Study of intraventricular Conduction Disturbances and Left Ventricular Hypertrophy in Patients with Hypertension in Government Royapettah Hospital

INTRODUCTION Hypertension is one of the leading causes of morbidity and mortality in the world and will increase in world wide importance as a public health problem by the year 2020 1. It is one of the most common diseases which is easily detectable, readily treatable, often leading to fatal complications if left untreated. Hypertension is a powerful risk factor that increases the likelihood of developing a wide variety of cardiovascular diseases like cerebrovascular accident, coronary artery disease, heart failure, renal insufficiency and peripheral vascular disease. 2 Hypertension causes an increase in left ventricular mass and fibrous tissue resulting in increased stiffness of the left ventricle leading possibly to reduced coronary reserve, silent myocardial ischaemia, abnormal electrophysiological properties of hypertrophied myocytes and conduction disturbances. Electrocardiogram is one of the tests recommended by the Seventh Joint National Committee of hypertension for the initial evaluation of a hypertensive patient 3 . Not only is the Electrocardiogram useful in documenting previously undetected myocardial infarction, myocardial ischaemia and conduction disturbances, but also it is the least expensive and possibly the most cost effective way to diagnose or exclude left ventricular hypertrophy. AIM OF THE STUDY: 1. To study the incidence of intraventricular conduction disturbances in patients with systemic hypertension. 2. To identify the most common type of intraventricular conduction disturbance. 3. To study the incidence of electrocardiographic evidence of left ventricular hypertrophy with or without strain in patients with systemic hypertension. MATERIALS AND METHODS: SETTING: This study was conducted in the Government Royapettah Hospital during the period from February 2007 to September 2007. The patients registered in the hypertension clinic were taken up for the study. STUDY POPULATION: Two hundred and fifty patients were selected randomly and included in the study group and their age ranged from thirty to eighty years. METHOD: A detailed history and a thorough clinical examination was done in all patients. The average of two blood pressure readings recorded five minutes apart in sitting position at two visits separated by a week were taken into account. Standard twelve lead ECG was recorded. Those patients with abnormal ECG were followed up a week later with another ECG. Only patients with persistent ECG abnormalities were taken up for analysis. Intraventricular conduction disturbances and LVH were documented using standard ECG criteria as mentioned above. Routine blood pressure, urine analysis and chest x-ray were taken in all patients Inclusion Criteria: Only patients with history of hypertension for more than a year were taken up for the study. Exclusion Criteria: Patients with clinical and ECG evidence of coronary artery disease, valvular heart disease and congenital heart disease were excluded from the study. Patients with history of diabetes, chronic obstructive airway disease were excluded from the study. Patients with secondary hypertension were excluded from the study. CONCLUSION: This study entitled “The study of intraventricular conduction disturbances and left ventricular hypertrophy in systemic hypertension” included the study of 250 patients of systemic hypertension with the clinical presentation and ECG findings. The following conclusions were derived. 1. The incidence of intraventricular conduction disturbance in systemic hypertension was 10%. 2. LAFB was the most common conduction disturbance in systemic hypertension followed by RBBB and LBBB. LPFB was not observed. 3. The distribution of conduction disturbances were almost equal in males and females. 4. Conduction disturbances were more common in the older age group. 5. The incidence of LVH in systemic hypertension was 17.2%. 6. The incidence of LVH without strain and with strain were 12.4% and 4.8% respectively. 7. Female hypertensives were more likely to have LVH . 8. LVH was more common in the older age group. 9. Patients with conduction disturbances and LVH were more likely to have high BP. 10. The presence of intraventricular conduction disturbances and LVH in hypertensives indicates the need for more vigilant antihypertensive therapy

Pleuropulmonary aspergillosis presenting as hydropneumothorax in second trimester pregnancy

