Outcome of Impella 2.5 use in patients undergoing Percutaneous Coronary Intervention in Henan, China: a case series.

BACKGROUND: Acute myocardial infarction (AMI) complicated by cardiogenic shock (AMI-CS) or heart failure is associated with an unacceptably high in-hospital mortality of 33%-55% and a lost chance to accept PCI (Percutaneous Coronary Intervention). AIM: The aim of the study was to find out whether percutaneous hemodynamic support device Impella 2.5 improves prognosis of high-risk PCI patients or not. METHODS: This study was a case series involving six patients who underwent a Left Ventricular Assist Device (LVAD, Impella 2.5, Abiomed, Danvers, MA) implantation after suffering from AMI with a very low ejection fraction and acute heart failure. The clinical experience and outcomes of the patients are hereby discussed. RESULTS: All PCI procedures were safely completed under LVAD support. The hemodynamic parameters of all patients improved clinically over the next 30 days and following 12 months after Impella insertion except in two patients, of which one patient (Case number 6) died 4 days post-Impella protected PCI procedure due to acute left ventricle heart failure with cardiogenic shock and pulmonary oedema; and another one died at 12 months after Impella protected PCI procedure (Case number 4) due to decompensated heart failure and infected pneumonia. CONCLUSION: Percutaneous hemodynamic support is favorable and feasible during high risk Percutaneous Coronary Intervention (PCI). A bigger study is needed to substantiate the claims of the current study.

Sexual assault and associated factors among the cases reported in a tertiary care hospital of Delhi.

Background: Sexual assault is said to be an under-reported and under-researched crime worldwide. The high number of cases of sexual assault reported in India is the tip of the iceberg. We did this study to understand various factors associated with this crime. Methods: We did a retrospective analysis of 312 forensic examination reports of alleged sexual offenders, available from a tertiary care hospital of Delhi from January 2014 to December 2016. Results: Of the 312 victims of sexual assault, 62.9% were adults and 37.1% minors. The time of assault was mentioned in only 73 cases. Among these, about two-thirds of cases (60.3%) occurred during daytime. Among the 213 cases where the reporting time of the crime was mentioned, only 35.7% of cases were reported within 24 hours of the crime. Around 92% offenders were known to the victims. Conclusion: More than one-third of sexual assaults were against minors and in a majority of instances the alleged offenders were known to the victims. A major delay in reporting the crime was observed when the victim was known to the perpetrator.

The Effects of the SARS-CoV-2 Virus on the Cardiovascular System and Coagulation State Leading to Cardiovascular Diseases: A Narrative Review.

The novel coronavirus pandemic has led to morbidity and mortality throughout the world. Until now, it is a highly virulent contagion attacking the respiratory system in humans, especially people with chronic diseases and the elderly who are most vulnerable. A majority of afflicted are those suffering from cardiovascular and coronary diseases. In this review article, an attempt has been made to discuss and thoroughly review the mode of therapies that alleviate cardiac complications and complications due to hypercoagulation in patients infected with the SARS-CoV-2 virus. Presently a host of thrombolytic drugs are in use like Prourokinase, Retelapse, RhTNK-tPA and Urokinase. However, thrombolytic therapy, especially if given intravenously, is associated with a serious risk of intracranial haemorrhage, systemic haemorrhage, immunologic complications, hypotension and myocardial rupture. The effects of the SARS-CoV-2 virus upon the cardiovascular system and coagulation state of the body are being closely studied. In connection to the same, clinical prognosis and complications of thrombolytic therapy are being scrutinized. It is noteworthy to mention that myocardial oxygen supply/demand mismatch, direct myocardial cells injury and acute plaque rupture are the multiple mechanisms responsible for acute coronary syndrome and cardiac complications in Covid-19 infection. However, this review has limitations as data available in this context is limited, scattered and heterogenous that questions the reliability of the same. So, more multi-centric studies involving representative populations, carried out meticulously, could further assist in responding better to cardiac complications among Covid-19 patients.

Galactosemia presenting as recurrent sepsis.

Galactosemia is a treatable metabolic disorder caused by the deficiency of enzyme galactose-1-phosphate uridyl transferase (GALT) and inherited as an autosomal recessive trait. A case of neonate manifesting with recurrent Escherichia coli sepsis is presented here which turned out to be a classic galactosemia. No other common presenting features were observed in this infant except cataract on slit lamp examination. To the best of our knowledge, there is no case of galactosemia reported in literature which presented with recurrent neonatal sepsis without hepatomegaly, hyperbilirubinemia, bleeding disorder, vomiting, diarrhea, failure to thrive, hypoglycemia, coagulopathy, hemolysis or renal tubular acidosis.

Exposure to Household Air Pollution During Pregnancy and Birthweight.

