A study on the effect of biochemical parameters on the outcome and risk stratification of patients with cardiogenic shock following acute myocardial infarction

Cardiogenic shock is the most extreme complication of myocardial infarction and it is the initial presentation of at least 1 in 15 patients admitted to ICCU. 5-10% of patients with myocardial infarction develop cardiogenic shock and 2/3 rd among these are expected to die within 2-3 weeks. The various risk factors contributing to cardiogenic shock has been studied individually in different parts of the world. AIMS AND OBJECTIVE: To study the prognosis of patients admitted with cardiogenic shock as a complication of acute MI and to stratify the risk in the above patients with respect to the levels of admission day random blood glucose, thyroid hormone levels- T3, T4, TSH, Lipid profile-Total cholesterol, triglycerides, HDL, LDL, serum uric acid, blood urea and serum creatinine. MATERIALS AND METHODS: This is a cross sectional observational intention to treat study of 200 cases of cardiogenic shock following acute myocardial infarction admitted in the ICCU of Coimbatore medical college done in the period from July 2106 to June 2017. The cases were evaluated with thorough clinical examination, blood investigations and echocardiography. OBSERVATION: In our study, the prognosis of cardiogenic shock was found to be poor despite early effective intervention methods, only 170 survived among the 200 cases. The majority of the patients were males in the age group of 61-70 years. There were more number of smokers and alcoholics in the group who died. Most of the patients presented within the window period of 6-12 hrs and STEMI. A low systolic blood pressure of 120 /min, anterior wall STEMI, ejection fraction 200mg/dl, serum uric acid > 6 mg/dl, Serum creatinine>2 mg.dl, blood urea >40mg/dl was found to adversely effect the outcome and related to MACE. Lipid profile analysis showed elevated triglycerides, elevated total cholesterol and reduced HDL in majority of the patients. Among these, a TC level > 200 mg/dl, TG >150mg/dl and HDL 8mg/dl, urea level>40mg/dl were found independently to be statistically significant in determining the outcome of cardiogenic shock. CONCLUSION: This study has revealed the importance of stratifying the risk among patients who present with cardiogenic shock. Even though a few of the variables studied here has already been established in literature, this study has put together both clinical as well as biochemical factors in predicting the outcome of cardiogenic shock. In addition to the non modifiable risk factors like age, family history of CAD and hypertension, factors like initial blood pressure, heart rate has been found to be important. Blood urea, creatinine, serum uric acid and lipid profile are less often looked on variables when a patient presents with cardiogenic shock. This study has established the cut off values above which these variables should be cautiously watched for treatment. Studies on thyroid profile have not much been conducted and sick euthyroid syndrome and its effects on cardiogenic shock needs further studies. The use of thrombolytic therapy has not shown much yield in this study. This highlights the importance that any patient with cardiogenic shock should and must undergo a primary coronary intervention, which can only be the life saving measure

A study of cutaneous manifestations in systemic lupus erythematosus

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific) or may be non specific (LE non specific). Acute cutaneous LE (Lupus specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management. AIMS AND OBJECTIVES: To determine the following in the cases of SLE: 1. Age incidence, 2. Sex incidence, 3. Precipitating factors, 4. To assess the various types of cutaneous lesions in patients with SLE, 5. To evaluate the relation between skin lesions and other systemic involvement, MATERIALS AND METHODS: Study design: Cross sectional observational study. Study sample: 62 patients. METHODOLOGY: All patients with SLE attending Dermatology Outpatient Department and from Rheumatology Dept. Detailed case history of each patient with special attention to cutaneous lesions is taken. Gender, age, marital and family history, history of autoimmune diseases, sunlight exposure, smoking, drugs and relapses is asked for. Clinical features including LE specific and LE nonspecific lesions were noted. Detailed dermatological examination with inclusion of histopathological finding by skin biopsy as and when required. RESULTS: The commonest age group to be affected was observed to be second and third decade. Female preponderance was seen with a female to male ratio of 7:1. Multiple precipitating factors are involved in the clinical manifestation of disease. Photosensitivity was the commonest among the precipitating factors. Fever, easy fatigability, diffuse hair loss, and arthralgia were the common symptoms seen. Malar rash was the commonest disease specific lesion and diffuse hair loss was the commonest non specific but disease skin lesion. Generalized macular papular rash was associated with active disease. Musculoskeletal system was the commonest system involved and renal involvement was associated with the most morbidity. Antinuclear antibodies were positive in all patients in this study. CONCLUSION: Cutaneous manifestations in SLE can yield valuable diagnostic as well as prognostic information. As skin lesions are associated with increased morbidity, proper understanding of cutaneous manifestations is necessary for early diagnosis and effective intervention in patients with SLE

Predicting Users’ Responses of Public Utility Services - Multivariate and Neural Network Analysis - A Case Study

This research addresses the problem of predicting the user’s responses through multivariate choice (MVC) and neural network (NN) frameworks for predicting quality, quantity and overall User satisfaction of public water supply organization, BWSSB (Bangalore Water Supply and Sewerage Board) in Bangalore - India for policy initiatives. The MVC study identifies statistically significant factors that explain users’ loyalty to express satisfaction and voice to express dissatisfaction. The MVC model correctly predicts 85% of satisfied customers across satisfaction dimensions.  Wald test on 1940 responses confirms that there exits cross equation correlation across quality, quantity and overall Users’ satisfaction dimensions and thus appropriateness of MVC framework over traditional logit for predicting the user responses. NN framework outperforms the econometric model with 94% correct classification of user responses. The study opens up potential research opportunities for applying the advanced analytical frameworks for predicting user responses in various public and private settings for Policy initiatives so that the service providers could improve their service delivery

