Clinical dimensions of hypokinetic non-dilated cardiomyopathy in terms of severity and hospital outcome

Background: Hypokinetic non-dilated cardiomyopathy [HNDC/DCM (ND-H)] is a recently proposed (by ESC, 2016) subtype of dilated cardiomyopathy (DCM), which is characterized by the absence of left ventricular (LV) dilatation despite of global LV systolic dysfunction. Knowledge regarding clinical severity and outcomes of patients with DCM (ND-H) is very limited. Objective of the study was to evaluate clinical severity and hospital outcome of patients with HNDC [DCM (ND-H)].Methods: Total 1248 admitted patients with primary DCM were finalized as study participants considering inclusion and exclusion criteria. The study participants were categorized into two groups depending on presence or absence of LV dilatation. 411 (32.9%) patients without any LV dilatation included in group A [HNDC/DCM (ND-H) group] and 837 (67.1%) patients with LV dilatation included in group B [DCM (D-H) group]. Data with respect to clinical, electrocardiographic, echocardiographic findings and disease outcome of patients compared statistically between the two groups.Conclusions: HNDC [DCM (ND-H)] is a subclinical subtype, which represents 1/3rd population of DCM. Apart from absence of cardiomegaly, typical clinical signs, electrocardiographic abnormalities, from which we can suspect heart disease, were less prevalent in patients with DCM (ND-H). Therefore, patient most often miss the diagnosis till the advance stage. Non cardiac co-morbidities along with late diagnosis can be important contributing factors for adverse clinical outcomes in patients with DCM (ND-H) comparable to the DCM (D-H) counterpart

Diagnostic implication of hyperkinesia of the inferior septum for prediction of culprit artery in patients with inferior wall myocardial infarction

Background: Inferior wall MI is known for its diversity in clinical presentation due to substantial difference in clinical features in case of LCX and RCA occlusion. Hence prediction of culprit vessel of occlusion is very essential for anticipation of infarct related complications. However superposition of area of blood supply between LCX and RCA in inferior wall and adjacent lateral wall is a hindrance in prediction of culprit artery in inferior wall MI.Whereas adjacent inferior septum is supplied by both RCA &LAD but not supplied by LCX, so in case of LCX occlusion, adjacent myocardial fibres of inferior septum contracts vigorously to minimize the LV dysfunction and present as compensatory hyperkinesia. Aim: To study regional wall motion abnormality (RWMA), more specifically hyperkinesia in inferior septum for prediction of culprit artery in patients with acute inferior wall MI. Materials and Methods:A cross sectional study was conducted enrolling a total of 1429 patients with acute Inferior wall STEMI. All the patients were subjected to echocardiography to study RWMA in inferior septum. Taking into consideration of the inclusion & exclusion criteria total of 884 patients with single vessel disease as confirmed by angiography were finalised as the study participants.Results:Out of 884 patients, RCA was found as culprit artery in 645(73%) patients (group A) and LCX as culprit artery in 239(27.0%) patients (group B).While studying wall motion abnormality in the inferior septum, hyperkinesia was found in 87.4% cases in LCX disease as compared to 6.04% cases with in RCA disease with and the difference was found statistically highly significant.Conclusion: Hyperkinetic inferior septum can be an important diagnostic marker for distinguishing LCX lesion from RCA lesion in inferior wall MI

Clinical and angiographic pattern of coronary artery disease in smokeless tobacco users in comparison to smokers

Background: Smoking is a well-established cardiovascular risk factor for coronary artery disease (CAD), which is in a decremental trend among population over last few decades. Whereas use of smokeless tobacco is an establishing risk factor for CAD, which is in an incremental trend among population. Worldwide prevalence of use of smokeless tobacco is also higher than smoking among population. As amount of intake of tobacco, route of administration, rate of absorption, serum level of nicotine are different in both form of tobacco consumption, therefore clinical and angiographic patterns can be different in both cases.Objective:To compare and determine the difference in clinical and angiographic patterns of CAD between smokeless tobacco users and smokers.Materials and methods: Total 1848 patients attending catheterisation lab for coronary angiography with chief complain of angina or angina equivalent were enrolled in the study .Out of 1848 patients, 252 patients with history of tobacco consumption either in the form of smokeless or smoked tobacco without having any other cardiovascular risk factors for CAD were finally enrolled as study participants. Based on mode of consumption of tobacco, all study participants were categorised into two groupsi.e smokeless tobacco users group and smoker group. Data about clinical and angiographic patterns were compared between two groups.Results: Among smokers, prevalence of fatal coronary events like STEMI (32.4%), NSTEMI (29.6%) and multi vessel disease (27.7%) were significantly higher as compared to 15.2 %, 18%,19.4% cases among smokeless tobacco users respectively .On the contrary among smokeless tobacco users, prevalence of chronic stable angina (40.2%),single vessel disease(61.8%) were significantly higher as compared to 13.8%,48.1% casesamong smokersrespectively. While studying severity of lesion in patients with single vessel disease, 57.6 % patients in smoker group had occlusive(total or subtotal) lesion in comparison to 35.9% patients in smokeless tobacco user group with statistical significant P value.Conclusion: Prevalence of fatal coronary diseases, multi vessel diseases among smokeless tobacco usersis lower than that of smokers. However cardiovascular effects of smokeless tobacco can’t be ignored considering above facts. More than 1/3rd of smokeless tobacco users who presents to the catheterisation lab with angina or angina equivalent had fatal coronary artery disease and around 1/5th of the smokeless tobacco users with angina or its equivalent had multi vessel coronary artery disease

Assessment of Vaccine storage Practices in 2 districts of Eastern India -Using Global Assessment tool.

  Background: Introduction of  EPI was to accelerate disease control efforts and outcomes.EPIs are typically governed by Ministries of Health in cooperation with the WHO , UNICEF to provide technical assistance in planning, social mobilization , reach vaccine-specific target immunization coverage rates and reduce  incidence  of VPDs. The WHO  recommendation  on immunization schedules is  to ensure  proper administration of vaccines to each age-specific target group.   Effective program should reach  target population at  right time,  right place and  right condition before patients are exposed to infectious diseases. The first VMAT assessment of India was undertaken by Odisha in December 2007.Objectives: 1.To gather information on vaccine storage temperature and wet and dry storage capacity in the facility. 2.To assess the vaccine storage practices.3.To suggest recommendations. Methods: Place of the study: DVS and CCPs  in Cuttack and Jagatsinghpur ,Type of study: cross-sectional, Study design: By simple random sampling 7 CCPs in Cuttack  district and  3 CCPs in Jagatsinghpur district were selected and  2 DVSs were  included, Period of Study:Nov 2018 to Oct 2019, Study instrument: Global assessment tool designed by WHO, Ethical consideration: Obtained from  IEC of S.C.B Medical College Results: The vaccines were arranged properly from bottom upwards as recommended by WHO and the vaccines stored were within expiry period and having usable stage VVM. No reconstituted BCG, Measles or JE vaccines were found in any equipment in both the districts.Conclusion:In all the CCPs in this study the vaccines were arranged properly from bottom towards upwards as recommended by WHO. No reconstituted BCG, Measles or JE vaccines were found in any equipment in both the districts. Opened vials were stored in 87.5 % and 75% of facilities in both districts  separately. &nbsp

Strengthening molecular genetics and training in craniosynostosis: The need of the hour

Craniosynostosis (CS) is premature fusion of skull. It is divided into two groups: Syndromic craniosynostosis (SCS) and non-syndromic craniosynostosis (NSC). Its incidence in Indian population is 1:1000 live births where as in the USA it is 1:2500 live births. Its incidence varies from country to country. Molecular genetics having great interest and relevance in medical students, faculty, scientist, pediatric neurosurgeon and staff nurses, our objective was to educate the medical students, residents, researchers, clinicians, pediatric neurosurgeon, anesthetists, pediatricians, staff nurses and paramedics. We summarized here including with diagnosis, investigations, surgical therapy, induction therapy, and molecular therapy. Molecular genetics training is needed to know the information regarding development of skull, cranial connective tissue, craniofacial dysplasia, frame work, network of receptors and its etiopathogenesis. The important part is clinically with molecular therapy (MT) how to manage CS in rural sector and metropolitan cities need a special attention

Role of 99mTc-ECD SPECT in the Management of Children with Craniosynostosis

Purpose of the Report. There is a paucity of data on correlation of various imaging modalities with clinical findings in craniosynostosis. Moreover, no study has specifically reported the role of Tc99m-ECD SPECT in a large number of subjects with craniosynostosis. Materials and Methods. We prospectively analyzed a cohort of 85 patients with craniosynostosis from year 2007 to 2012. All patients underwent evaluation with Tc99m-ECD SPECT and the results were correlated with radiological and surgical findings. Results. Tc99m-ECD SPECT revealed regional perfusion abnormalities in the cerebral hemisphere corresponding to the fused sutures preoperatively that disappeared postoperatively in all the cases. Corresponding to this, the mean mental performance quotient (MPQ) increased significantly P<0.05 postoperatively only in those children with absent perfusion defect postoperatively. Conclusions. Our study suggests that early surgery and release of craniosynostosis in patients with preoperative perfusion defects (absent on Tc99m-ECD SPECT study) are beneficial, as theylead to improved MPQ after surgery