 0.502 ± 0.11. D2cc rectum and bladder was 3.40 ± 0.56 and 2.95 ± 0.62 respectively which was within the tolerance limit of this organs. There should be an optimum balance between these indices for improving the quality of the implant and to yield maximum clinical benefit out of it, keeping the dose to the OARs in limit. Dose optimization should be carefully monitered and an institutional protocol should be devised for the acceptability criteria of these plans.

Brassinosteroids Reciprocates Heavy Metals Induced Oxidative Stress in Radish by Regulating the Expression of Key Antioxidant Enzyme Genes

ABSTRACT Heavy metal toxicity in plants lead to accumulation of reactive oxygen species (ROS). Antioxidant enzyme system is also not able to revert altered ROS homeostasis. The present study reports the heavy metal induced ROS toxicity by up-regulating the expression of key antioxidant enzyme genes through Brassinosteroids pre-soaking treatment in radish.

Seasonal abundance of Henosepilachna vigintioctopunctata (Fab.) on Solanum melongena L. and natural occurrence of its two hymenopteran parasitoids

ABSTRACT The 28-spotted hadda beetle Henosepilachna vigintioctopunctata Fab. (Coleoptera: Coccinellidae) is a poly-phagous pest, commonly infesting solanacious crops including brinjal, Solanum melongena L. Upon its severe infestation on brinjal, it causes considerable damage to the foliage and also to the calyx of fruits. The studies were made to record the seasonal abundance of hadda beetle and identification of its natural enemies present in the region for two consecutive years. The pooled data for two years showed that the maximum number of H. vigintioctopunctata egg clusters on brinjal were recorded in the 27th (0.40 egg cluster/ plant), followed by grub population in 35th (3.78 grubs/ plant), pupae in 33rd and 39th (0.83 pupae/ plant) and adult beetles in 36th (5.48 adults/ plant) standard meteorological weeks, respectively. It was observed that the key meteorological factors had 35.9%, 87.3%, 66.8% and 81.9% effect on the abundance of egg clusters, grubs, pupae and adults respectively in summer planted brinjal crop. Two natural enemies of hadda beetle viz. Tetrastichus sp. (egg parasitoid) and Pediobius foveolatus (pupal parasitoid) were recorded. The maximum parasitisation by Tetrastichus sp. and P. foveolatus on the egg clusters and pupae was recorded 22.64% and 6.62% respectively, during the month of August (34th and 35th standard meteorological week respectively). Further, the morphometric parameters of these two adult parasitoids were recorded and greater morphometric variability was observed in P. foveolatus in comparison to Tetrastichus sp.

Seasonal dynamics and management of whitefly ( Bemesia tabaci Genn.) in tomato ( Solanum esculentum Mill.)

ABSTRACT Studies on seasonal dynamics of white fly (Bemesia tabaci) on tomato (Solanum esculentum var. Pusa Ruby) revealed that it appeared first during the 13th and reached maximum during 21st standard meteorological week. A positive correlation between adult population and abiotic factors viz. temperature (maximum and minimum) and sunshine hours was observed, whereas humidity (maximum and minimum) and rainfall showed a negative correlation with it. Taken together, the key weather parameters studied, caused 89.00 per cent variation in whitefly population (R2 value). Combination of carbofuran (soil application) + imidacloprid (seed treatment ) + imidacloprid (foliar application) proved significantly superior and caused maximum reduction in whitefly population followed by imidacloprid (seed treatment) + thiomethoxam (spray), imidacloprid (seed treatment) + imidacloprid (spray), imidacloprid (seed treatment) + dimetheoate (spray), carbofuran (soil application) + malathion (spray), and imidacloprid (seed treatment) + yellow sticky traps. The highest cost benefit ratio of 1:25.04 was recorded in case of carbofuran (soil application) + imidacloprid (seed treatment ) + imidacloprid (foliar application) followed by 1:22.38 for imidacloprid (seed treatment) + thiomethoxam (spray) ; 1:21.81 for imidacloprid (seed treatment) + imidacloprid (spray); 1:19.27 imidacloprid (seed treatment) + dimetheoate (spray); 1:19.48 carbofuran (soil application) + malathion (spray), and 1:8.33 for imidacloprid (seed treatment) + yellow sticky traps. The soil application of carbofuran + seed treatment with imidacloprid and three foliar sprays of imidacloprid at fortnight interval starting 40 days after transplanting is found effective and is advised for whitefly management in susceptible tomato cultivars.

An overview of gene therapy in head and neck cancer.

Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA) and RNA interference‑based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction and expression, mediation of apoptosis and clinical response including pathological complete responses. The objective of this article is to provide an overview of the current available gene therapies for head and neck cancer.

Impact factor and other standardized measures of journal citation: a perspective.

The impact factor of journals has been widely used as glory quotients. Despite its limitations, this citation metric is widely used to reflect scientific merit and standing in one's field. Apart from the impact factor, other bibliometric indicators are also available but are not as popular among decision makers. These indicators are the immediacy index and cited half-life. The impact factor itself is affected by a wide range of sociological and statistical factors. This paper discusses the limitations of the impact factor with suggestions of how it can be used and how it should not be used. It also discusses how other bibliometric indicators can be used to assess the quality of publications.