Pleuropulmonary aspergillosis is a rare entity and usually occurs in a patient with preexisting lung disease or surgery. A 29-year-old pregnant woman with 16 weeks of gestation presented with shortness of breath, right-sided chest pain, and productive cough of 2 weeks' duration. A chest radiograph done with abdominal shield revealed right hydropneumothorax. Intercostal drainage insertion was done under ultrasound guidance. Pleural fluid was exudative with high adenosine deaminase levels, and GeneXpert test was negative for Mycobacterium tuberculosis. Pleural fluid and sputum culture revealed significant growth of Aspergillus fumigatus. She was treated with voriconazole intravenously followed by oral route. The patient improved clinically with good lung expansion, and she delivered a normal live baby by elective cesarean section. We report this case in view of the rarity of pleuropulmonary aspergillosis occurring in a young pregnant female with no evidence of prior lung pathology

Erysipelothrix bacteremia; is endocarditis a rule?

Erysipelothrix rhusiopathiae is a Gram-positive bacillus, a zoonotic pathogen rarely causing human infections ranging from localized skin infections to invasive infections such as endocarditis. In this report, we present two cases of Erysipelothrix bacteremia. The first case is a native valve tricuspid endocarditis, which is a highly unusual valve to be involved. The second case is bacteremia, probably secondary to a minor skin breach, which did not involve heart valves. Erysipelothrix bacteremia is considered highly associated with infective endocarditis and a high mortality rate, which could be a bias due to underreporting of Erysipelothrix bacteremia without endocarditis. Erysipelothrix is intrinsically resistant to vancomycin, the first-line agent for Gram-positive bacteremia. Both the patients in this report were treated successfully with ceftriaxone

Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective

In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged called COVID-19. A vast number of people affected by this disease are asymptomatic and yet contagious with up to 79% of COVID-19 infections reportedly caused by undocumented infections. Surprisingly, these asymptomatic subjects are also known to quietly harbor pneumonia changes on CT scans. RT-PCR, the definitive test for COVID-19, maybe false negative in patients with COVID-19 pneumonia on CT. Incidental findings highly suspicious of COVID-19 pneumonia on CT chest of asymptomatic patients may increase as the community transmission of the virus rises and isolation restrictions are released. It is advisable to be aware of its appearances and the challenges associated with it

Target product profiles for diagnosis of sepsis: Proposing a new approach for diagnostic innovation

Background & objectives: Sepsis, including neonatal sepsis, remains a prevalent cause of morbidity and mortality in low- and middle-income countries such as India, representing 85 per cent of all sepsis-related deaths globally. Early diagnosis and timely initiation of treatment is challenging due to non-specific clinical manifestations and non-availability of rapid diagnostic tests. There is an urgent need for affordable diagnostics with fast turnaround time catering to the needs of end-users. Target product profiles (TPPs) have been found instrumental in developing 'fit-for-use' diagnostics, thus reducing the time taken to facilitate development and improving diagnosis. Hitherto, no such guidance or criteria has been defined for rapid diagnostics for sepsis/neonatal sepsis. We propose an innovative approach for developing the diagnostics for sepsis screening and diagnosis which can be utilized by diagnostic developers in the country. Methods: Thr@ee-round Delphi method, including two online surveys and one virtual consultation, was adopted to define criteria for minimum and optimum attributes of TPPs and build consensus on characteristics. Expert panel (n=23) included infectious disease physicians, public health specialists, clinical microbiologists, virologists, researchers/scientists and technology experts/innovators. Results: We present a three-component product profile for sepsis diagnosis, (i) screening with high sensitivity, (ii) detection of aetiological agent, and (iii) profiling of antimicrobial susceptibility/resistance, in adults and neonates with an option of testing different considerations. An agreement of >75 per cent was achieved for all TPP characteristics by Delphi. These TPPs are tailored to the Indian healthcare settings and can also be extrapolated to other resource-constraint and high-disease burden settings. Interpretation & conclusions: Diagnostics developed using these TPPs will facilitate utilization of invested resources leading to development of the products that have potential to ease the economic burden on patient and save lives

Post-COVID multisystem inflammatory syndrome in adults: a study from a tertiary care hospital in south India

Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e. 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids