COVID-19 infection in patients with haematological disease - A tertiary centre experience from north India

This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population

Injecting drug use & HIV prevalence among female sex workers: Evidence from the National Integrated Biological & Behavioural Surveillance, India

Background & objectives: Female sex workers (FSWs) who inject drugs (FSW-IDs) have a higher risk of HIV infection and transmission. Understanding the socio-demographic characteristics and other risk behaviours among FSW-IDs will help in strengthening targeted interventions for HIV prevention and management. In the present study, the HIV prevalence, associated socio-demographic characteristics and risk behaviours among FSWs who injected drugs (FSW-IDs) and those who did not ID (FSW-NIDs) was determined in India. Methods: The national cross-sectional, community-based, integrated biological and behavioural surveillance was conducted in 2014-2015 at 73 randomly selected FSW domains across 28 States and Union Territories in India. The sample size was fixed at 400 for each domain, and a probability-based sampling method was followed. The data were analyzed by logistic regression methods. Results: Data from 27,007 FSWs were included in the analysis, of which 802 (3%) were FSW-IDs. HIV prevalence among FSW-IDs was significantly higher than that in FSW-NIDs (4.5 vs. 1.9%). Univariate analysis showed that factors significantly associated with higher HIV prevalence among FSW-IDs were older age, sex work as the only source of income, dissolved marriage, living with a sex worker, urban locality of sex work and consumption of alcohol or oral drugs. In multivariable analysis, factors such as older age of FSW-IDs (35 yr and above), having a dissolved marriage and sex work being the only source of income were observed to be independently and significantly associated with higher HIV prevalence. Interpretation & conclusions: Scaling up the HIV preventive interventions for FSW-IDs, such as facilitating awareness and improved access to needle and syringe exchange programme (NSEP) and opioid substitution therapy (OST), encouraging safe sex and injecting practices, educating on the harmful effects of alcohol and drugs and providing alternative vocation options to secure their financial needs are several strategies that may reduce HIV transmission among FSWs.

Post-corneal transplant Candida keratitis – Incidence and outcome

Purpose: To report the risk factors, clinical characteristics, and outcomes of Candida keratitis following corneal transplantation in India. Methods: On retrospective review of medical records of 789 patients, 31 eyes developed a graft infection following corneal transplantation or keratoprosthesis and we could identify the Candida infection in only five. These cases were operated at two tertiary care centers in India. These five records were reviewed for demographics, risk factors (local and systemic) for graft infection, characteristics of infective lesion, corneal scraping results, treatment plan, and the final outcome following management. Results: The median age of the subjects with the Candida graft infection was 62.4 ± 10.33 years (range, 62–71 years). All patients were males. The predominant risk factors included repeat corneal transplantation (5/5), prolonged usage of topical steroids (5/5), and epithelial defects (4/5). The clinical characteristics included infiltrates of variable configuration like powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy. The smear showed budding yeasts in all five cases whereas culture was positive in four out of five cases. The final outcome with antifungals (systemic [4/5] and topical [5/5]) is variable. Two eyes underwent evisceration, two eyes had scar formation in the failed grafts, and one patient succumbed to the systemic disease 1?month post?corneal infection. Conclusion: Candida keratitis, in India, seems to be an emerging pathology following corneal transplantation and has a varied presentation. Though the outcomes following management seem to be grim, however, such infection can easily be avoided by a timely reduction of the risk factors.

Detection of recombinant dengue virus 2 NS1 protein in Aedes aegypti mosquitoes using commercial Dengue NS1 ELISA kit

Dengue, a vector-borne disease remains as one of the most serious public health problems globally. Incidence of this disease is on an increasing trend and currently over a billion people in tropical and subtropical regions are at risk. In the absence of an operational vaccine, prevention of dengue virus (DENV) is primarily focused upon controlling mosquito vectors. Mosquito vector surveillance programmes require simple and rapid tools to detect mosquitoes infected with DENV. Here, we tested the commercially available DENV Detect™ NS1 ELISA kit (InBios International, Inc.) for detection of recombinant DENV-NS1 protein in Aedes mosquito samples. The kit was evaluated to find out the minimum detection limit of recombinant DENV-2 NS1 protein following the manufacturer’s instructions. Initially, the NS1 protein detection threshold of the kit was determined and later the assay was standardized for detection of NS1 protein in Aedes aegypti mosquito pools containing 5, 10 and 25 mosquitoes. The ELISA kit displayed high sensitivity towards detection of recombinant dengue virus-2 NS1 protein in mosquito pools (up to 25 mosquitoes per pool) at 25 pico gram concentration. Since the commercial NS1 ELISA is highly sensitive and follows a very simple procedure, it could be employed for DENV surveillance in Aedes aegypti mosquitoes, after carrying out laboratory and field bioassays with DENV infected specimens.

