Musculoskeletal Symptoms among Plantation Workers in Kerala, India

Introduction: Musculoskeletal disorder (MSD) is one of the major occupational health problems worldwide. Musculoskeletal symptoms (MSS) can indicate an underlying MSD. This paper assesses the prevalence of MSS among different plantation workers in Kerala, India. Methods: A cross-sectional survey was conducted from January to February 2021 among 83 rubber tappers, 90 cardamom plantation workers, and 87 tea pluckers (N=260). The Standardized Nordic Questionnaire (SNQ) was used to capture the MSS. MSS was compared across the three types of plantation workers, and the Chi-square test was used to test the significance. The Odds Ratios (OR) and 95% Confidence Intervals (CI) were estimated using binary logistic regression analysis.  Results: The prevalence of MSS (any regions) in the last 12 months among all participants was 87.7% and did not significantly vary between the three groups of workers. In general, the most affected regions were the low back (61%), one or both knees (47%) and shoulders (44%), respectively. Compared to rubber tappers, the odds of MSS in hips/ thighs (adjusted OR=2.38: 95% CI: 1.17-4.84) and wrists (adjusted OR=3.77: 95% CI:1.85-7.69) were significantly high among cardamom plantation workers. But the odds of MSS in elbows (adjusted OR=0.58: 95% CI: 0.31-1.07) and knees (adjusted OR=0.26:95% CI: 0.10-0.63) were low in the tea plantation workers as compared to rubber tappers. Conclusion: Though there was no variation in the overall prevalence of MSS between the three groups, there was a significant variation between the groups regarding the MSS in different body regions. Using supportive aids according to the nature of work and doing simple stretching exercises during breaks may help to improve the musculoskeletal health of plantation workers

The EXCEL Trial: The Interventionalists’ Perspective

Left main stem (LMS) disease is identified in up to 5% of diagnostic angiography cases, and is associated with significant morbidity and mortality due to the proportion of myocardium it subtends. In the past 10 years, there has been a significant change in the way we contemplate treating lesions in the LMS due to evolving experience and evidence in percutaneous coronary intervention (PCI) strategies and technologies. This has been reflected in recent changes in European and International guidance on managing patients with this lesion subset. Here, the authors provide an overview of the current literature regarding the management of LMS disease using PCI in light of new developments and emerging concepts in this field, specifically looking at the recent EXCEL trial

Which pre-dilatation balloons provide the best lesion preparation prior to use of drug coated balloons in De Novo lesions? Results from the PREPARE study.

BACKGROUND There is a lack of data on the clinical outcomes following the use of different strategies for lesion preparation prior to the use of drug-coated balloons (DCB). In this study, we have explored the clinical outcomes between different types of pre-dilatation balloons: semicompliant (SB), non-compliant (NB) and scoring balloons (ScB) used when preparing denovo lesions prior to the use of DCB. METHODS We retrospectively evaluated all patients who underwent treatment with DCB for de-novo lesions between 2011-2019 at 4 high-volume European centres. The measured study endpoints were: cardiac-death, TV-MI, TLR and MACE. RESULTS During the study period, 553 patients were treated with DCB for de-novo lesions, 327 with SB only, 172 with NB and 54 with ScB. There were some differences in the procedural characteristics between the 3 groups. Pre-dilatation balloons were significantly larger in the ScB and NB groups as compared to the SB (2.7 mm and 2.6 mm vs. 2.3 mm; p< 0.001). The reference vessel diameter was significantly larger in the NB group as compared to the ScB and SB (2.6 mm vs. 2.2 mm and 2.3 mm; p<0.001). During the median follow-up duration of 547-days, there were no differences in the hard-clinical end-points, however, TLR was significantly higher in the ScB as compared to SB and NB group (11% vs. 3.4% and 4.7%; p=0.02). CONCLUSIONS The PREPARE study results do not suggest routine use of ScB prior to DCB in de novo lesions

Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study.

To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort. There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO. Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes. There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %. In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes. [Abstract copyright: Copyright © 2024 Elsevier Inc. All rights reserved.

Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities.

Background Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. Methods and results We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). Conclusion This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA