Left Main Coronary Artery Aneurysm with Fistula to Superior Vena Cava: A Challenging Case

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25?year?old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography

Correlation of Venous to Arterial Carbon Dioxide Partial Pressure Difference with other Cardiac Output Indices in Patients Undergoing Intracardiac Repair for Tetralogy of Fallot

Background: Clearance of tissue carbon dioxide by circulation is measured by venous to arterial carbon dioxide partial pressure difference (AVCO2 ) and is correlated with cardiac output (CO) in critically ill adult patients. This study aimed to correlate AVCO2 with other CO indices like arteriovenous oxygen saturation difference (AVO2 ), central venous oxygen saturation (ScVO2 ), and serum lactate in pediatric patients undergoing intracardiac repair (ICR) for tetralogy of Fallot (TOF). Methods: We conducted a prospective observational study in 50 patients, of age 5months to 5 years, undergoing ICR for TOF and analyzed AVO2 , AVCO2 , ScVO2 , and lactate from arterial and venous blood gas pairs obtained at different time intervals from admission to pediatric intensive care unit(PICU)(T0 ), at 6 h (T1 ), 12 h (T2 ), 24 h (T3 ), and 48 h (T4 ) postoperatively. Bivariate correlations were analyzed using Pearson for parametric variables. Results: Admission AVCO2 was not correlated with AVO2 (R2 = 0.166, P = 0.246), ScVO2 (R2 = ?2.2, P = 0.124), and lactate (R2 = ?0.07, P = 0.624). At T1 , AVCO2 was correlated with AVO2 (R2 = 0.283, P = 0.0464) but not with ScVO2 (R2 = ? 0.25, P = 0.079) and lactate (R2 = ?0.07, P = 0.623). At T2 , T3 and T4 , AVCO2 was correlated with AVO2 (R2 = 0.338,0.440 & 0.318, P = 0.0162, 0.0013, and 0.024), ScVO2 (R2 = ? 0.344, ? 0.488, and ?0.366; P = 0.0143, <0.0001, and 0.017), and lactate (R2 = 0.305, 0.467 and 0.607; P = 0.0314, 0.00062 and <0.0001). AVCO2 was negatively correlated with ScVO2 . No correlation observed between admission AVCO2 and mechanical ventilation duration. Two nonsurvivors had higher value of admission AVCO2 compared to survivors. Conclusion: AVCO2 is correlated with other CO surrogates like AVO2 , ScVO2 , and lactate in pediatric patients undergoing ICR for TOF.

Comparison of Hemodynamic Consequences of Hand Ventilation Versus Machine Ventilation for Transportation of Post?Operative Pediatric Cardiac Patients

Learning Objective: Hemodynamic monitoring during in?hospital transport of intubated patients is vital; however, no prospective randomized trials have evaluated the hemodynamic consequences of hand versus machine ventilation during transport among pediatric patients� post?cardiac surgery. The authors hypothesized that manual ventilation after pediatric cardiac surgery would alter hemodynamic and arterial blood gas (ABG) parameters during transport compared to mechanical ventilation. Design: A prospective randomized trial. Setting: Tertiary cardiac care hospital. Participants: Pediatric cardiac surgery patients. Materials and Methods: One hundred intubated pediatric patients were randomized to hand or machine ventilation immediately post?cardiac surgery during transport from the operating room to the pediatric post?operative intensive care unit (PICU). Hemodynamic variables, including end?tidal CO2 (ETCO2 ), oxygen saturation, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), peak airway pressure (Ppeak), and mean airway pressure (Pmean), were measured at origin, during transport, and at the destination. ABG was measured before and upon arrival in the PICU, and adverse events were recorded. The Chi?square test and independent t?test were used for comparison of categorical and continuous parameters, respectively. Results and Discussion: The mean transport time was comparable between hand?ventilated (5.77 � 1.46 min) and machine?ventilated (5.96 � 1.19 min) groups (P = 0.47). ETCO2 consistently dropped during transport and after shifting in the hand?ventilated group, with significantly higher ETCO2 excursion than in machine?ventilated patients (P < 0.05). SBP and DBP significantly decreased during transport (at 5 and 6 min intervals) and after shifting in hand?ventilated patients than in the other group (P < 0.05). Additionally, after shifting, a significant increase in Ppeak (P < 0.001), Pmean (P < 0.001), and pH (P < 0.001), and a decrease in pCO2 (P = 0.0072) was observed in hand?ventilated patients than machine?ventilated patients. No adverse event was noted during either mode of ventilation. Conclusion: Hand ventilation leads to more significant variation in ABG and hemodynamic parameters than machine ventilation in pediatric patients during transport post?cardiac surgery. Therefore, using a mechanical ventilator is the preferred method for transporting post?operative pediatric cardiac patients