Prevalence of Dental Caries and Treatment Needs among Adult Population of Mangalore Taluk - A Pilot Survey.

Dental caries remains the most common oral disease affecting a considerable proportion of people worldwide. It not only causes damage to the tooth, but is also responsible for several morbid conditions of the oral cavity and other systems of the body. Without treatment, caries can proceed and destroy the tooth leading to infection of dental pulp. We wanted to evaluate the prevalence of dental caries and treatment needs among adult rural population. METHODS619 participants aged 18 years and above from peripheral health centres were examined to determine the prevalence of caries and treatment needs. A pretested proforma was used for data collection. Collected data was analysed using Chi Square test. P<0.05 was considered as significant. RESULTSNo significant difference was found in the mean number of teeth affected by caries between the two age groups (<40 years & >40 years) (p= 0.352), between genders (p=0.704) and education levels (p=0.983). When treatment needs (TN) was considered, maximum 2 surface fillings were needed in both the age groups (<40 years 45.6% & >40 years 54.4%). Various treatment needs prevailed among participants of different education level. CONCLUSIONSOral health educative programs may change the attitude of an individual and population as a whole towards maintenance of oral health.

Genotype shift of dengue virus (DENV1) during the 2017 outbreak of dengue fever in Thiruvananthapuram, Kerala, India

An unprecedented outbreak of dengue occurred during 2017 in Kerala. Thiruvananthapuram was worst affected. We carried out a joint investigation with the Health department of the State, to understand the epidemiological and entomological factors involved in this outbreak, so as to develop strategies to contain it. Blood samples from suspected patients were collected from three worst affected areas and genomic analysis of the Dengue virus (DENV) was performed. Also, a cross sectional entomological survey was carried out in these areas. The data obtained was compared with the available secondary data of DENV in Kerala. The investigations revealed a genetic shift from the erstwhile predominant DENV2/DENV3 serotypes to the newly introduced DENV1 Asian genotype during the current outbreak. Breeding indices of Aedes aegypti, the predominant vector species was also found to be remarkably high. Asian genotype of DENV1 was detected in field collected Ae. aegypti also. The index cases of the Asian genotype of DENV1 in Kerala were detected from Erumeli village (gateway to the famous Sabarimala shrine) among two plantation workers migrated from the neighbouring Karnataka state, during 2013. This introduced virus strain attained an epidemic proportion in 2017 in Thiruvananthapuram, owing to immunologically naïve population and high receptivity.

Knowledge and attitude toward use of internet in smartphones for dental education

Introduction: Internet has become ubiquitous with the advent of smartphones. The dental fraternity keeps themselves updated and share knowledge through webinars, video conferences, research publications, etc. Hence, the internet serves as an imperative tool for dissemination of information. The usage of internet in dental education can be exploited to the fullest, especially due to the increased ownership rates of smartphones. Materials and Methods: A total of 490 students from four dental colleges in Tamil Nadu were asked to fill a close-ended questionnaire to assess the knowledge and attitude of dental students toward internet usage in smartphones. This study was conducted from November 2016 to January 2017. Results: The response rate was 100%. Almost all the students (98%) had knowledge on browsing. The percentage of internet use in smartphones were the highest (55.2%) followed by computers or laptops at home (26.5%). About 34.6% of students used internet in smartphones daily. More than half of the students (52.2%) used internet in smartphone at least 2–3 h a day. About one quarter (23.4%) of students used internet on a daily basis while 29.59% of students accessed the internet thrice a week for searching content related to dentistry. The preferred source for collecting dental-related information was through the internet (28.9%) and textbooks (28.5%). Conclusion: Dental students have considerable knowledge in using the internet for dental education and some of them utilize internet more frequently because of the possession of smartphones.

