Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

Visual impairment and blindness due to retinitis pigmentosa in India: 15-year follow-up of the Andhra Pradesh Eye Disease Study cohort

Purpose: To assess the incidence, visual impairment, and blindness due to retinitis pigmentosa (RP) in a rural southern Indian cohort. Methods: This is a population?based longitudinal cohort study of participants with RP from the Andhra Pradesh Eye Disease Study (APEDS) cohorts I and III, respectively. The study included participants with RP of APEDS I who were followed until APEDS III. Their demographic data along with ocular features, fundus photographs, and visual fields (Humphrey) were collected. Descriptive statistics using mean ± standard deviation with interquartile range (IQR) were calculated. The main outcome measures were RP incidence, visual impairment, and blindness as per the World Health Organization (WHO) definitions. Results: At baseline (APEDS I), 7771 participants residing in three rural areas were examined. There were nine participants with RP with a mean age at baseline of 47.33 ± 10.89 years (IQR: 39–55). There was a male preponderance (6:3), and the mean best?corrected visual acuity (BCVA) of 18 eyes from nine participants with RP was 1.2 ± 0.72 logarithm of minimum angle of resolution (logMAR; IQR: 0.7–1.6). Over a mean follow?up duration of 15 years, 5395/7771 (69.4%) were re?examined, which included seven RP participants from APEDS 1. Additionally, two new participants with RP were identified; so, the overall incidence was 370/ million in 15 years (24.7/million per year). The mean BCVA of 14 eyes of seven participants with RP who were re?examined in APEDS III was 2.17 ± 0.56 logMAR (IQR: 1.8–2.6), and five of these seven participants with RP developed incident blindness during the follow?up period. Conclusion: RP is a prevalent disease in southern India that warrants appropriate strategies to prevent this condition.

Effects of air exposure, time, temperature, and humidity on different serum electrolytes

Background: Pre-analytical, analytical, or post analytical variations can induce, change, or alter the tests results. Laboratory errors lead to unnecessary delays in test report and also increased costs by repeat samples which have become a pain to the patients. Aims and Objectives: The aims of this study were to determine alterations in the concentration of serum sodium (Na+), potassium (K+), and ionized calcium (Ca++) concentration with reference to air exposure, time, temperature, and humidity. Materials and Methods: Fifty samples as case and 50 samples as control were included from a normal healthy population in this study. After getting the samples, first readings were taken for case samples and were uncapped and the remaining samples were set aside capped at 24°C, 20% humidity for half an hour and followed by second reading which was taken. Results: Variation in the mean serum sodium between groups is 0.06 mEq/L (0.04%) and 0.08 mEq/L (0.07%) which is very negligible and insignificant (P > 0.05). The mean level of serum K+ in cases is 4.35 mEq/L and in controls is 4.27 mEq/L. After half an hour, the mean level of serum K+ in cases is 4.51 mEq/L and, in controls, is 4.29 mEq/L. Hence, the variation in results in cases is 0.16 mEq/L (3.68%) and in controls is 0.02 mEq/L (0.47%) which is highly significant (P < 0.05). The mean level of serum Ca++ in cases is 1.15 mmol/L and in controls is 1.17 mmol/L. After half an hour, the mean level of serum Ca++ in cases is 1.09 mmol/L and in controls is 1.16 mmol/L. Hence, the variation in results in cases is 0.06 mmol/L (5.22%) and in controls is 0.01 mmol/L (0.85%) which is highly significant (P < 0.05). Conclusion: Air exposure significantly alters the serum K+ and Ca++ level, but the alteration in serum Na+ level is not significant.

