Profile of arrythmogenic right ventricular cardiomyopathy/dysplasia (ARCV/D) patients presenting with sustained ventricular tachycardia in a tertiary care center

Background: Arrhythmogenic right ventricular cardiomyopathy /dysplasia (ARVC/D) is a genetic form of cardiomyopathy and is one among the most common causes of sudden cardiac death (SCD). The aim of our study was to analyze the clinical profile of (ARVC/D) patients presenting with sustained Ventricular Tachycardia (VT).Methods: This single center cohort study evaluated 107 patients who presented with sustained ventricular tachycardia (VT) in our hospital. After aetiological evaluation of all these patients, 15 patients were found to have ARVC/D as the cause of sustained ventricular tachycardia (VT) as per the Modified Task Force Criteria. The clinical profile of these patients was observed in detail to enhance our knowledge about this entity in our part of the world.Results: Mean age at presentation was 30 years and 12 patients were males. Nine patients were haemodynamically stable at the time of sustained VT and the rest of patients were haemodynamically unstable. Left Bundle Branch Block (LBBB) was the most common ECG morphology present in 11 patients. Antiarrhythmic drugs terminated VT in 7 patients. All the 6 patients presenting in a state of haemodynamic instability received DC cardioversion. Mortality occurred in 2 patients during the hospital stay.Conclusions: ARVC/D presenting with sustained VT is an important manifestation of the disease. Males are more commonly affected than females. Haemodynamic instability at the time of presentation carries a poor prognosis

New onset diabetes after transplantation (NODAT) in renal transplant recipients: a study from tertiary care center in Kashmir, India

Background: New onset diabetes after transplantation (NODAT) is a common entity in the post-transplant period after several types of organ transplants like kidney, liver heart and lungs. NODAT is a common complication after solid organ transplantation and has been reported to have an adverse impact on patient and allograft outcomes. Risk stratification and intervention to minimize risk should be an integral part of management of transplant recipients.Methods: A total of 100 patients who underwent renal transplantation were observed for the development of NODAT in the post transplantation period. Patients were evaluated in the pre- transplant and post-transplant period. Risk factors which were associated with the development of NODAT were analyzed.Results: Out of 100 patients, 79 were males and 21 were females. The mean age of the patients undergoing renal transplantation was 40 years. The youngest patient was 18 years old and the eldest was 64 years old. Majority of the patients were in the age group of 31 to 50 years (60 patients, 60%). The incidence of NODAT in present study was 17%. The major risk factors for the development of NODAT were identified as male sex, positive family history of diabetes, history of alcohol intake before renal transplantation, hypertriglyceridemia, post renal transplantation hypomagnesemia, proteinuria, and use of drugs like tacrolimus and prednisolone.Conclusions: NODAT has been identified as a risk factor for graft rejection, long-term graft failure, and decreased patient survival. Once NODAT has been diagnosed, specific anti-hyperglycemic therapy is essential to reach a tight glycemic control, which contributes to significantly reduced post-transplantation morbidity. Due to the importance of NODAT, diabetes education and its impact on the outcome of post-transplantation morbidity and mortality becomes crucial point of research among organ transplantation populations. Diabetes education in a group setting can be adopted for organ transplantation recipients with NODAT

A cross-sectional study to unravel the cryptic epidemiology of bovine tropical theileriosis by comparing four traditional and molecular techniques in water buffaloes

A comparison of 4 techniques, viz. blood smear examination, lymph node examination, PCR on blood and PCR on lymph node aspirate for the accurate and sensitive diagnosis of cryptic cases of BTT in water buffaloes, was made. These tests were laboratory standardized and later validated on 85 field samples of suspected bubaline hosts. Keeping blood smear examination as a gold standard for detecting actual number of confirmed positive cases, PCR on blood was 100% sensitive and 88.6% specific. When blood PCR was kept as standard, the lymph node biopsy and lymph node PCR were 90 and 86.96% sensitive along with 77.33 and 90.32% specific, respectively, in detecting theileriosis from suspected samples. The described PCR-based assay provides a valuable tool to study the epidemiology of BTT in buffaloes and some vital data regarding epidemiology of theileriosis in water buffaloes from semi arid parts of India was generated

PCR based unraveling of the cryptic epizootiology of bubaline theileriosis targeting the merozoite surface antigen gene

Lower parasitemia often skips the conventional microscopic and serological techniques from detecting latent, cryptic and chronic carrier states of bovine tropical theileriosis infection in buffalo hosts. A PCR was laboratory standardized and later validated on 80 field samples of suspected bubaline (Bubalis bubalis) hosts. Oligonucleotide primers (TBR F/R), selected from the gene encoding the 30-kDa major Theileria annulata merozoite surface antigen were custom designed and used for PCR amplifications. The sensitivity and specificity of PCR in relation to blood smear was compared based on kappa value predictions. Keeping blood smear examination as a gold standard for detecting actual number of confirmed positive cases, PCR on blood was 100 % sensitive and 88.6 % specific. The described PCR-based assay provides a valuable tool to study the epidemiology of bovine tropical theileriosis (BTT) in buffaloes and some vital data regarding epidemiology of theileriosis in water buffaloes from semi arid parts of India was generated

A nested polymerase chain reaction (nPCR) based assay for sensitive detection of latent Trypanosoma evansi infection in water buffaloes

A nested polymerase chain reaction (nPCR)-based assay was developed and evaluated for rapid detection of latent and cryptic cases of Trypanosoma evansi in buffaloes. Four oligonucleotide primers (TE1, TE2, TE3 and TE4), selected from nuclear repetitive gene of T. evansi, were designed and used for PCR amplifications. The first amplification, using a pair of outer primers TE1 and TE2, produced a 821– bp primary PCR product from T. evansi DNA. The second amplification, using nested (internal) pair of primers TE3 and TE4, produced a 270–bp PCR product. The nested primers TE3 and TE4 increased the sensitivity of the PCR assay and as little as 10 fg of T. evansi DNA (equivalent to a single copy of the putative gene of the parasite) was amplified and visualized onto ethidium bromide-stained agarose gels. Amplification products were not detected when the PCR-based assay was applied to DNA from other blood parasites including Thieleria annulata and Babesia bigemina. The described nPCR-based assay provides a valuable tool to study the epidemiology of T. evansi infection in buffaloes and other susceptible animal populations

Evaluation of phenotypic markers in local goats from semi arid areas for resistance to natural infection with gastrointestinal nematodes

The present study was designed to investigate the different degrees of genetic resistance and resilience in non-descript goats of semi-arid zone of Mathura to natural infections with gastrointestinal nematodes to introduce future breeding schemes. Animals were found to be naturally infected by Haemonchus spp. (85%) followed by Trichostrongylus spp. (7%), Oesophagostomum spp. (5%), Bunostomum spp. (2%) and Strongyloides spp. (1%). Faecal egg counts and blood samples were collected for the determination of indicator traits such as faecal egg count (FEC), packed cell volume (PCV) and haemoglobin (Hb). The mean EPG, PCV and Haemoglobin (Hb) were 1121.6±175, 34.71±2.2% and 8.3±0.5 g/dl, respectively. Based on EPG alone, goats were divided into 3 groups (2,000) and their EPG values were correlated with Hb and PCV. EPG showed a significant negative correlation with both Hb and PCV (P<0.01)

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe