Case report of congenital rubella syndrome with sub aortic membrane non-coronary cusp perforation and patent ductus arteriosus

Rubella, a common viral infection caused primarily by the rubella virus, is still a global public health concern. Every year, about 30000 instances of congenital rubella syndrome are reported in India, according to health ministry surveillance. A case study of a 6-year-old boy with congenital rubella syndrome was presented here. The child presented with classic abnormalities of congenital rubella syndrome like hearing loss, vision problems, heart defects and intellectual disabilities. Among its many manifestations, congenital heart defects are life threatening, this child was planned for surgical correction of above cardiac lesions. Treatment modalities differ in each type of congenital heart defects and its early detection and surgical intervention can reduce childhood mortality and morbidity

Reliability of intra-atrial ECG method of insertion of central venous line through right internal jugular vein when compared to formula and radiological landmark method: a prospective randomized study

Abstract Background Ideal position of central venous catheter tip should be within 2 cm above and 1 cm below superior vena cava–right atrium (SVC-RA) junction. The objective of the study was to compare intra-atrial ECG method of Central venous catheterization of right internal jugular vein (IJV) with traditional methods. A prospective randomized trial enrolling 90 patients were alternatively allocated to three groups and comparison of intra-atrial electrocardiography, radiological landmark and Pere’s formula method for correct positioning of central venous catheter tip were done and tip position were confirmed with post-procedural TEE (transesophageal echocardiography). Results Catheter tip was present at the ideal position in 100% cases in intra-atrial ECG method compared to only 23.4% in formula method and 93.3% in landmark method (p value 0.001). In intra-atrial method group, the central venous catheter tip was placed perfectly in all patients, position of the catheter tip was not acceptable in 71.4% of the patients where formula method is used and not acceptable in 11.1% when landmark method is used (p value 0.001). However, we did not encounter any catheter related complications in any of these groups. Conclusions Intra-atrial ECG method carries the advantage of ideal positioning of the central venous catheter tip by right IJV route in almost all cases when compared to conventional formula and landmark method to some extent. Also, immediate confirmation and real time verification of central venous catheter (CVC) tip is possible, thereby avoids the need for post-procedural chest X-ray and other methods of central venous placement confirmation like arterial blood gas analysis etc., Hence, intra-atrial ECG method is cost effective and safer for confirmation of CVC tip in all the situations

Applicability of the Cleveland clinic scoring system for the risk prediction of acute kidney injury after cardiac surgery in a South Asian cohort

Background: Acute kidney injury (AKI) after cardiac surgery is a frequent post-operative complication associated with an increased risk of mortality, morbidity and hospital costs. Preoperative risk scores such as the Cleveland Clinic Scoring Tool (CCST) have been validated in Western population group to identify patients at higher risk of AKI and may facilitate preventive strategies. However, the scoring tool has not been validated systematically in a South Asian cohort. We aimed to evaluate the applicability of the CCST in prediction of AKI after open cardiac surgery in a South–Indian tertiary care center. Materials and methods: A retrospective study of all patients who underwent elective open cardiac surgery over a 4 year period from Jan 2012 to Dec 2015 at a single centre were included and relevant details extracted from a comprehensive chart review. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified as per the CCST to assess for prediction of AKI into low risk (0–2), intermediate risk (3–5) and high risk (>6) groups. Results: A total of 276 patients underwent open cardiac surgery with mean age of 51.5 ± 13.06 yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum creatinine, diabetes mellitus, chronic obstructive pulmonary disease, cardiopulmonary bypass time was similar in patients who developed AKI vs those who did not have AKI postoperatively. The mean CCST scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had received preoperative statins. Comparison of drug use between the two groups revealed that preoperative use of ACEI/ARB was associated with highest risk of AKI (p = 0.006). Mortality rate was also high at 15.7% in those with AKI compared to 3.1% in non-AKI group (p = 0.04). Conclusion: The modified CCST was valid in risk identification of patients with severe stage of AKI but did not have strong discrimination for early AKI stages. Preoperative statin use did not protect against AKI in our study, however preoperative ARB/ACEI use was significantly associated with occurrence of postoperative AKI. Key Words: Cardiac surgery, Acute kidney injury, Mortality, Risk scoring, Statin

1930 map of Bombay’s eastern waterfront and Tank/Kaula Bandar [44].

1930 map of Bombay’s eastern waterfront and Tank/Kaula Bandar [44].</p

Demographic composition of individual interview participants (<i>n</i> = 40).

Demographic composition of individual interview participants (n = 40).</p

Snapshot of findings according to pathways summarized by Pearce’s [39].

Snapshot of findings according to pathways summarized by Pearce’s [39].</p

Open-ended questions from the qualitative interview guide.

Open-ended questions from the qualitative interview guide.</p

Pathways underlying the association between spatial stigma and health as summarized by Pearce [39].

Pathways underlying the association between spatial stigma and health as summarized by Pearce [39].</p

Adapted Pearce’s conceptual model and inter-relationships between pathways.

Black boxes and lines represent Pearce’s conceptual model. Red dotted lines represent the unique contribution of our results: structural factors independently led to disinvestment in infrastructural resources. Spatial stigma, enacted through disinvestment and discrimination was a major pathway to internalization of such stigma. Internalization impacted community solidarity signifying via lateral denigration.</p