Renewal of embryonic and neonatal-derived cardiac-resident macrophages in response to environmental cues abrogated their potential to promote cardiomyocyte proliferation via Jagged-1-Notch1

Cardiac-resident macrophages (CRMs) play important roles in homeostasis, cardiac function, and remodeling. Although CRMs play critical roles in cardiac regeneration of neonatal mice, their roles are yet to be fully elucidated. Therefore, this study aimed to investigate the dynamic changes of CRMs during cardiac ontogeny and analyze the phenotypic and functional properties of CRMs in the promotion of cardiac regeneration. During mouse cardiac ontogeny, four CRM subsets exist successively: CX3CR1+CCR2-Ly6C-MHCII- (MP1), CX3CR1lowCCR2lowLy6C-MHCII- (MP2), CX3CR1-CCR2+Ly6C+MHCII- (MP3), and CX3CR1+CCR2-Ly6C-MHCII+ (MP4). MP1 cluster has different derivations (yolk sac, fetal liver, and bone marrow) and multiple functions population. Embryonic and neonatal-derived-MP1 directly promoted cardiomyocyte proliferation through Jagged-1-Notch1 axis and significantly ameliorated cardiac injury following myocardial infarction. MP2/3 subsets could survive throughout adulthood. MP4, the main population in adult mouse hearts, contributed to inflammation. During ontogeny, MP1 can convert into MP4 triggered by changes in the cellular redox state. These findings delineate the evolutionary dynamics of CRMs under physiological conditions and found direct evidence that embryonic and neonatal-derived CRMs regulate cardiomyocyte proliferation. Our findings also shed light on cardiac repair following injury.

Assessment and Applicability of Various Elements of Quality Assurance in Histopathology Laboratory: A Study from A Tertiary Care Hospital in Eastern Region of India

Background Quality control in histopathology is rela?vely newer concept and less understood because of its subjec?vity. Aim:The present study was conducted to assess and determine applicability of the different elements of quality assurance in the histopathology laboratory of a ter?ary care hospital in eastern region of India. Material and methods: An observa?onal, retrospec?ve and analy?c study for one year and three months was conducted. 2000 samples were selected by simple random sampling including the biopsy specimens and cell blocks received in the histopathology laboratory. Results:Of the 2000 samples, 1880 (94%) were accepted and 120 rejected (6%) due to mainly pre analy?cal factors. Of the rejected samples, 35 samples (29.2%) were without proper fixa?ve, 48 samples (40%) had incomplete requisi?on forms, 37 samples (30.8%) had incomplete/ absent clinical history. Lack of adherence to standard ?ssue fixa?on protocols were observed in 55 cases (2.75%). Inadequate preven?ve maintenance and delay in renewal of maintenance contracts were the most common cause of failure of maintenance of equipment. Improper staining was found in 35 cases (1.75%). Grossing of specimens were inadequate in 104 cases (5.2%). Concurrence in diagnosis was found in majority cases (1892 cases, 94.6%). Random case review was done with adequate precision (97.5%) and accuracy (96.6 %). Maintenance of turnaround ?me was found in most cases (1800 cases, 90%). Conclusion: Standard opera?ng procedures, training of staffs, equipment maintenance, alertness to maintain turnaround ?me and awareness, proper report documenta?on and storage are the key factors to successfully uphold quality assurance.

Blood Stream Infection Caused by Carbapenem-resistant Chryseobacterium indologenes Harboring blaNDM-1 Gene Isolated from a Tertiary Care Hospital in Tripura: An Emerging Threat

Objectives: Chryseobacterium indologenes has recently been identified as an inherently drug-resistant organism, responsible for a wide spectrum of infections, mainly device-associated infections in hospital settings. The presence of carbapenem resistance due to blaNDM-1 metallo-?-lactamase (MBL) gene further complicates the matter, leading to widespread dissemination of carbapenem resistance. This study aims to find out the presence of blaNDM-1 gene among C. indologenes strains causing bloodstream infections in a tertiary care hospital. Materials and methods: During 1 year of the study period, blood culture samples were collected from patients with features of bacteremia, and C. indologenes strains were isolated and identified as per protocol. Antibiotic sensitivity test was performed by using VITEK 2 Compact Automated AST machine (Biomerieux, France). Carbapenem-resistant strains were subjected to a combined disk diffusion test for detecting the presence of MBL enzyme. Strains positive for MBL production were subjected to a polymerase chain reaction (PCR) for detection of blaNDM-1 gene. Results: Out of 21 strains isolated during the study period, 12 strains (57.1%) were carbapenem-resistant. Among them, seven strains (58.3%) were MBL producers. After PCR, 3 strains (42.9%) were found to be harboring blaNDM-1 gene Discussion: As per our knowledge, this is the first report of blaNDM-1 gene harboring C. indologenes strain from Northeast India. This shows the emerging therapeutic dilemma due to the narrowing of treatment options against bloodstream infections due to C. indologenes strains. Strict antimicrobial stewardship has to be implemented to prevent the further compounding of the problem.

Efficacy and Safety of Transdermal Buprenorphine Patch for Cancer Pain Relief in Elderly Patients : A Retrospective Study from a Tertiary Care Centre of Eastern India

Cancer is one of the leading causes of morbidity and mortality worldwide & cancer pain is experienced by patients with advanced, metastatic and terminal disease. Buprenorphine, a partial µ-receptor agonist and antagonist at the kopioid receptor, shows no clinically relevant accumulation of active metabolites, and pharmacokinetics remain unchanged in renal insufficiency. In elderly cancer patients, the use of opioids for control of cancer pain is a therapeutic challenge, as these group of patients often associated with renal and hepatic comorbidity that limited the use of strong opioids like morphine. Methods : A retrospective observational study was conducted in elderly patients to estimate the efficacy of transdermal buprenorphine patch for controlling of cancer pain as well as to assess the safety of the patch. For pain control Numerical Rating Score (NRS) was used & for safety assessment Grade 3 or 4 toxicity were recorded.Hepatic & renal toxicity were measured at baseline, at 1st month & at 3rd month of treatment & lastly at 6th month of treatment. Results : Majority of the patients showing good to excellent global satisfaction with Buprenorphine patch and 57% of patients suffered from constipation along with 38% nausea & vomiting. It was found that there was a significant reduction in pain intensity from baseline with a p value of <0.05. There was no significant hepatic or renal toxicity found in the study. Conclusion : Transdermal buprenorphine patch is effective and safe in elderly cancer patients for pain control. Further studies should be performed in order to find safe and effective opioid methods necessary to give greater insight into the difficult balance between analgesia and toxicity

Patterns and outcomes of empirical antimicrobial use in elderly outpatients: A pilot observational study from North India

Introduction: Despite the rampant use of antimicrobials in health?care settings, the safety and clinical outcome data of antimicrobials are scarce in the elderly population. The main aim of this study is to assess the prescription pattern, therapeutic gains, and adverse reactions resulting out of antimicrobial use in elderly outpatients. Subjects and Methods: This was a prospective observational study conducted for 7 months from June 2019 to December 2019 in elderly patients visiting the geriatric outpatient department of a tertiary hospital of North India. Primary outcomes included clinical improvement as well as the incidence and type of adverse drug reactions (ADRs) observed with antimicrobial use. Results: Of 110 participants recruited, 107 were assessed for clinical outcomes. The common indications of antimicrobial use were lower respiratory tract infection (48.6%), urinary tract infection (18.7%), and worm infestations (14%). Macrolides (57%) and beta?lactams (43%) were the commonly prescribed individual antimicrobials. Outcome?wise, clinical improvement was seen in 91.3%, 88.5%, and 14.3% of patients receiving beta?lactams, macrolides, and antiprotozoals, respectively. ADRs occurred in 17.7% of participants and gastrointestinal disturbance was the commonly reported ADR. Beta?lactams and macrolides were responsible for the majority of ADRs, in 19.6% and 13.1% of participants, respectively. No association of antimicrobial?associated clinical responses or ADRs was observed with demographics and underlying comorbidities. Conclusions: Elderly patients with respiratory tract infections showed improvement with empirical extended-spectrum beta-lactams and azithromycin therapy. The response was suboptimal to empirically selected antiprotozoal therapy. Elderly patients are at increased risk of ADRs. Close to one out of every five elderly prescribed beta?lactams may develop ADR to the antimicrobial agent. Larger clinical studies are required to predict the risk factors of ADRs and poor responsiveness to antimicrobials.

