Cortisol Secreting Adrenal Adenoma in a 5 Year Old Child

Adrenal adenoma is a rare endocrinal tumor in children. It can present with features of Cushing's syndrome. We present a case report of five years old female child who came with morbid obesity and hypertension. The patient manifested polyphagia, weight gain, and changes in sleep patterns. During physical examination we found a full-moon face, bulkiness in the cervico-dorsal (buffalo-hump) region, high blood pressure

Combined Factor VII and X Deficiency

Factor VII deficiency and factor X deficiency and very rare disorders individually. Combined Factor VII and X is a rare congenital blood disorder with very few cases reported in the literature. We report a case of 7 years old male child who presented to us as a diagnosed case of factor 7 deficiency with recurrent epistaxis

Brothers with constrictive pericarditis – A novel mutation in a rare disease

Familial constrictive pericarditis is extremely rare. We report a case of two brothers both suffering constrictive pericarditis along with having multiple painless joint deformities. Genetic workup confirmed the clinical diagnosis of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome CACP syndrome and also revealed a rare mutation in the causative gene

Simultaneous transcatheter closure of ruptured sinus of Valsalva aneurysm and stent implantation for aortic coarctation

Ruptured sinus of Valsalva aneurysm is a rare anomaly and an associated coarctation of aorta is even rarer. A combination of such defects is traditionally treated surgically. The surgery is necessarily staged and done through different approaches. We report successful simultaneous transcatheter treatment of both these defects performed in the same setting in an acutely ill adult male patient with a good intermediate-term follow-up

Appropriateness of elective percutaneous coronary intervention and impact of government health insurance scheme — A tertiary centre experience from Western India

Background: There is a dearth of data regarding the appropriateness of elective percutaneous coronary intervention (PCI) in a limited-resource country such as India. In an attempt to rationalise the use of PCI, Appropriate Use Criteria (AUC) were developed for cardiovascular care in the USA. In the Indian context, considering the high prevalence of coronary artery disease, the dramatic rise in the number of revascularization procedures and an increasing role of government/private reimbursements, application of AUC could potentially guide policy to optimize the utilization of resources and the benefit-risk ratio for individual patients. Objectives: The study sought to determine the overall and year-wise trends in the appropriateness of elective PCI using the AUC and also understand the impact of the government health insurance scheme (GHIS). Material and Methods: The inpatient records of all patients undergoing elective PCI, at a single large tertiary care centre in Western India, from January 2009 to December 2014 were retrospectively analysed (n=972, 759 males, 213 females) by a neutral observer. The AUC scores and subsequent ranking were calculated using the dedicated web-based software and each PCIwas ranked as either ‘appropriate’, ‘uncertain’ or ‘inappropriate’. Elective PCI performed within a month after the index acute coronary syndrome (ACS) was considered as 'ACS' while applying the AUC. All other indications were considered as 'non-ACS'. Nearly 95% of elective PCI performed after July 2012 were covered under theGHIS and therefore the period January 2009–June 2012 was compared with the July 2012– December 2014 to assess the impact of this scheme. Results: A total of 894 elective PCI (379 and 515 PCI in the ACS setting and non-ACS setting respectively) performed on 857 patients were analysed. The elective PCI performed in the pre-GHIS and GHIS period were 458 and 436 respectively. As per AUC, 352 (39.6 ± 4.4 %) of the overall elective PCI were ranked as ‘appropriate’, while 487 (55.3 ± 4.1 %) cases as ‘uncertain’ and 55 (5.1 ± 0.6 %) cases as ‘inappropriate’. An overall year-wise temporal trend in the proportion of cases in any of the AUC rankings did not show any significant trends(p > 0.05). However, 80.4 ± 7.3 % of elective PCI in the ACS setting were categorised as ‘appropriate’ and 82.6 ± 6.9 % of elective PCI in non-ACS setting were ranked as ‘uncertain’. With state-wide implementation of the GHIS, the total number of elective PCI increased by 50% (436 in the 3½ year pre-GHIS study period as against 458 in the 2½ year GHIS study period). The introduction of GHIS led to a marginal increase (p > 0.05) in the average annual number of elective PCI in non-ACS setting as opposed to a 120% rise in the number of elective PCI done in the ACS setting (p < 0.001) and the delay in performing PCI after coronary angiogram reduced from 55.8 ± 43.6 days to 33 ± 22.9 days (p < 0.01). Also, the ratio of men: women undergoing elective PCI rationalised from 5.4:1 to 2.7:1 (p < 0.001). With the introduction of the GHIS, the share of ‘inappropriate’ elective PCI in the ACS setting increased from 1.34 % to 4.81 % (p =0.065). However, there was also a fall in ‘appropriate’ elective PCI in the non-ACS setting from 15.0 ± 3.2% to 7 ± 1.6% (p < 0.001). Conclusion: On applying the 2012 updated AUC, about 5 % of overall elective PCI were deemed as ‘inappropriate’. About four in every five elective PCI in the non-ACS setting were of ‘uncertain’ appropriateness. The implementation of the GHIS not only significantly reduced the gender bias and delay in seeking interventional coronary care but also led to a significant rise in the proportion of PCI performed in the ACS setting. However, there was also a rise in ‘inappropriate’ PCI in the ACS setting and a significant fall in ‘appropriate’ PCI in the non-ACS setting after introduction of the GHIS.