An Unusual Presentation of Right Atrial Myxoma: A Case Report.

A right atrial myxoma extending to the inferior vena cava with associated right-to-left shunting leading to systemic desaturation is an exceedingly rare clinical entity. The number of cases reported in the literature to date is not more than five. This case study presents a 45-year-old female who was referred to our center with symptoms of breathlessness, easy fatigability, generalized weakness, and central cyanosis. On routine blood investigation, polycythemia was detected. On preoperative 2D-transthoracic echocardiography, the diagnosis of right atrial mass was confirmed but the reason for cyanosis was not revealed. A tumor thrombus in a branch of the right lower pulmonary artery with a small locoregional pulmonary infarct along with right atrial myxoma was reported in computed tomography angiography of the heart and great vessels. On-table transesophageal echocardiography showed patent foramen ovale (PFO) with right-to-left shunting because of raised right atrial pressure and dynamic obstruction of the tricuspid valve by the mass. The myxoma was resected completely via right atrial approach along with primary closure of PFO. Postoperative period was uneventful, and the patient was discharged on day seven. At three-month follow-up, the patient was doing well.

A rare case of Tetralogy of Fallot with right atrial thrombus presenting with hemiplegia complicating the clinical course.

BACKGROUND: Cerebrovascular accidents represent a dangerous complication of cyanotic children with tetralogy of Fallot with the incidence of 8.6%. Tetralogy of Fallot has been associated with raised hematocrit with low arterial saturation. AIM: Here we describe an 18 months old female child of Tetralogy of Fallot with cyanotic spells acute onset right-sided hemiplegia with right atrial thrombus who underwent emergency surgery with the intraoperative predicament. MATERIALS AND METHODS: A female child with Tetralogy of Fallot presented to emergency department with acute onset right sided hemiplegia. After hemodynamic stabilization the patient underwent series of investigations and was diagnosed to have thrombus of size in right atrium. DISCUSSION: Among the few causes causing neurological complications in Tetralogy and Fallot, right atrial thrombus appears to be a rare but possible cause. CONCLUSION: ntracardiac thrombus can be considered as a cause for embolic neurological events in patients with Tetralogy of Fallot.

Pricing and components analysis of some key essential pediatric medicine in Odisha state.

OBJECTIVE: Study highlighting prices, i.e., the patients actually pay at ground level is important for interventions such as alternate procurement schemes or to expedite regulatory assessment of essential medicines for children. The present study was undertaken to study pricing and component analysis of few key essential medicines in Odisha state. METHODOLOGY: Six child-specific medicines of different formulations were selected based on use in different disease condition and having widest pricing variation. Data were collected, entered, and analyzed in the price components data collection form of the World Health Organization-Health Action International (WHO-HAI) 2007 Workbook version 5 - Part II provided as part of the WHO/HAI methodology. The analysis includes the cumulative percent markup, total cumulative percent markup, and percent contribution of individual components to the final medicine price in both public and private sector of Odisha state. RESULTS: Add-on costs such as taxes, wholesale, and retail markups contribute substantially to the final price of medicines in private sector, particularly for branded-generic products. The largest contributor to add-on costs is at the level of retailer shop. CONCLUSION: Policy should be framed to achieve a greater transparency and uniformity of the pricing of medicines at different health sectors of Odisha.

Pricing and availability of some essential child specific medicines in Odisha.

OBJECTIVES: Continuous availability of affordable medicines in appropriate formulations is essential to reduce morbidity and mortality in children. Odisha an eastern Indian state records very high mortality of children. The study aims at documenting the availability and prices paid for purchasing essential child-specific medicines. MATERIALS AND METHODS: The survey of 34 essential medicines was conducted in six randomly selected districts of Odisha. Data were collected from medicine outlets of the public, private, and other sector (Nongovernmental Organization [NGO]/mission sectors) of six randomly selected districts, using WHO/Health Action International medicine price collection methodology. For each medicine surveyed, data were collected on the highest and lowest-priced formulations available in each facility. RESULTS: Both public sector and other sector health facilities procure only one brand of medicines, mean percentage availability of medicines being 17% and 21.8%, respectively. In the private sector, the mean percentage availability of the high and lowest-priced medicines for a particular drug product was 10.8% and 38.5%, respectively. The public sector procurement price is 48% lower than international reference prices. In the private sector, high-priced, and low-priced products are sold at 1.83 and 1.46 times the international reference price, respectively. Substantial price variation was observed for some medicines across individual outlets. Medicines were found to cost 2.08 times their international reference price in NGO/mission sector facilities. CONCLUSIONS: The availability of children's medicines in public sector facilities of Odisha state is poor. Medicines for children cost relatively high in both private and NGO sectors compared to the international reference price. The availability medicines should be improved on an urgent basis to improve access of medicines for children of Odisha.