COVID-19 Lockdown and Improvement in Air Quality Index: A Learning Lesson

Introduction: The basic requirements for human survival include air, food, and water; a decrease in quality of which has a deep impact on health. An increase in population with increasing globalization, industrialization, and increased energy demand has led to increased air pollution in cities world over. Multiple national programs to improve air quality have been unsuccessful. Coronavirus disease 2019 (COVID-19) pandemic-led lockdown is a large-scale experiment that is unprecedented and could not have been done at regular times. Indirect effects include cutting down emissions from industries, vehicles, and diesel generators. Materials and methods: In this ambispective observational study, we compared the air quality index (AQI) and levels of other pollutants in the two cities of Delhi and Kanpur during the period of the lockdown, the same period during the preceding year, and during the rainy season. Results: It was observed that the cities of India with notoriously polluted air, i.e., Delhi and Kanpur, had unprecedented improvement in air quality during lockdown (Delhi, AQI: 86.91 � 32.38 vs 249.36 � 60.25 and Kanpur, AQI: 81.60 � 38.54 vs 137.06 � 46.74). The improvement was even better than the preceding year's monsoon for Delhi. The AQI was comparable in both cities during the lockdown. Conclusion: The AQI was falling in the 搒atisfactory� range in both Delhi and Kanpur during the lockdown. This may, in turn, favorably unfold a reduction in the incidence, progression, and exacerbation of respiratory illnesses. This is an eye-opening change and calls for urgent action to maintain the same. Timely and well-framed steps should be sought; a revolutionary carbon-free and green energy economic model is much needed. Most air pollution is preventable and can be managed by humans if a stringent action plan is rolled out and implemented sternly by government agencies.

A comparison of lens parameters in patients with various subtypes of primary angle-closure disease and the normal population: A prospective study

Purpose: To assess the role of lens parameters in the detection and progression of primary angle-closure disease (PACD) by combining A-scan and A-scan optical coherence tomography (AS-OCT) parameters. Methods: A cross-sectional study was conducted in a tertiary health-care center in eastern India. A total of 91 study subjects including cases and controls were included in the study. The parameters studied were lens thickness (LT), lens axial factor (LAF), relative lens position (RLP), and lens vault (LV). Anterior chamber depth (ACD) and axial length (AL) were also analyzed using A-scan. Results: The LT was significantly more in all subtypes of PACD (from 4.24 ± 0.84 to 5.02 ± 0.18 mm) than in controls (4.04 ± 0.46 mm; P < 0.01). Similarly, LAF was significantly less among all subtypes of PACD compared to controls (P < 0.001). The RLP, calculated using the formula (ACD + 0.5 LT)/AL × 10, showed no significant difference (P > 0.05) between various study groups. The LV in acute angle-closure glaucoma (AcCG) patients was significantly higher compared to the control population (P < 0.01). Ocular parameters like ACD decreased, whereas LT and LAF increased from normal through primary angle closure (PAC) to primary angle-closure glaucoma (PACG). Logistic regression analysis found a significant association between a decrease in ACD and an increased risk of PACG (P-value was 0.0001) and an increase in LT and LAF with increased risk of PACG (P = 0.040 and P = 0.006, respectively). Conclusion: Inclusion of lens parameter assessment in the workup of a patient with PACD helps in detection and close monitoring of the progression from suspected to disease state.

