A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

A Study of Peak Expiratory Flow Rate (PEFR) in 6-12 years Age Group in Relation to Height in Eastern India

Background: Bronchial Asthma is a common cause of mortality and morbidity in the developing world like India. Objective: The purpose of the present study was to establish a nomogram for PEFR in 6-12 yrs age group in relation to height in Eastern India, a first of its kind study from Eastern India. Setting: 1003 randomly selected healthy school children in Kolkata. Study Design: Prospective cross sectional study. Methods: Mini Wright peak flow meter was used to measure PEFR in resting condition and standing position. The best value of three attempts was recorded and compared to height, weight, sex and age separately. Multiple regression analysis was used to determine the influence of various variables. Results: Height ranged from 95 cm to155 cm and PEFR ranged from 115 L/min to 335 L/min irrespective of sex. Mean PEFR was 241.5 L/min in all sexes whereas the median, 25th percentile and 75th percentile values were 244.1 L/min, 186 L/min and 290 L/min respectively. PEFR values increased in a linear pattern with increase in height in both sexes. Using multiple regression analysis we can estimate the PEFR values with height alone in both sexes with more than 95% accuracy. Conclusion: PEFR values depend on height, weight, age and sex, the former being the most important parameter

Ocular Manifestations of ß -Thalassemia Patients with the Use of Oral Iron Chelating Agents

Background: Ocular involvement in β-thalassemia major is very common. Iron chelators like Desferrioxamine and Deferiprone avoid systemic complications but chelate metals in retina. Objectives: 1.To study the relation of oral iron chelator (Deferiprone) on various ocular manifestations in β-thalassemia major patients. 2. To study the relation of serum ferritin with various ocular manifestations. Methods: 100β-thalassemia major patients out of those attending our thalassemia clinic were selected for the study as per our inclusion and exclusion criteria. They were divided into two major groups based on whether they were taking oral iron chelator (Deferiprone) or not. Detailed history, examination and investigations were done and recorded. Results: The study revealed that 52% of the patients had ocular involvement with 86.5% of them taking Deferiprone (p<0.0001), 13% had retinal pigment epithelium (RPE) degeneration with 92.3% of them on Deferiprone (p=0.003) and 18% had RPE mottling with 88.8% of them taking Deferiprone (p=0.001). Other ocular changes like lens opacity, disc hyperemia, best corrected visual acuity (BCVA) and venous tortuosity showed some difference between the two groups but that was insignificant. Further the study also showed that higher serum ferritin levels were significantly associated with ocular changes like decreased BCVA (p<0.001), RPE degeneration (p<0.001), RPE mottling (p<0.001) and venous tortuosity (p<0.025). Conclusion: Ocular changes in β-thalassemia major increases with greater duration of the disease and increased number of blood transfusions due to increased serum ferritin levels. Using iron chelators may reduce iron overload but they causechelator induced ocular involvement.

Intrathecal Clonidine Co-Administered With Hyperbaric Bupivacaine in Infra-Umbilical Surgery - A Dose Response Study.

Background: Clonidine, the α2 – adrenergic agonist, has a variety of different action including the ability to potentiate the effect of local anaesthetic without any significant undesirable effects. The intrathecal use of different doses of clonidine when co-administered with hyperbaric bupivacaine provides prolongation of pain free period than hyperbaric bupivacaine alone. Objectives: Our present study was targeted to find out the optimum intrathecal dose of clonidine as an adjunct to hyperbaric bupivacaine.Methods: Patients with ASA physical status I & II scheduled for elective infra umbilical surgery under spinal anaesthesia were randomly divided into four equal groups (n = 30) by a computerized randomization chart. Groups BC15, BC30, and BC45 received mixture of 10 mg hyperbaric bupivacaine plus clonidine in the doses of 15, 30, and 45 μg respectively intrathecally and the control group (Group B) received 0.5% hyperbaric bupivacaine 10 mg and normal saline as placebo. All analysis was two tailed and P value < 0.05 was considered statistically significant. Data analyzed with the help SPSS software version 16.0 for Windows, SPSS Inc. Chicago. Results: It was observed that intrathecal clonidine to hyperbaric bupivacaine dose dependently prolongs both sensory blockade of spinal anesthesia and time to request for first supplemental analgesia in post operative period. Conclusion: Because of the absence of significant adverse effects, we conclude that, within the tested dose range, 30 μg of clonidine is the preferred dose, when prolongation of spinal anesthesia is desired.

Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India.