This case-control, hospital-based study aimed to study the role of household air pollution in adverse birth outcomes like low birth weight. 200 newborn babies weighing <2500 g were included in the study along with 200 matched controls. After adjusting for confounders, it was found that exposure to second hand smoke (adjusted OR 1.72, 95% CI 0.85, 3.50, P=0.13) or indoor air pollution due to cooking fuel (adjusted OR 1.63, 95% CI 0.71, 3.72, P=0.25) were not significantly associated with birth weight.

A Cross-Sectional Study of Prevalence of Depression, Anxiety and Stress among Professional Cab Drivers in New Delhi.

BACKGROUND: The profession of drivers is one of the occupational groups exposed to very poor working conditions. This study aimed to establish the prevalence of depression, anxiety and stress among cab drivers. MATERIALS AND METHODS: This cross-sectional study included 134 cab drivers. Their mental health status was assessed with the help of a screening tool - Depression Anxiety Stress Scale (DASS-21). Their demographic details, working conditions, lifestyle factors and use of habit-forming substances were also assessed with the help of a semi-structured questionnaire. RESULTS: It was revealed that all cab drivers were male and between 20 to 64 years of age. Eighty two (62%) drivers said they are sometimes irritated at work, 29 (21.5%) said they feel irritated daily and rest 23 (17.2%) said that they were never irritated at work. When screened for depression, anxiety and stress, it was found out that 81 (60.5%) were suffering from depression, 63 (47%) from anxiety and 49 (36.5%) had variable degree of stress. CONCLUSION: Cab drivers are at high risk of acquiring mental health diseases, yet the mental health of this large workforce is ignored.

Malaria and dengue: Knowledge, attitude, practice, and effect of sensitization workshop among school teachers as health educators.

BACKGROUND AND OBJECTIVES: Outbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Teachers can act as excellent educators by playing a key role of delivering important health education messages to school children and targeting an important health determinant - the health behavior. This study was done to assess the knowledge, attitude, and practice (KAP) of school teachers regarding VBDs and the effect of a sensitization workshop on the same. MATERIALS AND METHODS: This is a cross-sectional study done on 212 school teachers to know their KAP regarding dengue and malaria. They were also exposed to an intervention workshop after the pretest, and the gain in knowledge scores was compared. RESULTS: The mean age of respondents was 38.5 years and 57.5% of them were females. Participants had fairly good knowledge about dengue and malaria. More than 90% participants knew that mosquito bite is responsible for dengue and malaria. Around 75% of respondents were also aware of the symptoms of these diseases. The number of participants having a low, medium, and high pretest knowledge score (<50%, 50%-74%, and ≥75%, respectively) was 6.6%, 42.5%, and 50.9%, respectively. A significant improvement was seen in the knowledge score after the intervention workshop (χ2 = 23.6, P < 0.001). CONCLUSION: Key success for mosquito-borne diseases control depends not only on services provided by Health Authority but also on knowledge, awareness, preventive practices, and early care-seeking behavior of the community. There is a need to know and improve existing knowledge and practice regarding mosquito-borne diseases and its control in community, especially with the collaboration of school teachers as health educators.

Assessment of knowledge, attitude, and practices toward prevention of hepatitis B infection among medical students in a high-risk setting of a newly established medical institution.

BACKGROUND: India is in the intermediate hepatitis B virus endemicity zone with hepatitis B surface antigen prevalence among the general population ranges from 2% to 8%. Among health-care workers, seroprevalence is two to four times higher than that of the general population. AIM: The aim of the study was done to assess the knowledge, attitude, and practices (KAPs) of medical students regarding hepatitis B. MATERIALS AND METHODS: This is a cross-sectional study that was conducted from March to April 2018. Students were invited to the department on specified dates for awareness and immunization against hepatitis B. Their KAP was assessed with the help of a self-administered questionnaire. RESULTS: With a response rate of 81.3%, a total of 161 students participated in the study out of 198. Out of the 161 study participants, only 13 (8%) students had received a completed course of hepatitis B vaccination in the past, 30 (18.7%) students had a history of inability to complete the three doses of hepatitis B vaccination, and the rest 118 (73.3%) students were never immunized against hepatitis B. The knowledge about the risk of acquiring the disease at the hospital or high-risk setting was present in less than half of the students. The average knowledge score was 10.63 out of 16 and average healthy practice score was 2.94 out of 4. On applying Pearson correlation test, it was found that there was a positive correlation of knowledge and practices of the students (P = 0.012), implying that better knowledge of the disease has a positive effect on the practices exercised by an individual. CONCLUSION: Newly enrolled students and other individuals attached to a high-risk setting such as a medical institution should be screened for immunization status during initial medical examination as the number of unimmunized persons, especially against hepatitis B is high.

Vitamin D and child health in the 21st century.