Phenotypic variations in ocular features among siblings with oculocutaneous albinism

Purpose: To assess the clinical profiles, presenting ocular features, and variations in the phenotypic features in siblings with oculocutaneous albinism (OCA). Methods: Electronic medical records of consecutive siblings diagnosed with albinism from January 2016 to December 2020 were reviewed to identify the affected siblings. The variations in their phenotypic characteristics were studied. Results: Significant variations were observed in the clinical features between the siblings (n = 42). A difference of >2 lines in visual acuity was observed in 50% (n = 21) of the sibling pairs. Compound hyperopic astigmatism was the commonest refractive error. The refractive status was different in 80.95% (n = 34) pairs. Although individually strabismus and abnormal head posture were observed in one?third and one?fourth of individual children, respectively, both siblings with similar strabismus were seen in only 16.67% (n = 7) and with a similar abnormal head posture in 13.33% (n = 5). Nystagmus was the most consistent finding across these siblings with a similar nature of horizontal jerk or pendular in 65% of sibling pairs. Conclusion: This study observed significant variations in phenotypic presentations among siblings with OCA. Such differences in clinical manifestations and severity would be helpful in appropriate counseling of these families as the need for rehabilitation services is likely to vary across siblings

Is there any correlation between tumor infiltrating lymphocytes and expression of EGFR in squamous cell carcinoma of head and neck? A retrospective observational study

Background: The dismal survival of one of the commonest malignancies of the world, head neck squamous cell carcinomas (HNSCC), has prompted researchers to probe into its various characteristics, especially those which reflect the outcome. Over the years, even though epidermal growth factor receptor (EGFR) and tumor-infiltrating lymphocytes (TIL) have emerged as useful biomarkers of the disease, the two parameters have rarely been considered in conjunction. Aims and Objectives: The study aimed to assess if there is any correlation between TIL levels (both stromal and intratumoral) and site, grade, stage, and EGFR score of HNSCC. Materials and Methods: A retrospective observational study was conducted in which histopathologically confirmed cases of HNSCC were included. The site of tumor, grade, stage, stromal and intratumoral TIL levels, and EGFR score were noted for each case. The data were analyzed using standard statistical tests. Results: The study population consisted of 122 patients with a mean age of 53.8 ± 9.2 years. The oral cavity was the commonest site of tumor (109 cases, 89.3%). Most cases were moderately differentiated (75, 61.5%). Pathological staging showed 66 cases (54%) to be in pT1, and 92 cases (75.4%) to be in pN0. In 68 cases (55.7%), stromal TIL level was high, and intratumoral TIL was low in 102 cases (83.6%). A statistically significant correlation was found between TIL levels and site, grade, pathological stage, and EGFR score of HNSCC. Conclusion: This pioneering study is unique in its exploration of the correlation between two significant biomarkers of HNSCC – TIL and EGFR score.

LDBio Aspergillus immunochromatographic test lateral flow assay for IgG/IgM antibody detection in chronic pulmonary aspergillosis: Single-centre evaluation and meta-analysis

Purpose: Chronic pulmonary aspergillosis (CPA) is an infection of the lung usually caused by Aspergillus fumigatus in patients with pre-existing pulmonary diseases. Its diagnosis hinges on demonstrating IgG antibodies against A. fumigatus. Herein, we evaluated the performance of a newly introduced point of care test (POCT) kit, the LDBio Aspergillus IgG/IgM lateral flow assay (LFA) in India with the standard ImmunoCAP kit for diagnosing CPA. Methods: A total of 60 serum samples (30 CPA cases and 30 controls) were evaluated by the Aspergillus immunochromatographic test (ICT) IgG/IgM LFA. Fluorescent-enzyme immunoassay was used to determine specific A. fumigatus-IgG concentrations (positive >27 mgA/L). Further, a systematic review and meta-analysis of studies (up to August 26, 2021) reporting the performance of LDBio ICT for the diagnosis of CPA was performed. Result: A sensitivity of 86.7%, specificity of 90%, negative predictive value of 87.1%, positive predictive value of 89.7%, negative likelihood ratio of 0.15, positive likelihood ratio of 8.67, and was observed for the LDBio IC. There was good agreement between LDBio ICT and ImmunoCAP (88.3%) with a Cohen's Kappa score of 0.77. Our systematic review identified four studies and the pooled sensitivity of 90%, specificity of 91%, area under the curve of 0.94 and diagnostic odds ratio of 57.2, for CPA diagnosis by LDBio ICT. Conclusion: Aspergillus LDBio ICT assay exhibits good sensitivity and can be used to screen CPA cases

