Evaluating the efficacy and safety of mavacamten in hypertrophic cardiomyopathy: A systematic review and meta-analysis focusing on qualitative assessment, biomarkers, and cardiac imaging.

BACKGROUND: Hypertrophic Cardiomyopathy (HCM) is a complex cardiac condition characterized by hypercontractility of cardiac muscle leading to a dynamic obstruction of left ventricular outlet tract (LVOT). Mavacamten, a first-in-class cardiac myosin inhibitor, is increasingly being studied in randomized controlled trials. In this meta-analysis, we aimed to analyse the efficacy and safety profile of Mavacamten compared to placebo in patients of HCM. METHOD: We carried out a comprehensive search in PubMed, Cochrane, and clinicaltrials.gov to analyze the efficacy and safety of mavacamten compared to placebo from 2010 to 2023. To calculate pooled odds ratio (OR) or risk ratio (RR) at 95% confidence interval (CI), the Mantel-Haenszel formula with random effect was used and Generic Inverse Variance method assessed pooled mean difference value at a 95% CI. RevMan was used for analysis. P<0.05 was considered significant. RESULTS: We analyzed five phase 3 RCTs including 609 patients to compare mavacamten with a placebo. New York Heart Association (NYHA) grade improvement and KCCQ score showed the odds ratio as 4.94 and 7.93 with p<0.00001 at random effect, respectively. Cardiac imaging which included LAVI, LVOT at rest, LVOT post valsalva, LVOT post-exercise, and reduction in LVEF showed the pooled mean differences for change as -5.29, -49.72, -57.45, -36.11, and -3.00 respectively. Changes in LVEDV and LVMI were not statistically significant. The pooled mean difference for change in NT-proBNP and Cardiac troponin-I showed 0.20 and 0.57 with p<0.00001. The efficacy was evaluated in 1) A composite score, which was defined as either 1·5 mL/kg per min or greater increase in peak oxygen consumption (pVO2) and at least one NYHA class reduction, or a 3·0 mL/kg per min or greater pVO2 increase without NYHA class worsening and 2) changes in pVO2, which was not statistically significant. Similarly, any treatment-associated emergent adverse effects (TEAE), treatment-associated serious adverse effects (TSAE), and cardiac-related adverse effects were not statistically significant. CONCLUSION: Mavacamten influences diverse facets of HCM comprehensively. Notably, our study delved into the drug's impact on the heart's structural and functional aspects, providing insights that complement prior findings. Further large-scale trials are needed to evaluate the safety profile of Mavacamten.

Tangible impact of patient communication modules on medical students and interns.

Attitude, ethics, and communication are key attributes in the doctor-patient relationship and to strengthen these qualities, the National Medical Commission, the body that regulates medical education and medical professionals in India introduced a course called Attitudes, Ethics and Communication (AETCOM) in the undergraduate medical curriculum. The objective of this study was to ascertain the perceptible qualitative influence of the modules in communication in the AETCOM course and to obtain feedback on its implementation. In this cross-sectional study, the attitude of medical students in all stages of training including internship was first explored using a Communication Skills Attitude Scale. Out of 27 modules in AETCOM course, five modules named foundations of communication deal with communication, and they are taught from the first to final professional years of training. After introducing communication modules in AETCOM for all professional years, feedback was collected from interns who had completed training in all modules. The interns provided feedback with a validated scale and two focused group discussions. Additionally, feedback from faculty involved in teaching AETCOM was analyzed. There was a significant increase in the positive attitude scores in the final year and internship compared to the first year. Eighty percent of the interns agreed that communication modules in AETCOM were useful and that they equipped them with the communication skills required for actual practice during their internship. Faculty agreed that these modules motivated the students to acquire communication skills. However, faculty also felt that these modules alone may not be sufficient to learn communication skills.NEW & NOTEWORTHY In the current study, we have assessed the attitude of medical students toward learning communication skills in all stages of their training. The novelty of our study is that communication modules were formally introduced for the first time into the medical curriculum and feedback was obtained from a cohort of interns who completed training in all modules in communication from AETCOM. The feedback from faculty and students provided us with concepts to improvise these modules.

