Consensus document for invasive coronary physiologic assessment in Asia-Pacific countries

Background: Currently, invasive physiologic assessment such as fractional flow reserve is widely used worldwide with different adoption rates around the globe. Patient characteristics and physician preferences often differ in the Asia-Pacific (APAC) region with respect to treatment strategy, techniques, lesion complexity, access to coronary physiology and imaging devices, as well as patient management. Thus, there is a need to construct a consensus document on recommendations for use of physiology-guided percutaneous coronary intervention (PCI) in APAC populations. This document serves as an overview of recommendations describing the best practices for APAC populations to achieve more consistent and optimal clinical outcomes.  Methods and Results: A comprehensive multiple-choice questionnaire was provided to 20 interven- tional cardiologists from 10 countries in the APAC region. Clinical evidence, tips and techniques, and clinical situations for the use of physiology-guided PCI in APAC were reviewed and used to propose key recommendations. There are suggestions to continue to develop evidence for lesion and patient types that will benefit from physiology, develop directions for future research in health economics and local data, develop appropriate use criteria in different countries, and emphasize the importance of education of all stakeholders. A consensus recommendation to enhance the penetration of invasive physiology-based therapy was to adopt the 5E approach: Evidence, Education, Expand hardware, Economics and Expert consensus.  Conclusions: This consensus document and recommendations support interventional fellows and cardiologists, hospital administrators, patients, and medical device companies to build confidence and encourage wider implementation of invasive coronary physiology-guided therapy in the APAC region.

Factors associated with stigma and manifestations experienced by Indian health care workers involved in COVID-19 management in India: A qualitative study

Healthcare personnel who deal with COVID-19 experience stigma. There is a lack of national-level representative qualitative data to study COVID-19-related stigma among healthcare workers in India. The present study explores factors associated with stigma and manifestations experienced by Indian healthcare workers involved in COVID-19 management. We conducted in-depth interviews across 10 centres in India, which were analysed using NVivo software version 12. Thematic and sentiment analysis was performed to gain deep insights into the complex phenomenon by categorising the qualitative data into meaningful and related categories. Healthcare workers (HCW) usually addressed the stigma they encountered when doing their COVID duties under the superordinate theme of stigma. Among them, 77.42% said they had been stigmatised in some way. Analyses revealed seven interrelated themes surrounding stigma among healthcare workers. It can be seen that the majority of the stigma and coping sentiments fall into the mixed category, followed by the negative sentiment category. This study contributes to our understanding of stigma and discrimination in low- and middle-income settings. Our data show that the emergence of fear of the virus has quickly turned into a stigma against healthcare workers

Continental concerted efforts to control the seventh outbreak of Ebola Virus Disease in Uganda: the first 90 days of the response

On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi-country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross-border preparedness and response actions. The outbreak spanned 69 days and recorded a total of 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response the Government was able to galvanise robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions put in place that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks

A clinico-epidemiological study of dermatoses in pediatric HIV patients in a tertiary care center

Introduction: Cutaneous lesions are very common in pediatric HIV infection, and many of the dermatoses are linked to the underlying levels of CD4 counts. Aims: The primary aim was to study the clinico-epidemiological patterns of dermatoses in pediatric HIV infection, and the secondary aim was to ascertain if any dermatoses is a marker of HIV infection. Materials and Methods: This is a retrospective descriptive, 1-year study. All data regarding the clinico-epidemiological features of pediatric HIV patients in the study period were analyzed. Results: There were 65 patients in this study, comprising 44 males (67.69%) and 21 females (32.31%). The age group 7–12 constituted the maximum number of cases, 35 (53.84%). Parental to child transmission was the most common mode of transmission seen in 54 patients, (83.07%). Cutaneous manifestations were seen in 43 patients (66.15%). Exaggerated insect bite reaction (IBR) was the most common cutaneous manifestation seen in this study accounting for 19 patients (29.23%), with a mean CD4 count in patients in the age group 1–5 being 425 cells/mm3 and 212 cells/mm3 in the age group 6–12. Conclusions: IBR in pediatric HIV infection indicates very low CD4 counts and in the absence of other caused for immunosuppression can be a marker of HIV infection