Outcome of Concurrent Chemoradiation in Inoperable Muscle Invasive Urothelial Carcinoma of Urinary Bladder in terms of Locoregional Response and Toxicities — A Longitudinal Study in a Tertiary Care Hospital

Background : The presenting study was performed to assess the efficacy in terms of tumour response and toxicity profile of a curative intent organ preservation approach in Inoperable Non-metastatic Muscle-Invasive Urinary Bladder Carcinoma. Materials and Methods : Prospective Interventional Single-Arm, Single Center study with a duration of one and half year in which 47 patients with Muscle-invaded Bladder Cancer were treated with Radiotherapy with 64 Gy in 32# along with Concurrent Chemotherapy with three weekly injection Cisplatin in dose of 70 mg/m2. Response evaluation was done using both Clinical and Radiological means and categorized using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. For adverse events measurement: NCI CTCAE (Common Terminology Criteria for Adverse Events, v4.1) and RTOG/EORTC Acute and Late Morbidity criteria was used. Results : Of the 47 patients who completed chemoradiation, complete treatment response was seen in 25 patients (53.2%), 17 patients (36.2%) had partial response on initial assessment and one patient had disease progression both in form of locoregional and distant (lung) metastasis. Stable disease found in (8.5%). Patients with residual disease were advised to undergo salvage treatment. Grade 3 Nephrotoxicity reported in one patient, Grade 2 Cystitis in 32 patients (68.1%), while Grade 2 Diarrhoea occurred in four patients (8.5%). Hematological toxicity attributable to Chemoradiotherapy included Grade 2, Grade 3 Neutropenia seen in 6.4% and 2.1% respectively and Grade 2 Anaemia in 4.3% patients. Conclusion : Concurrent Chemoradiotherapy is well-tolerated, effective and convenient curative treatment option for patients with Inoperable Non-metastatic Muscle Invasive Carcinoma of Urinary Bladder

Correlation of oxidative stress and serum gonadotropins in female infertility - A cross sectional study in a tertiary care hospital in Eastern Zone of India

Background: Infertility is a very important issue to family and society. Oxidative stress (OS) may affect ovulation, fertilization, embryo development, and implantation resulting in infertility in women. Gonadotropins are required for follicle development and estrogen production, hence low levels of these hormones may result infertility. Aim and Objectives: Our aim was to study OS and serum gonadotropins level in infertile women and to study whether the OS has any effect on gonadotropins level in infertile women. Materials and Methods: It is a hospital-based cross-sectional study. The study group included 50 infertile women in the age of 20–45 years. Age-matched 50 women without a history of infertility were selected as control. Serum samples were collected on the third day of the menstrual cycle and assayed for carbonylation of serum protein, a marker of OS by Levine’s method and Serum Follicle-stimulating hormone and luteinizing hormone by Chemiluminescence Immunoassay method in ADVIA, Centaur CP (SIEMENS) autoanalyzer. Statistical analysis of data was done by SPSS software. P < 0.05 was considered statistically significant. Results: From our study, we observed that OS was significantly high in infertile women than control (P < 0.05). Serum gonadotropins levels were significantly low in infertile women than control (P < 0.05). Our study shows significant negative correlations between OS and serum gonadotropins level in infertile women (P < 0.001). Conclusion: It can be concluded that both OS and low serum gonadotropin levels may be etiological factors for infertility in women. Oxidative can cause infertility by direct effect on reproduction physiology as well as by lowering gonadotropin level. So OS and serum gonadotropin levels can be emphasized in case of treatment of female infertility.