False-Negative RT-PCR Findings and Double Mutant Variant as Factors of an Overwhelming Second Wave of COVID-19 in India: an Emerging Global Health Disaster.

RT-PCR is considered to be the standard gold diagnostic test for detecting COVID-19 causing SARS-CoV-2. Recent reports and recent pieces of evidence from scientific literature, however, tell a different story. There have been speculations of SARS-CoV-2 escaping the RT-PCR because of the series of mutations it has gone through. It is possible that host-dependent RNA editing and high person-to-person transmission have equipped the virus with mutations enabling it to spread faster and even evade the RT-PCR. Added to this is burnout among healthcare workers and technicians handling the RT-PCR machines and sampling. All of these factors may be working in unison to result in the deluge of false-negative cases India is facing during the second COVID-19 wave. The mutant strains are spreading to other parts, posing challenges to the whole world. These circumstances warrant supplementary diagnostic tests such as serological and radiological findings to deal with cases of high clinical suspicion. Even one misdiagnosed COVID-19 patient poses a risk to hundreds of others in the vicinity. Healthcare workers' burnout also has to be dealt with. Erroneous staff should be re-trained.

Impact of poor disease surveillance system on COVID-19 response in africa: Time to rethink and rebuilt.

Infectious disease outbreaks have long posed a public health threat, especially in Africa, where the incidence of infectious outbreaks has risen exponentially. Although, Africa has witnessed several outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic-prone diseases, little attention has been given towards strengthening the health surveillance systems. However, the recent COVID-19 pandemic has uncovered the region's already due to inefficient and ineffective health surveillance systems. However, the impact posed by the COVID-19 pandemic on health systems in the region has been catastrophic, it has also stressed the importance of rethinking and focusing on lessons learned during the COVID-19 pandemic. In this paper, we examine how Africa's poor disease surveillance systems affected the responses and strategies aimed at COVID-19 containment. To ensure early disease outbreak identification and prompt public health interventions in Africa, the current disease surveillance and response mechanisms must be strengthened.

COVID-19 and mucormycosis syndemic: double health threat to a collapsing healthcare system in India.

In addition to the overwhelming and uncontrollable second wave of COVID-19 in India, the country is also dealing with an outbreak of mucormycosis, a deadly fungal infection, which is affecting thousands of COVID-19 patients. With the increasing number of cases of mucormycosis and a fatality rate of 50%, many Indian states and union territories have declared an epidemic of black fungus due to its unprecedented emergence, which has adversely affected the already debilitated health system of the country. The advent of the new fungal epidemic in the country is due to the overdosage, panic and injudicious use of corticosteroids among COVID-19 patients, as well as their pre-existing medical history of diabetes, given that India is the diabetes capital of the world. Thus, there is an urgent need to address this public health concern by having nationwide surveillance, diagnostic and management system of the disease, along with public awareness and education to combat the syndemic of COVID-19 and mucormycosis in the country.

Typhoons During the COVID-19 Pandemic in the Philippines: Impact of a Double Crises on Mental Health.

The Philippines, a disaster-prone country in Asia, was hit by 22 tropical cyclones during the coronavirus disease (COVID-19) pandemic. Among the 22 tropical cyclones, 1 is recorded as the strongest tropical cyclone that made a landfall in world history. The recurrent typhoons in the Philippines during the pandemic have led to a long-lasting humanitarian crisis as hundreds of thousands of houses and collateral assets have been destroyed due to floods and landslides, leaving thousands of Filipinos homeless. Concurrently, the country has been experiencing a rise in the number of COVID-19 cases due to overcrowding in evacuation centers and lack of social distancing. The simultaneous existence of natural disasters and pandemic has caused devastating and detrimental effects to the mental health of Filipinos. Nonetheless, the Government of the Philippines, together with the World Health Organization and other humanitarian organizations, has been working hand-in-hand in implementing mental health approaches and providing psychological interventions to Filipinos who were greatly affected by the natural disasters and the COVID-19 pandemic.