To Study The Percentage of HIV Seropositivity in Smear Positive Tuberculosis Cases

Tuberculosis is the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries and accounts for about 40% of all manifestations seen in HIV patients. Correct diagnosis and treatment of tuberculosis helps to reduce burden of TB. However there are difficulties in achieving this goal such as difficulties in diagnosing tuberculosis in HIV infected patients due to unusual clinical picture with increase in smear negative AFB pulmonary tuberculosis and atypical findings on chest radiography. There is a paucity of literature regarding determination of percentage of HIV seropositivity in smear positive tuberculosis cases in Northern India. Hence, this study was planned to study the correlation and burden of HIV seropositivity in smear positive tuberculosis cases. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 150 smear positive tuberculosis cases. HIV seropositivity was determined in all the patients. Results: In our study, the HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India. Conclusion: The HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India.

To Determine the Percentage of Isoniazid Monoresistant Tubercular Mutations Via Kat G V/S INH A Genes

Some important challenges for TB control strategies include the increasing prevalence and rapid distribution of drug-resistant TB. Recently, this concern has been further intensified by reports of multi drug resistant (MDR) and extensively drug resistant-TB (XDR-TB). Although resistance to first and second line drugs poses the important risk to patients, resistance to isoniazid (INH) alone is also important. INH is the most potent anti-TB drug and is the main part of any first-line treatment regimen for TB. Our objective is to determine the percentage of isoniazid monoresistance mutations via Kat G v/s Inh A gene. Methods: We conducted a retrospective record review of 100 INH monoresistant TB patients without rifampicin resistance registered during Feb 2017 - March 2018. Results: Of the 100 INH monoresistant patients taken in a year, 82% were found to be resistant via Kat G gene and only 18% were found to be resistant for Inh A gene. Conclusion: In conclusion, our study showed increased prevalence of isoniazid resistance via Kat G gene mutation than with Inh A gene.

Role of diffusion weighted MRI in characterization of renal diseases

Background: MRI has the unique ability to show both structure and function objectively without any radiation exposure to the patient. Apparent diffusion coefficient (ADC) is a quantitative parameter that combines the effects of capillary perfusion and water diffusion. Renal parameters have shown inverse relationship with the ADC values in these studies. So, ADC values have a potential to serve as a marker of renal function. The aim of the present endeavor was to study the role of DW MRI in characterization of renal function and to find out the clinical use of DW MRI in renal diseases; and establish the relationship between renal function assessed by eGFR and that by DW MRI calculated in terms of ADC values in various renal diseasesMethods: Total 30 patients were included in the study. The study was carried out in department of radiodiagnosis at Dr. RPMGC Kangra. 1.5 Tesla MRI machine was used. The ADC value was calculated at upper, mid and lower pole of each kidney and the mean was taken. Then the mean of right and left kidneys was taken to calculate the mean ADC of the patient.Results: Serum creatinine in present study ranged from 0.67 to 13.9mg/dl, with mean value of 7.28mg/d. Serum urea ranged from 22 to 293mg/dl with the mean of 119.6mg/dl. There was significant inverse correlation occurred between ADC values and serum urea (r=-0.43, p=0.02). There was significant inverse correlation between ADC values and serum creatinine (p=0.01) and a positive correlation between eGFR and ADC values (r=0.14, p=0.47).Conclusions: ADC values consistently decreased with increasing stage of renal failure, so these can be used as an indirect maker of renal function. Authors conclude that lower would be the ADC value more advanced would be the stage of renal failure. DW MRI can also be detect early stages of renal failure even when the serum maker are within normal range.