Right ventricular systolic pressure – Non-invasive bedside predictor of mortality and readmission in heart failure with reduced and preserved ejection fraction hospitalization

Objective: To study the prognostic role of right ventricular systolic pressure (RVSP) in patients with heart failure (HF). Background: Although RVSP is a readily available echocardiographic parameter, it is often underused. Its prognostic role in patients with heart failure is not well established compared with pulmonary artery pressure measured by right heart catheterization. Methods: This single-center retrospective cohort study included patients with acute heart failure hospitalization admitted to the hospital from January 2005 to December 2018. The primary predictor was right ventricular systolic pressure (RVSP) obtained from bedside transthoracic echocardiography at admission. We divided RVSP into two groups, RVSP <40 mm Hg (reference group) and RVSP 40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were all-cause readmission and cardiac readmission. We conducted propensity-score matching and applied cox-proportional hazard model to compute hazard ratio (HR) with 95% confidence interval (CI). Results: Out of 972 HF patients, 534 patients had RVSP <40 mm Hg and 438 patients had RVSP 40 mm Hg. Patients with RVSP 40 mm Hg compared with RVSP <40 mm Hg were associated with higher rates of death [HR: 1.60, 95% CI: 1.22e2.09, P-value ¼ 0.001], all-cause readmissions [HR: 1.37, 95% CI: 1.09 e1.73, P-value ¼ 0.008] and cardiac readmissions [HR: 1.41, 95% CI: 1.07e1.85, P-value ¼ 0.014]. Conclusion: Higher RVSP (40 mm Hg) in HF patients was associated with higher rates of death, allcause readmissions, and cardiac readmissions. RVSP can be considered as a prognostic marker for mortality and readmission.P

Conventional TBNA with 19 G TBNA Needle in Diagnosis of Mediastinal Lymph Nodes – Diagnostic Yield and Safety with 19G TBNA Needle

Introdution: As the practice of TBNA becomes more widelyaccepted, it has also revived a longstanding question on theoptimum size of needle and whether larger needle with corebiopsy is of any additional benefit. In routine practice 19Gneedle is rarely used even in large nodes as it is perceivedto be technically difficult and likely to give a poor yield ofrepresentative tissue. We report our experience with yield andsafety using 19G needle for Conventional TBNA.Material and methods: Eighteen patients with largemediastinal nodes (short axis > 25 mm) underwent 19GConventional TBNA and station 4R and/or stations 7 werepunctured respectively.Results: Out of Eighteen patients, core biopsy material wasinadequate or unrepresentative in 14 / 18 cases and cytologymaterial was unrepresentative in 2 patients. A diagnosiswas reached in 16 of 18 patients by smear cytology and in14 cases by histology. Out of eighteen patients, 12 patientshad Granulomatous etiology, 2 had poorly differentiatedadenocarcinoma, 1 had Malignant Round Cell Tumor, and onepatient had reactive lymphadenitis.Conclusion: The 19G TBNA procedure is effective and safe,and can be a cost-saving alternative to surgical mediastinalexploration. It should be performed after careful case selectionduring initial diagnostic bronchoscopy and familiarizationwith the technique should not be neglected in trainingprogrammes and workshops.

Association between Gallstone Disease and Metabolic Syndrome.

Introduction: Gallbladder stone disease is common and aleading cause of inpatient admissions for gastro-intestinalproblem in modern world. Metabolic syndrome is slowlyassuming shape of a global epidemic. There is currently onlyminimal data regarding the relationship between cholelithiasisand Metabolic syndrome in Indians. This study aims to assessif there is an association between the presence of gallstonesand Metabolic Syndrome.Material and methods: At a tertiary care centre in Mumbai,100 patients with cholelithiasis were compared with 100controls to assess the profile with respect to MetabolicSyndrome.Result: 36% cases had Metabolic syndrome as against 16%controls. Of the components of Metabolic syndrome, obesitywas the only one found to have a positive association.Conclusion: In our study, gallstone disease showed astatistically significant association with metabolic syndrome,however this association was positive only in female patients.

Dental students’ knowledge and attitude towards cone‑beam computed tomography: An Indian scenario.

Background: Cone‑beam computed tomography (CBCT) is an upcoming imaging modality in field of dentistry with promising outcomes. Aim of the Study: To assess the dental student’s knowledge and attitude regarding CBCT in K. M. Shah Dental College and Hospital as they are future practitioners. Methodology: An anonymous questionnaire consisting of 11 questions was distributed among 320 dental students which included final BDS students, interns, and postgraduate students. Descriptive statistics was used to analyze the responses of the participants, and Chi‑square test was applied to statistically evaluate the differences in the responses according to the education level. Results: Totally, 96.9% response rate was achieved. All the students had heard of CBCT used for dental practice. The majority of them gained knowledge about CBCT through faculty lessons. Lower radiation dose was given as the most important advantage of CBCT over medical computed tomography. Many of the students thought that CBCT should be taught during clinical phase of their education, and there is necessary for CBCT unit at dental faculties. More than half of the students believed that the use of CBCT would become more widespread in the near future, and they aspire to use CBCT technology in their future careers. Conclusion: Seeing the positive attitude, it was concluded that the students’ should be provided with thorough practical knowledge and efforts should be made to improve their concepts regarding CBCT.

Neuronal differentiation of PC12 and embryonic stem cells in two- and three-dimensional in vitro culture.

The quality of neuronal differentiation and reduction in apoptosis that occurred in two-dimensional (2D) and three-dimensional (3D) culture conditions is compared. PC12 and embryonic stem cells are two commonly utilized cell lines for the study of neuronal regeneration. These cells were induced to neuronally differentiate by adding NGF and retinoic acid respectively. Total neurite length and expression of neuronal markers (MAP-2 and β3-tubulin) was assessed by morphometry and immunocytochemistry. Also, TUNEL assay was used to detect apoptosis. Upon exposure to a differentiation media in the 3D fibrin gel, PC12 and embryonic stem cells stopped dividing, had increased adhesion to the substratum, extended neurite processes and expressed neuronal markers. The same results, however, were not observed with the 2D culture. Also, the apoptosis index performed by TUNEL assay demonstrated a reduction in the degree of apoptosis in the 3D culture compared to 2D culture. Fibrin matrix supports growth and neuronal differentiation of PC12 and embryonic stem cells. In addition, the 3D culture enhanced cellular resistance to apoptosis when compared to the 2D culture. It appears as if a 3D culture system may offer a better technique for future neuronal tissue engineering investigations.