A study on the lipid ratios and inflammatory markers in pre-diabetic and diabetic patients

Background: One of the leading causes of diabetic mortality is cardiovascular disease. Diabetes progression is preceded by pre-diabetic phase which is also at higher cardiovascular risk. Both hyperglycemia and atherosclerotic processes are inflammatory phenomenon. Keeping this in view, it was aimed to evaluate atherogenic indices and correlate them with inflammatory mediators.Methods: This study included 80 controls, 80 pre-diabetic and 80 diabetic patients. Anthropometric parameters (BMI, WHR) and blood parameters like fasting glucose, HbA1c, lipid profile (cholesterol, HDL, LDL TG, VLDL), adiponectin, IL-6, CRP, fibrinogen and uric acid were analysed.Results: Significantly high atherogenic indices were observed in pre-diabetic and diabetic subjects compared to healthy controls. The indices were also significantly correlated with BMI, fasting sugar, HbA1c, cholesterol, HDL, TG and LDL. The correlation with HDL was negative and with other parameters, the correlation was positive. In pre-diabetic patients, adiponectin showed significant negative correlation while fibrinogen and CRP showed significant positive correlation with cardiac risk indices. IL-6 was positively correlated only with AIP while correlation of uric acid with these indices was insignificant. In case of diabetic patients, the cardiac risk indices were significantly correlated with adiponectin, IL-6, CRP, fibrinogen and uric acid. The correlation with adiponectin was negative.Conclusions: The altered atherogenic indices and their significant association with inflammatory markers signify the direct association of inflammation with CVD risks. Thus, there is requirement of novel approaches that can retard inflammatory responses and arrest unwanted cardiac health outcomes.

Inflammatory Markers in Pre-diabetes and Diabetes: A Comparative Study

Diabetes is a metabolic disorder associated with chronic inflammation. It is preceded by pre-diabetic phase that is also influenced with the inflammatory mechanisms which finally culminate into diabetes and its associated complications. Thus the main objective of this study was to assess the level of inflammatory mediators in pre-diabetic and diabetic patients. Methods: This case control study was conducted with 100 controls, 145 pre-diabetic patients and 126 diabetic patients in Santosh medical College and Hospital, Ghaziabad. Serum routine parameters like fasting glucose, HbA1c, lipid and inflammatory mediators like adiponectin, fibrinogen, IL-6, CRP and uric acid were estimated using kit based methods. Results: We observed significantly low adiponectin and significantly high CRP, IL-6, fibrinogen and uric acid in pre-diabetic and diabetic patients compared to controls. The level showed gradual decrease from control-prediabetic-diabetic groups in case of adiponectin while the trend was increasing in case of CRP, IL-6, fibrinogen and uric acid. We also found significant negative correlation of adiponectin with CRP, IL-6, fibrinogen and uric acid in both the patient groups but the correlation with uric acid in pre-diabetic patients was insignificant. Conclusion: These results reveal the involvement of inflammatory mechanisms in progression from normoglycemia to impaired fasting glucose and finally to hyperglycemia. Therefore the development of mechanisms that aid in reducing pro-inflammatory and alleviating ntiinflammatory mediators may be fruitful in reducing diabetes risks.

Comparison of Health Education, Oral Rehydration Solution, Metoprolol and Midodrine Intervention in Children with POTS

Introduction: The postural orthostatic tachycardia syndromeis heterogeneous group of disorder. When a healthy individualstands up, gravity causes about 10%-15% of his or her bloodto settle in the abdomen or limbs. This pooling of bloodmeans that less blood reaches the brain, the result of whichcan be a feeling of lightheadedness, darkening of vision, oreven fainting. Hence, the aim of the present study was toevaluate the clinical features and the effectiveness of nonpharmacological and pharmacological treatment in patientswith POTS.Material and Methods: A retrospective medical recordanalysis of the patients referred to pediatric cardiology unitof our Second Xiangya Hospital of Central South Universitysince June 2003 to February 2010 was done. This studyincluded 33 children patients aged 6 to 16 years old among17 male (mean 10.62±2.88 years) and 16 female (mean11.81±1.64 years) after medication within 14 days to 6 monthswith follow up record.Results: The most common presenting symptoms of POTSwere found to be dizziness or light-headedness (66.66%)followed by chest tightness (30.30%), syncope (27.27%),headache (24.24%) and pallor (24.24%) respectively. About75.5% of children patients met diagnostic criteria for POTSduring 5 to 10 minute of HUTT. There was significant statisticdifference in heart rate between before and after treatment oftotal patients during 5 and 10 minute of HUTT (P<0.05). Theoverall improvement found in 24(72.72%) patients whereas9(27.27%) patients not respond to the given treatment regimen.Conclusion: The most common presenting symptom of POTSwas dizziness or light-headedness. Most of the patients meetdiagnostic criteria for POTS during 5 to 10 minute durationof HUTT. Health education, ORS, propranolol and midodrinewere effective in treatment of POTS and helpful to diminishthe upright tachycardia. Whereas health education and healtheducation with midodrine hydrochloride treatment methodwere more likely effective than health education with ORSand health education with metoprolol method

