Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19.

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Inhibition of P. falciparum PFATP6 by curcumin and its derivatives: a bioinformatic study.

Curcumin, a yellow spice has been shown to have many pathological uses including cancer and malaria. Recent experimental data have shown the inhibitory effect of curcumin and its two derivatives on the growth of Plasmodium falciparum in cell culture at low micromolar concentrations. Previous studies have suggested that Ca(2+)­ATPase (PfATP6) of P. falciparum is the target of many antimalarial drugs. However, the mechanism of inhibition of Ca(2+)­ATPase (PfATP6) is not known. In addition, it is not clear which specific isomeric form of curcumin is the most potent inhibitor of P. falciparum. Here we address this issue using bioinformatics tools. We generated a molecular model of Ca(2+)­ATPase (PfATP6) of P. falciparum and carried out molecular docking of all curcumin analogues of Zinc database of compounds (zinc.docking.org). Two molecular docking programs Glide and FlexX were used to determine binding feasibility of 351 analogues of curcumin. The comparison of docking parameters showed, more than 20 analogues are better ligands of PfATP6 than curcumin itself. . The binding of curcumin and its analogues to PFATP6 is mediated by both hydrophobic and polar interactions. Our results suggest that curcumin analogues are promising lead compounds for the development of antimalarial drugs.

Stabilization of intrinsic defects at high temperatures in ZnO nanoparticles by Ag modification.

The stabilization of defects in ZnO at high temperatures has been investigated. The properties of unmodified and modified ZnO nanoparticles (NPs) with 2 at.% of Ag prepared by microwave assisted combustion method, have been systematically studied using X-ray diffraction (XRD), photoluminescence (PL), X-ray photoelectron spectroscopy (XPS) and photocatalytic activity measurements. Though the XRD data shows a marginal shift in the ZnO peak position upon Ag addition, the amount of shift does not change with annealing temperatures. The PL data reveals that the defect mediated visible emission intensity of unmodified ZnO NPs increases with increase in the annealing temperature, whereas it remains almost unchanged in Ag-ZnO. This study clearly establishes that silver is an efficient stabilizer of intrinsic defects in ZnO at high temperatures. This is further supported by the core and valence band XPS spectra.

Curved knife "Khukuri" injury in the back and anaesthesia induction in lateral position for thoracotomy.

Penetrating injury in the back with knife (Khukri) demands induction of anaesthesia and intubation in lateral position. In thoracic injury a double lumen tube placement is required to facilitate one lung ventilation during thoracotomy. In emerging situation, we could successfully execute induction of patient in right lateral position using right sided DLT for left thoracotomy. Its correct placement was confirmed by fiberoptic bronchoscopy. In conclusion right-DLT intubation can be performed without difficulty by conventional direct laryngoscopy using Macintosh blade in lateral position.

The evolution of a quality of care approach for improving emergency obstetric care in rural hospitals in Nepal.

We describe the iterative process of developing a locally-appropriate quality of care approach and its role in emergency obstetric care (EmOC) programming in Nepal. We describe the context of maternal health issues in Nepal, the rationale for developing a quality of care approach within a model to improve EmOC, and outline the outcomes and catalytic effects of the process. The lessons learned during the development of this approach are detailed. The program developed and implemented a quality of care approach at three district hospitals in Nepal. This resulted in improvements in the structure, process and outcomes of EmOC in these institutions. The process also resulted in improved understanding of quality of care approaches on both local and national levels and the creation of a Nepalese quality of care evaluation framework for maternity services. While the theoretical concept of quality of care is difficult to translate into a concrete approach, we used a process in rural hospitals in Nepal that created highly motivated teams and improved the overall functioning of these hospitals.

Process indicators for safe motherhood programmes: their application and implications as derived from hospital data in Nepal.

Measuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and < 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and < 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.

Combining aspirin with angiotensin converting enzyme inhibitors in heart failure: how safe is it?

The above discussion on the interaction of aspirin and ACE inhibitors seems to suggest that aspirin in high doses may have adverse interaction with ACE inhibitors in patients with heart failure but the data obtained is not sufficient or conclusive to recommended omission of aspirin in patients with heart failure. This raises a query in the mind of the physician whether to use a combination or not? The role of aspirin in the early period after myocardial infarction is well established so is the role of ACE inhibitors. Hence in patients with myocardial infarction and preserved left ventricular function it would not be wrong to administer combination of ACE inhibitors and aspirin. Albeit at a lower dose. In patients with large myocardial infarction or heart failure, warfarin may be an option but still needs to be documented in large trials. As suggested long term use of aspirin after infarction is still ambiguous and may be harmful in patients with heart failure with its anticedent side effects. But long term benefits of ACE inhibitors in heart failure are well documented. Hence if a choice has to be made whether to discontinue either of the two drugs it would be preferable to stop the aspirin. To answer the issue of use of aspirin in patients with heart failure it would be essential to conduct a double blind randomized trial comparing known anti-thrombotic treatment, aspirin and anti-coagulants on mortality in patients with heart failure, especially caused by coronary artery disease. Such a trial is underway at the present and till the results are available it should be left to clinical judgement of the physician whether to administer aspirin in patients with heart failure after weighing the benefits versus risk.

Haemangiopericytoma of the nasal cavity.

Haemangiopericytoma of nose and paranasal sinuses is relatively uncommon tumour. It occurs in adults in sixth and seventh decades of life. In view of paucity of intranasal haemangiopericytoma old in Indian literature and young age of patient, we are reporting one case in 28-year-old female who presented with recurrent, profuse epistaxis.

Left ventricular aneurysm: angiographic determinants.

To determine antiographic factors involved in left ventricular aneurysm formation after myocardial infarction, 50 patients with a first anterior wall myocardial infarction who underwent cardiac catheterisation within 6 months of infarction were evaluated. Extent of coronary artery disease and status of collateral circulation were studied in detail. Thirty patients had aneurysm in apical region while 20 patients showed aneurysm in anteroapical region. Coronary angiography revealed single-vessel disease in 17 patients, double-vessel disease in 17 patients and triple-vessel disease in 15 patients while in one patient coronary angiogram was normal. Fortynine patients showed significant involvement of left anterior descending artery which was poorly collateralised. Left anterior descending artery disease in association with inherent poor collateral blood supply may predispose for aneurysm formation after anterior wall myocardial infarction.

Unusual presentation of aneurysm of aorta.

An unusual case of a saccular aneurysm of arch of aorta, masquerading as pulmonary artery branch stenosis, proved by cardiac catheterisation and angio cardiography is presented.