Role of glycemic control on lipid profile in patients with type 2 diabetes mellitus-a cross-sectional study in tertiary care hospital of West Bengal

Background: Dyslipidemia is one of the common conditions associated with poor glycemic control in Type 2 diabetes mellitus (T2DM) patients. It is associated with an increased risk of cardiovascular disease which is the leading cause of death in these patients. Glycated Hemoglobin (HbA1c) is the gold standard test for monitoring glycemic control. Thus, the level of HbA1c could potentially be utilized as a possible biomarker for predicting the risk of dyslipidemia. However, there is a discrepancy in the data available till now regarding the relationship between HbA1c and the lipid profile. Hence, it requires further studies. Aim and Objectives: The present study was conducted to assess the role of glycemic control (as indicated by HbA1c level in blood) on lipid profile of patients with T2DM. Materials and Methods: This was an analytical cross-sectional study done over a period of 5 months. Total 165 participants were randomly selected from out patient department OPD of which 138 were diagnosed cases of T2DM and 27 were age and sex-matched non-diabetic healthy individuals. Patients of T2DM were sub grouped based on American Diabetic Association Criteria (2013) as having either controlled diabetes with HbA1c ?7% or uncontrolled diabetes with HbA1c >7%. Blood samples collected from all the participants were analyzed for HbA1c and lipid profile using standard methods. The collected data were analyzed with Statistical Package for the Social Sciences software using appropriate statistical method. Results: In the present study, we found a significant positive correlation between HbA1c and total cholesterol, Triglyceride, Low-density lipoproteins, and very low-density lipoproteins (P < 0.01) though high-density lipoprotein was not significantly correlated with HbA1c level. Conclusion: We concluded that apart from a reliable index of glycemic control, HbA1c can also be used as a predictor of dyslipidemia in T2DM patients, and thus regular monitoring of it can help us to reduce the mortality of these patients.

Massive splenomegaly as the presenting feature of multiple myeloma in an elderly man

A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib杔enalidomide杁examethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom抯 macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.

Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not

Background:We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods:In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed.Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result:Of 294 patients, 5.1% (n=15) received Covaxin™and 26.5% (n=78) received Covishield™;68.4%(n=201) patientswere unvaccinated.Of patientswho were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine.The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease andvaccination (OR, 3.02; p=0.01); and the presence ofdiabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p<0.001), and malignancy (OR: 2.33; p=0.0325).Conclusion:The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19.

High‑definition mapping of the atria using a novel multipolar mapping catheter in patients with complex adult congenital heart disease

Background@#The Advisor™ HD Grid Mapping Catheter (Abbott Technologies, Minneapolis, MN) has been recently introduced. Although the clinical use of HD Grid mapping catheter is well described in adults with no congenital heart disease, there is limited data on the feasibility of using the HD Grid multipolar catheter to create voltage and activation mapping in adults with congenital heart disease. The purpose of this study was to evaluate the safety and technical feasibility of using the Advisor™ HD Grid mapping catheter during the catheter ablation of atrial arrhythmias in adults with congenital heart disease. We included 6 consecutive adults with congenital heart disease suffering from atrial arrhythmias in our study. The HD Grid mapping catheter was used to perform voltage and activation mapping. @*Results@#Six patients with congenital heart diseases (d-TGA n = 1, Tricuspid atresia n = 1, atrioventricular defect repair n= 1, secundum atrial septal defect n = 1, double-inlet single-ventricle n = 1, Tetralogy of Fallot = 1); majority (84%) male, with the mean age was 35 ± 10 years included in our series. The mean ablation duration and the fluoroscopy time were 789 ± 433 and 502 ± 355 s, respectively. The mean radiation dose was 7.52 ± 9 milliGy/cm2. The HD Grid mapping catheter was used successfully for entire arrhythmia mapping in 5 out of 6 cases. During one procedure, HD Grid mapping catheter could not be used for the entire mapping due to suboptimal reach through baffle puncture. The acute success rate of ablation was 100% with no immediate complications. @*Conclusions@#The use of HD Grid mapping catheter is a safe and valuable adjunct to accurately create voltage and activation mapping in ACHD patients undergoing radiofrequency catheter ablation. However, a contact force-sensing ablation catheter should be considered in conjunction to supplement data acquisition in challenging anatomy and substrates.

Use of 3D mapping system for ablating an accessory pathway associated with coronary sinus diverticulum

Background@#This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.Case Presentation: The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. @*Conclusion@#We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.