Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors.

INTRODUCTION: Mitral valve repair is the accepted treatment for mitral regurgitation (MR) but lack of resources and socioeconomic concerns delay surgical referral and intervention in developing countries. We evaluated immediate and short-term results of mitral valve repair for non-ischemic MR at our centre and aimed to identify the predictors of in-hospital and follow-up mortality. MATERIALS AND METHODS: The study was conducted at a tertiary-level hospital in South India. All patients >18 years with severe non-ischemic MR who underwent mitral valve repair over a period of 6 years were included. Perioperative data was collected from hospital records and follow-up data was obtained by prospective methods. RESULTS: There were 244 patients (170 males). Most of the patients were in the age group 31-60 years (76.6%). Aetiology of MR was degenerative (n = 159; 65.2%), rheumatic (n = 34; 13.9%), structural (n = 42; 17.2%), or miscellaneous (n = 9; 3.7%). All patients underwent ring annuloplasty with various valve repair techniques. One hundred patients (44.7%) underwent additional cardiac procedures. At discharge, MR was moderate in 4 patients; the rest had no or mild MR. The mean hospital stay of survivors was 7.1 days (SD 2.52, range 5-25 days). There were 9 in-hospital deaths (3.68%) and 10 deaths during follow-up (4.2%). The mean follow-up period was 1.39 years, complete for 87.6%. Pre-operative left ventricle ejection fraction (LVEF) <60% (p = 0.04) was found to be significantly associated with immediate mortality. Logistic regression analysis detected age (p = 0.019), female sex (p = 0.015), and left ventricular (LV) dysfunction at discharge (p = 0.025) to be significantly associated with follow-up mortality. CONCLUSION: Pre-operative LV dysfunction was identified as a significant risk factor for in-hospital mortality. Female sex, age greater than 45 years, and LV dysfunction at discharge were found to be significantly associated with follow-up mortality. Hence, it is important to perform mitral valve repair in severe regurgitation patients before significant LV dysfunction sets in for a better outcome.

Prospective sero surveillance among healthcare workers vaccinated with ChAdOx1 nCoV-19 Corona vaccine in a tertiary hospital of Kerala, India

BackgroundIndia started Covid-19 vaccination from January 16, 2021 after the approval of two candidate vaccines namely Covishield and Covaxin . We report antibody responses among healthcare workers following two doses of Covishield vaccination in a tertiary care setting. MethodsThis prospective serosurveillance study was done among healthcare workers of Jubilee Mission Medical College, vaccinated during January- March 2021. Blood samples were drawn from 170 participants after their 1st dose and from 156 participants after their 2nd dose of Covishield to measure the specific Ig G antibodies against the recombinant S1 subunit of the S protein of SARS-CoV-2. ResultsThe median level of anti SARS CoV-2 Ig G antibody 28 days after the first dose vaccination is 3.64 S/C (IQR=5.91) and 11.6 S/C (IQR= 5.97) after 14 days of second dose vaccination. Protective levels of anti SARS CoV-2 Ig G antibodies is developed by 25 participants (14.7%) after 28 days of first dose of vaccination and by 109 participants (69.9%) after 14 days of second dose. 18-44 years age group (p=0.027) and absence of comorbidities (p=0.079) are associated with protective IgG levels. ConclusionsRise in specific Ig G is observed after vaccination. Higher antibody response is observed with younger age group and absence of comorbidities, though statistically not significant. The influence of BMI is also not significant.

Successful Pregnancy in a Patient With Recurrent Pregnancy Loss Due to Afibrinogenemia Managed With Cryoprecipitate Prophylaxis in a Resource-limited Setting

@#Recurrent pregnancy loss (RPL) can be defined as loss of pregnancy on or before 20 weeks of gestation. About half of the cases, cause of recurrent miscarriage is unknown. Bleeding disorders induced miscarriage has to be thoroughly investigated for the sake of both mother and fetus. Here is an interesting case report of a 24-year-old patient who was diagnosed to have afibrinogenemia after three consecutive miscarriages. Fibrinogen level was 5 mg/dl with prolonged prothrombin time greater than 180 seconds and activated thromboplastin time greater than 180 seconds. We managed with periodic cryoprecipitate transfusion. Pregnancy course was uneventful and delivered a healthy female child at 34 weeks of gestation under supervision of multidisciplinary team. Here we are discussing the management and how we approached the case to have a successful pregnancy outcome.