Disability among leprosy patients in the lustrum 2016-2020: Retrospective study from a tertiary care centre in Southern Kerala

Background: The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This research was done to estimate the proportion of leprosy patients who had G2D at the time of diagnosis and to identify the clinical and demographic factors that predicted G2D. Materials and Methods: Design -Hospital-based retrospective cross-sectional study. The outcome variable was G2D and the determinants were demographic and clinical characteristics. Results: G2D was seen in 22.3% and G1D in 17.5%. The M:F ratio of G2D was 5:1. G2D was highest in the hands (62.1%), followed by the feet (59.4%), and the eyes (16.2%). The claw hand was the most common deformity in the hand and the plantar ulcer was the most common deformity in the feet. Age >45 (OR 2.27, 95% CI 1.1–4.8), males (OR 3.3,95% CI 1.3–8.5), multibacillary type (OR 6.95,95% CI 1.6–30.6), pure neuritic type (OR 3.6,95% CI 1.1–12.3), and thickened nerves (OR 14.3, 95% CI 1.9–108.7) were the significant determinants. Conclusion: Being male, being older than 45, having multibacillary leprosy, having pure neurotic leprosy, and having a thicker nerve trunk predicted G2D. Training primary care health workers in recognising the subtle early symptoms and raising community awareness are the need of the hour. Frequent leprosy case detection programmes should be held to identify undiagnosed cases

<i>Ganoderma lucidum</i> (Fr.) P. Karst occurring in South India attenuates gastric ulceration in rats

19-27The ethanol extract of Ganoderma lucidum (Fr.) P. Karst occurring in South India was examined for antiulcer activity against ethanol and Indomethacin induced ulcer in rats. Pretreatment of oral doses of 500 mg/kg and 1000 mg/kg showed significant reduction of ulcer index, with a percentage of inhibition of 55.17, 72.79 and 47 and 76.14% in ethanol and Indomethacin induced gastric ulceration, respectively. Administration of G. lucidum extract elevated the levels of Glutathione (GSH) as well as activities of Superoxide dismutase (SOD), Glutathione Peroxidase (GPx) and Catalase (CAT) and significantly lowered the levels of lipid peroxidation (LPO) in a dose dependent manner. The antiulcer property of the mushroom might be due to its profound free radical scavenging activity. The findings suggest the potential therapeutic use of G. lucidum as an effective non-toxic antiulcer agent

The design and rationale of the primary angioplasty registry of Kerala

Background: ST-elevation myocardial infarction (STEMI) continues to be a major cause of cardiovascular mortality in Kerala, India. Timely primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy for STEMI. There is limited data on the safety, effectiveness, equity and efficiency of regional primary PCI services in India. Methods/Design: The primary angioplasty registry of Kerala is a clinician-initiated prospective state-wide longitudinal hospital-based registry of patients undergoing primary PCI for STEMI. The registry aims to document the efficacy and safety of the real world use of primary PCI in Indian patients presenting with STEMI, in order to achieve regional adoption of global standard performance indicators. In addition, the registry would analyze procedural variations in the performance of primary PCI and assess its impact on relevant patient centered outcomes. We plan to enroll 6000 STEMI patients, undergoing primary PCI, across 48 hospitals. These patients would be followed up for a minimum of 1 year. Conclusions: The primary angioplasty registry of Kerala would help analyze the quality and outcomes of primary PCI services in Kerala, thereby yielding insights that can help limit unacceptable procedural variations in the performance of primary PCI. Identifying deviations from guideline based therapies can form the basis of quality improvement programs, which in turn will enable hospitals to achieve better patient outcomes