Non-Cirrhotic Hyperammonemia In A Newly Diagnosed Diabetic Patient Presenting In Diabetic Ketoacidosis

Hyperammonemia, a known cause of encephalopathy, is commonly seen in patients with liver disease. Non-cirrhotic hyperammonemia is an uncommon condition. Patients with uncontrolled diabetes can have elevated levels of ammonia. Diabetic ketoacidosis is a life threatening complication in diabetes. This is a case of a middle-aged male who presented in encephalopathy. He was found to have diabetic ketoacidosis with hyperammonemia. Encephalopathy as a result of hyperammonemia in diabetes mellitus is a rare scenario.

Early Aggressive Enteral Feeding in Neonates Weighing 750-1250 Grams: A Randomized Controlled Trial

Background: In preterm neonates, enteral feeding is advancedslowly, considering the risk of necrotizing enterocolitis. Prolongedintravenous alimentation in these neonates, however, mayincrease the risk of sepsis-related morbidity and mortality,particularly in low resource settings.Objectives: Objective of this was study to evaluate impact ofaggressive enteral feeding on mortality and morbidities amongpreterm neonates.Design: Randomized controlled trial.Participants: Neonates with birthweight 750-1250 g.Interventions: 131preterm neonates with birth weight 750-1250g, admitted to neonatal intensive care unit between April 2012 andJune 2014, were randomized to aggressive feeding orconservative feeding regimen.Outcomes: The primary outcome of the study was all-causemortality during hospital stay. The secondary outcomes includedproportion of sepsis (blood culture proven), necrotizingenterocolitis, feed intolerance, survival without major morbidity atdischarge, time to reach full enteral feed (180 mL/kg/d), durationof hospitalization, and average daily weight gain (g/kg).Results: All-cause mortality was 33.3% in aggressive regimenand 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49,1.20)]. Neonates with aggressive feeding regimen reached fullenteral feed earlier; median (IQR) 7 (6, 8) days compared toconservative regimen, 10 (9, 14) days; P <0.001. There was nodifference in culture positive sepsis rate, survival without majormorbidities, feed intolerance, necrotizing enterocolitis, duration ofhospitalization and average daily weight gain.Conclusions: In neonates with birth weight 750-1250 g, earlyaggressive feeding regimen is feasible but not associated withsignificant reduction in all-cause mortality, culture positive sepsisor survival without major morbidities during hospital stay.Neonates with aggressive regimen have fewer days on IV fluidsand reach full feed earlier

Impact of Ban on Smokeless Tobacco (SLT) on Second Hand Smoke (SHS) Exposure among Males : Findings of a Community-based Survey in Delhi

Introduction: Ban on gutka/smokeless tobacco (SLT) in India beginning in 2011 raised apprehension of its users switching to smoking and thereby increased second-hand smoke (SHS) exposure to non-users. Delhi Government issued notification banning gutka and pan-masala containing tobacco and/or nicotine in 2012. To address circumvention of ban by SLT manufacturers, ban was revised and reissued in 2015 to explicitly ban all SLT products. Objectives: To assess change in second hand smoke (SHS) exposure in Delhi three years after gutka ban and one year after explicit ban on all SLT products. Method: Cross-sectional household survey was conducted in Delhi during March-December 2016 to assess SHS exposure at home, workplace and public places. Males aged 15 years and above living in urban Delhi were asked questions similar to Global Adult Tobacco Survey (GATS)-India, 2010. Survey data were compared with 2010 records to assess change in SHS exposure between 2010 and 2016. Results: As compared to 2010, 12.0% less non-smokers reported SHS exposure at home. Among those working outside home, 13.7% non-smokers reported SHS exposure at indoor workplace as compared to 19.3% in 2010. Less educated people are more likely to face SHS exposure at work. Chance of exposure at any public place during last one month has also decreased by 6.5%. Conclusion : Probability of coming across SHS exposure has decreased in urban Delhi at all places in 2016 as compared to 2010. Efforts to enforce SLT ban must sustain without fear of increase in SHS exposure.