Background: To assess the prescribing indicators in prescriptions of private practitioners in Kolkata. Methods: In the observational, retrospective, cross-sectional survey, 1830 prescriptions of private practitioners were collected over a 5 years period and assessed using core prescribing indicators as per the World Health Organization “How to investigate drug use in health facilities” tool. Results: Overall the average number of drug per prescription was 3.05±0.91. No drug was prescribed by generic name. Prescriptions with an antibiotics and injections were 30% (549/1830) and 8.12% (149/1830), respectively. Drugs prescribed from essential drug list (EDL) were 29.38% (1640/5582). Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices.

In vitro and in vivo neurogenic potential of mesenchymal stem cells isolated from different sources.

Regenerative medicine is an evolving interdisciplinary topic of research involving numerous technological methods that utilize stem cells to repair damaged tissues. Particularly, mesenchymal stem cells (MSCs) are a great tool in regenerative medicine because of their lack of tumorogenicity, immunogenicity and ability to perform immunomodulatory as well as anti-inflammatory functions. Numerous studies have investigated the role of MSCs in tissue repair and modulation of allogeneic immune responses. MSCs derived from different sources hold unique regenerative potential as they are selfrenewing and can differentiate into chondrocytes, osteoblasts, adipocytes, cardiomyocytes, hepatocytes, endothelial and neuronal cells, among which neuronal-like cells have gained special interest. MSCs also have the ability to secrete multiple bioactive molecules capable of stimulating recovery of injured cells and inhibiting inflammation. In this review we focus on neural differentiation potential ofMSCs isolated from different sources and how certain growth factors/small molecules can be used to derive neuronal phenotypes from MSCs. We also discuss the efficacy of MSCs when transplanted in vivo and how they can generate certain neurons and lead to relief or recovery of the diseased condition. Furthermore, we have tried to evaluate the appropriatemerits of different sources ofMSCs with respect to their propensity towards neurological differentiation as well as their effectiveness in preclinical studies.

Growth of Children with Juvenile Idiopathic Arthritis.

Objective: To evaluate the growth pattern in children with juvenile idiopathic arthritis and its subtypes in comparison with age, sex and temporally matched controls. Study design: Prospective study. Setting: Pediatric rheumatology clinic of a tertiary care hospital in Eastern part of India. Participants: Seventy-five children (2-12 years) diagnosed as juvenile idiopathic erthritis by International League of Associations for Rheumatology criteria and 75 age- and sex- matched controls. Intervention: Weight, height and body mass index were recorded at six monthly interval in both groups over a period of 3 years. Main outcome measures: weight, height and body mass index. Results: Subtype distribution of juvenile idiopathic arthritis was: oligoarthritis (49%, n=37), rheumatoid factor negative polyarthritis (27%, n=20), rheumatoid factor positive polyarthritis (8%, n=6), systemic onset (15%, n=11) and enthesitis related arthritis (1.3%, n=1). Anthropometric parameters in children with juvenile idiopathic arthritis were not significant different from controls. Comparison between the subtypes showed significant differences in height (P=0.011), weight (P=0.005), and growth velocity (P=0.005), but not in body mass index. Systemic onset disease led to significant restriction in height (P=0.018; 95% CI 2.13-33.77) and weight (P=0.008; 95% CI 1.47-14.43) compared to controls. Growth velocity was significantly affected in rheumatoid factor positive polyarthritis (P=0.003; 95% CIO. 46-3.14). Conclusions: Children with juvenile idiopathic arthritis do not have significantly lower values of anthropometric parameters compared to controls. Significant restriction in height and weight is seen in systemic onset disease, and growth velocity is significantly reduced in rheumatoid factor positive subjects.

Profile of hepatitis A infection with atypical manifestations in children.

We assessed the clinical course and biochemical profile of symptomatic children with viral hepatitis A who had atypical manifestations. Of 229 children with hepatitis A, atypical manifestations were found in 32 (14%) subjects. Prolonged cholestasis (n = 14), acute liver failure (9), relapse (9), ascites (8), and hematological problems (8) were the common presentations. Liver histology was suggestive of chronic liver disease in six children with protracted jaundice. Patients with atypical presentations were older (7.7 [1.6] years vs. 6.5 [2.6] years; p=0.012) and had higher total serum bilirubin (13.7 [8.1] mg/dL vs. 7.2 [4.0] mg/dL; p=<0.001) than those with typical presentation. Approximately 15% of children with acute hepatitis A infection have atypical presentation which is associated with increase in morbidity.