Ebola Outbreak amid COVID-19 in the Republic of Guinea: Priorities for Achieving Control.

In February 2021, a new Ebola outbreak occurred amid the coronavirus disease 2019 (COVID-19) pandemic in the Republic of Guinea. Technical committees and Ebola mitigation mechanisms used during the 2014-2016 Ebola epidemics, have been redeployed by the public health organizations and African health organizations. As the burden on the local healthcare system is rising, fears of socioeconomic disruption are growing as well. Strategies used during the previous epidemic need to be reactivated, and new measures taken during the challenges of COVID-19 are being considered. This perspective discusses the available evidence regarding the epidemic of Ebola in Guinea amid the COVID-19 pandemic, highlights the challenges to be prioritized, and provides evidence-based recommendations.

Protocol-driven Antibiotic Treatment of Pediatric Empyema After Fibrinolysis.

BACKGROUND: The duration of antibiotic treatment after resolution of empyema in children is variable. We evaluated the efficacy and safety of a protocol-driven antibiotic regimen aimed to decrease antibiotic duration following treatment with fibrinolysis. METHODS: Our institutional protocol consisted of 7 further days of antibiotics upon removal of the thoracostomy tube, with the patient being afebrile, off supplemental oxygen, and having negative cultures. A prospective observational study was then performed between September 2014 and March 2019. Empyema recurrence and antibiotic-related complications were recorded. Results were compared with previously published data from the preprotocol era. RESULTS: A total of 37 patients were included. Mean total duration of antibiotics decreased from 26 ± 6.5 days in the preprotocol group to 22 ± 9.7 days in the postprotocol group (P = 0.004). This resulted in a significant decrease in hospital stay from the preprotocol cohort to the postprotocol cohort, respectively (9.3 ± 4.8 d versus 6.8 ± 3.1 d, P = 0.003). Sixty-two percentage of the patients were intended to treat according to the protocol, with a 50% adherence rate. Patients in which the protocol was followed had an average of 2.8 fewer days of antibiotics after discharge (P = 0.004), although overall duration was not statistically different. Significantly fewer antibiotic-related complications were noted after protocol initiation. There was no difference in empyema recurrence or readmissions. CONCLUSIONS: Institution of a protocol-driven approach to antibiotic duration following resolution of pleural space disease may reduce antibiotic duration and complications without reducing efficacy.

Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group.

BACKGROUND: Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. METHODS: We retrospectively analyzed 37 pediatric case records who presented from January 2014-December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. RESULTS: Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non -vegetative. CONCLUSION: Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.

Declining frequency of thoracoscopic decortication for empyema - redefining failure after fibrinolysis.

BACKGROUND: Primary fibrinolysis for pediatric empyema has become standard of care at our institution. Early study of our protocol revealed a 16% thoracoscopic decortication rate after primary fibrinolysis. We now report the frequency with which children progress to operation with maturation of the protocol. METHODS: A database of patients diagnosed with empyema between September 2014 and March 2019 was examined. Patients who underwent tissue plasminogen activator (tPA) therapy with or without subsequent video-assisted thoracoscopic (VATS) decortication were included. Patients with additional indications for tube thoracostomy or VATS were excluded. RESULTS: Forty-eight patients were included. Median age was 4.5 years [IQR 2-9.3]. Median length of stay (LOS) was 8 days [IQR 6-11]. No patients underwent primary VATS. Median days with a chest tube was 5 [IQR 5-6] and median number of doses of tPA was 3 [IQR 3-3]. Seven patients (14.6%) had a chest tube replaced without undergoing VATS. The VATS rate was 4.2% in the first half of this study but 0% in the last 33 months. CONCLUSION: Thoracoscopic decortication is rarely necessary in children with empyema. Raising the threshold for surgical intervention and utilizing further nonoperative measures can avoid an operation in most children without increasing in-hospital length of stay. LEVEL OF EVIDENCE: IV.