Users’ Satisfaction of Public Utility Services – Multivariate System Analysis

This research develops a multivariate system framework for assessing user satisfaction of public water utility organization in a developing country and predicts quality, quantity and overall user satisfaction for policy initiatives. The model framework is applied to the data collected by Public Affairs Centre (PAC) based on the Citizen Report Card approach pioneered by it. Wald test confirms that there exits cross equation correlation across quality, quantity and overall users’ satisfaction dimensions. Based on the system model, the study identifies statistically significant factors that explain users’ loyalty to express satisfaction and voice to express dissatisfaction of users. Policy initiatives are proposed on key factors to reduce voice factors set so that the service provider could improve its service delivery. The system model correctly predicts 85% of satisfied customers across quality, quantity and overall satisfaction dimensions.  Keywords: Multivariate, Logit, Discrete choice Model, Public Sector Utility service provide

Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework.

An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbai's population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery

Micropropagation and conservation of selected endangered anticancer medicinal plants from the Western Ghats of India

Globally, cancer is a constant battle which severely affects the human population. The major limitations of the anticancer drugs are the deleterious side effects on the quality of life. Plants play a vital role in curing many diseases with minimal or no side effects. Phytocompounds derived from various medicinal plants serve as the best source of drugs to treat cancer. The global demand for phytomedicines is mostly reached by the medicinal herbs from the tropical nations of the world even though many plant species are threatened with extinction. India is one of the mega diverse countries of the world due to its ecological habitats, latitudinal variation, and diverse climatic range. Western Ghats of India is one of the most important depositories of endemic herbs. It is found along the stretch of south western part of India and constitutes rain forest with more than 4000 diverse medicinal plant species. In recent times, many of these therapeutically valued herbs have become endangered and are being included under the red-listed plant category in this region. Due to a sharp rise in the demand for plant-based products, this rich collection is diminishing at an alarming rate that eventually triggered dangerous to biodiversity. Thus, conservation of the endangered medicinal plants has become a matter of importance. The conservation by using only in situ approaches may not be sufficient enough to safeguard such a huge bio-resource of endangered medicinal plants. Hence, the use of biotechnological methods would be vital to complement the ex vitro protection programs and help to reestablish endangered plant species. In this backdrop, the key tools of biotechnology that could assist plant conservation were developed in terms of in vitro regeneration, seed banking, DNA storage, pollen storage, germplasm storage, gene bank (field gene banking), tissue bank, and cryopreservation. In this chapter, an attempt has been made to critically review major endangered medicinal plants that possess anticancer compounds and their conservation aspects by integrating various biotechnological tool

Keratocystic odontogenic tumor: A case report and review of literature

Keratocystic odontogenic tumor (KCOT) has been identified as a "tumor" after observation of its biological behavior and genetic abnormalities consistent with neoplastic progression. In 2005, the World Health Organization (WHO) working group considered odontogenic keratocyst (OKC) to be a tumor and recommended the term KCOT, distinguishing the lesion from the orthokeratinizing variant, which is now considered an OKC or orthokeratinized odontogenic cyst. Very rarely, KCOTs can transform into more aggressive lesions such as ameloblastoma and primary intraosseous carcinoma (PIOSCC). In this paper, we present a case of KCOT involving the angle and ramus of the mandible, with histopathologic evidence of ameloblastomatous changes. We also discuss about the evolution of this lesion from a cyst to a tumor along with the latest updates of the entity

Oral Myiasis: Report of 3 cases

Myiasis commonly refers to invasion of live human or animal tissue by fly larvae of the Diptera family. Infestationof tissues of vertebrate species is pandemic. Myiasis frequently found in tropical and subtropical countries wherepoor hygiene, poor housing infrastructure,warm humid climate, and proximity with domestic animals prevail. Oralmyiasis is a rare pathology and a risk to the patient’s life. Its diagnosis is made basically by the presence of larvae.Herewith presenting 3 cases of oral myiasis of oro-dental complex

Metastasis in context : Modeling the tumor microenvironment with cancer-on-a-chip approaches

Most cancer deaths are not caused by the primary tumor, but by secondary tumors formed through metastasis, a complex and poorly understood process. Cues from the tumor microenvironment, such as the biochemical composition, cellular population, extracellular matrix, and tissue (fluid) mechanics, have been indicated to play a pivotal role in the onset of metastasis. Dissecting the role of these cues from the tumor microenvironment in a controlled manner is challenging, but essential to understanding metastasis. Recently, cancer-on-a-chip models have emerged as a tool to study the tumor microenvironment and its role in metastasis. These models are based on microfluidic chips and contain small chambers for cell culture, enabling control over local gradients, fluid flow, tissue mechanics, and composition of the local environment. Here, we review the recent contributions of cancer-on-a-chip models to our understanding of the role of the tumor microenvironment in the onset of metastasis, and provide an outlook for future applications of this emerging technology