CONTEXT: Vitamin D has emerged as a topic of great interest among researchers. Recent evidence indicates that today the world is facing vitamin D deficiency pandemic. Sensitizing pediatricians to widespread vitamin D deficiency in children and benefits accrued from its correction would go a long way as far as clinical practice and public health is concerned. EVIDENCE ACQUISITION: We performed a literature search using PubMed/medline, EMBASE and ScienceDirect databases indexed under the Medical Subject Heading (MeSH) terms; Vitamin D OR Vitamin D deficiency combined with the terms children OR pediatric OR child health. The literature search was limited to articles in last 35 years and written in the English language. All articles having direct relevance to to the present review were searched. Reference lists of all articles were also reviewed. Emphasis was placed on pediatric literature, although sentinel adult studies relevant to this article have been included. Latest editions of standard texts were also searched. RESULTS: Vitamin D deficiency is highly prevalent throughout the world including India. Though some evidence suggests a role of hypovitaminosis D in pathophysiology of many clinical situations other than rickets and osteomalacia like autoimmune diseases, cardiovascular diseases, infections, cancers, fetal health, and exercise performance, some authorities feel there is a lack of unequivocal evidence in favour of nonskeletal health benefits of vitamin D. CONCLUSIONS: Widespread subclinical and pre-rachitic vitamin D deficiency in children should be diagnosed by serum 25(OH)D levels and these levels should be maintained above 20 ng/mL to obtain optimal health benefits. There is a need for large randomized clinical trials to investigate the nonskeletal benefits of vitamin D deficiency.

Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever.

OBJECTIVES: To report a series of cases of rickettsial infections from central India and to develop a clinical scoring system for its early detection. DESIGN: Retrospective review of children hospitalized during one year period with fever without a source, and presence of one or more of the clinical features suggestive of rickettsial infection. Diagnosis of rickettsial disease was made by classical clinical features and detection of IgM antibody by ELISA. A clinical scoring system was developed to diagnose spotted fever group by using classical clinical and laboratory findings. RESULTS: 161 patients were admitted and met the inclusion criteria, 75 (45.6%) were diagnosed with rickettsial diseases. 52 (69.3%) had spotted fever group and 23 (30.7%) scrub typhus. The mortality rate with rickettsial diseases was 9%. By using proposed clinical scoring system, a score of 14 has sensitivity and specificity of 96.15% and 98.84%, respectively in making a diagnosis of spotted fever group. CONCLUSION: Rickettsial diseases are common in the central part of India and should be included in the differential diagnosis of patients with fever of undetermined source. The proposed scoring system can be used for early detection, treatment and prevention of mortality and morbidity from spotted fever group.

Relapse of herpes simplex encephalitis presenting as choreoathetosis.

We report a case of herpes simplex virus (HSV) encephalitis (HSE) in an 11-year-old boy who recovered with acyclovir therapy but developed relapse after 2 weeks. Choreoathetosis was the presenting feature of relapse. Response to antiinflammatory treatment was excellent. To the best of our knowledge, this is the first case of HSE relapse presenting with choreoathetosis reported from India. We describe the patient and review the literature on HSE and HSE relapse.

Haemophilia A presenting as spontaneous spinal epidural haematoma in a 3-month-old infant.

Spinal epidural haematoma (SEH) is a rare complication of haemophilia. A 3-month-old boy presenting with non-traumatic acute onset quadriparesis was found to have SEH on MRI scan. On further investigations, diagnosis of severe haemophilia A was confirmed. He responded well to conservative treatment with replacement of factor VIII without any need for surgical decompression. Neurological recovery was complete. We believe this is the youngest reported case of haemophilia presenting with spontaneous SEH. Another peculiarity of this case is absence of excessive bleeding due to forceps and vacuum application, circumcision and intramuscular injection, even in the presence of severe haemophilia. This case calls attention to the clinical features, radiological appearances and management options of this rare complication of SEH in people with haemophilia.

Rickettsial infections: Indian perspective.

CONTEXT: Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician. EVIDENCE ACQUISITION: We did a PubMed, Medline and Cochrane library search for literature available in last 40 years. RESULTS: Rickettsial infections are re-emerging and are prevalent throughout the world. In India, they are reported from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal, Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnosic test, these infections are notoriously difficult to diagnose. Failure of timely diagnosis leads to significant morbidity and mortality. With timely diagnosis, treatment is easy, affordable and often successful with dramatic response to antimicrobials. As antimicrobials effective for rickettsial disease are usually not included in empirical therapy of nonspecific febrile illnesses, treatment of rickettsial disease is not provided unless they are suspected. Knowledge of geographical distribution, evidence of exposure to vector, clinical features like fever, rash, eschar, headache and myalgia alongwith high index of suspicion are crucial factors for early diagnosis.