Evaluation of FNAC in Bone Lesions

The aim of the present study is to evaluate the utility of FNAC in diagnosing bone lesions especially bone tumours. Methods: A total of 120 cases were selected from patients attending OPD and admitted in IPD in MLB Medical College, Jhansi, presenting with complaints of swelling arising from bone. FNAC of the lesion was performed, with guidance of X-Ray reports when available, clinical details, history of present illness & other physical findings have also been noted, and considered while making the diagnosis, and the findings were compared with that of histolgical specimen whenever available. Results: The present study includes 355 malignant cases, of which 53.8% are primary neoplasms, 7.6% are metastatic lesions, and 38.4% are locally malignant lesions. The most common primary bone malignancy in this study is Osteosarcoma. Comparison of Cytological and Histological Diagnosis in all cases was done. 39 malignant lesions were reported on Cytological basis and all 39 were found correct on histological correlation, while 18 out of total 21 benign lesions were diagnosed correctly, as confirmed by subsequent histological examination. Out of total 51 inflammatory lesions 42 were diagnosed correctly, 9 aspirations were found inadequate for reporting. Conclusion: Fine Needle Aspiration Cytology (FNAC) is a very valuable procedure in patients with bone lesions. The complications are almost nil, the cost is very low, is minimally painfull, is an OPD procedure and informative reports are available within 12-48 hours.

Evaluation of Mast Cell Profile in the Skin Lesions of Leprosy

Background: Aim of the present study was to evaluate the role of Mast cells in the Histo-Pathogenesis of Leprosy by assessing incidence of various Histo-Pathological types of Leprosy, Correlating of Mast cell profile (Mast cell Density & Morphology) in different Histological types of Leprosy lesions, by correlating with Reactional & Non-Reactional groups of Leprosy cases and by correlation of Mast cell profile in doubtful cases as in Indeterminate type. Lepromatous Leprosy was observed in higher age group as compared to Tuberculoid leprosy. Mast Cell Density was found increasing from Polar Tuberculoid to Polar Lepromatous spectrum of disease. In every type of Leprosy, mast Cell Density was reduced significantly in the Reactional Group as compared to Non-Reactional Group. The aim of the present study was to evaluate the role of Mast cells in the Histo-Pathogenesis of Leprosy by assessing incidence of various Histo-Pathological types of Leprosy. Methods: A cross sectional, observational study was conducted among 200.Correlation of mast cell profile (Mast cell Density & Morphology) in different Histological types of Leprosy lesions was done, by correlating with Reactional & Non-Reactional groups of Leprosy cases and by correlation of Mast cell profile in doubtful cases as in Indeterminate type. Lepromatous Leprosy was observed in higher age group as compared to Tuberculoid leprosy. Results: Mast Cell Density was found Increasing from Polar Tuberculoid to Polar Lepromatous spectrum of disease. In every type of Leprosy, mast Cell Density was reduced significantly in the Reactional Group as compared to Non-Reactional Group. Conclusion: Larger such studies of Leprosy employing special staining methods viz. pH dependent Toluidine Blue staining, studies employing Immuno-Fluorescence on Tissue biopsy specimens, as well as studies on experimental animals, to help us achieve a better understanding of the pathogenesis, outcome and prognosis of Leprosy.

Levels of Serum Vitamin B6 and GABA In Clinically Depressed Patients: A Study

Background:Depression is the most common type of mental illness. As per the WHO criterion of prevalence of depression, this disease has a prevalence of 4.4% all over the world and 4.5% in India. Some water-soluble vitamins like vitamin B2, B6, B9, B12; play an important role in mental health. Of these vitamins pyridoxal phosphate, the active form of vitamin B6 plays a pivotal role in a number of transamination reactions, decarboxylation reactions and in the control of plasma homocysteine concentration. PLP is vital for the biosynthesis of GABA, which is being used as the neurotransmitter in at least 40% of the inhibitory synaptic processing in the brain. Therefore, the present study was planned to assay the blood levels of vitamin B6 and GABA in patients with depression. The objective of the study was to help psychiatrists to take appropriate and informed decision about supplementation of vitamin B6 and use of specific antidepressant medication in the treatment of depression cases. Methods: Current study was an experimental case control study conducted at Santosh Medical College and Hospitals. A total of 204 (102 controls and 102 patients) both males and females, in the age group between 18-65 years were included in the study. Hamilton Depression Rating Scale (HDRS) 17 items was used to rate the level of depression. Results: In the present study, a total of 204 subjects including 97 females and 107 males participated, out of which 102 were clinically diagnosed cases of depression attending psychiatry OPD and included 55 females and 47 males. 47.1% of the cases were of mild depression, 23.5% were of moderate depression, 11.8% of severe depression and the remaining 17.6% belonged to very severe depression category. The mean value of vitamin B6 was found lowest in severe to very severe depressed patients (5.25) than in mild to moderate depressed patients (8.83) and the mean value of GABA was found to be highest in severe to very severe category (5571.73) than in mild to moderate depressed patients (5184.73). Conclusion: This study showed that majority of the patients with clinical depression had vitamin B6 deficiency and increase in GABA levels.

Levels of Serum Folate and Cobalamine in Clinically Depressed Patients in North Indian Population

Background: Depression, the most common type of mental illness is the second leading cause of disability worldwide next to CAD. Vitamin B6, folate and vitamin B12 are involved in a series of methylation reaction that produce monoamine neurotransmitters, phospholipids and nucleotide. Therefore the present study was planned to assay the blood levels of vitamin B12 and folate in patients with depression. The objective of this was to study if metabolites are affected by diet and may be helpful in the prevention of depression. Methods: Current study was an experimental case control study, was conducted at Santosh Medical College. A total of 88 cases (44 patients and 44 controls) both males and females in the age between 18 - 65 years were included in the study. Hamilton depression rating scale (HDRS) -17 items scale was used to rate the level of depression. Results: In the present study a total of 88 subjects including 45 females and 43 males participated, out of which 44 were control, 24 males and rest 20 were females. Majority 55 patients were of no depression category, 11 were of mild depression category, 10 were of severe depression and rest 9, were of moderate depression category. Mean value of B12 were found lowest in ‘moderate’ depressed patients (115), than in ‘most severe depressed’ (137), followed by ‘severe’ and ‘mild’ depressed patients category. Value of HDRS increases with severity of depression, it was found lowest in the ‘mild’ (10.64), then it steadily increases with severity, moderate (15.11), severe (21.20) and most severe (27.55). Conclusion: This study showed that majority of the patients with clinical depression had vitamin B12 deficiency.

Electrocardiographic changes of antidepressant medication in depressive episode

Introduction: Depressive disorder is leading cause of mortality in the world, with the help of recent therapeutic strategies it is easily manageable. Antidepressant medication is the most commonly used for management of depressive disorders. Among the side effects of antidepressant, cardiovascular effects of antidepressant deserve close monitoring. Invariably, it is observed that patients undergoing antidepressant therapy are not screened for pre-existing cardiovascular diseases and more so for cardiotoxicity. Various antidepressant medications are available, with different cardiac side effects profile. Ignorance, over clinical burden, poor follow up and under evaluation of cardiovascular side effects could be attributable to an ultimate surveillance of such cases. So, this study conducted to evaluate electrocardiographic changes in therapeutic doses of antidepressant medication.Methods: An Open label-controlled study was conducted on 386 subjects to evaluate the antidepressant-induced electrocardiographic changes. Treatment seeking subjects for the depressive episode was recruited from outpatient and inpatient section of Psychiatry department after fulfilling inclusion and exclusion criteria. Data was collected on socio-demographic characteristics, and detailed pre-treatment and post-treatment clinical evaluation and electrocardiographic assessment were done.Results: Data collected and analyzed from 204 subjects, mean age of subjects taking tricyclics and SSRI (Fluoxitine) 43.6±7.5 years vs 41.5±9.6 years respectively. The study sample consists of 66% females, 33% males. Among them, 35% study subject expose to tricyclics and 65% subjects taking SSRI. 19% study subjects presented electrocardiograph changes especially tachycardia among them 55% was taking the tricyclic antidepressant. Only 10% subjects taking SSRI had post-treatment abnormal electrocardiograph changes.Conclusions: Conclusively, antidepressant form a safe therapeutic modality for the management of major depression. Its cardiovascular side effects warrant against indiscriminate use of particularly in high dose and old aged person and preexisting cardiac disease.

Current and futuristic scope of biomarkers in acute myocardial infarction

Introduction: Acute myocardial infarction is a leading cause of death throughout the world. Myocardial infarction is defined as myocardial cell death due to prolonged ischemia. Objectives of the study were to look for the role of inflammatory markers (CRP, IL-6, and plasma fibrinogen) in the prediction of myocardial infarction. In recent times, IL-6 and plasma fibrinogen are not established marker in acute myocardial infarction. However, there is another biomarker i.e. CRP that have shown additional value in improving sensitivity and prognostic information. Novel biomarkers have improved assessment of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. Thus the finding of this study may help the clinician to develop more novel therapeutic strategies for the management of myocardial infarction (MI) patients. The outcome of the study will be very beneficial as well, to the researcher working in the concerned area in order to develop more focused research approach