Utility of Konar-Multifunctional Occluder in Complex Situations: Unconventional Uses in Rare Situations.

KONAR-MFO (multifunctional occluder) [Lifetech, Shenzhen, China] was first used in humans in 2013 and received the CE mark in May 2018. As name suggest, it can be use in various(multifunctional) situations in paediatric as well as adults. This is a versatile device with an improved delivery and flexibility which make this device a better option to be use with more comfort and minimum complications. This paper is regarding few rare and complicated lesions, like anomalous origin of coronary artery from pulmonary artery (ALCAPA) device closure, device closure of ventricular septal rupture (VSR) post myocardial infarction in sick elderly and finally device closure of paravalvar leak (PVL)after mitral valve replacement which were treated with this device with excellent results. This study is a retrospective review from a tertiary level dedicated cardiac referral centre in south India. Three cases we are reporting here in which Konar-multifunctional occluders were used in locations other than commoner and regular defects like patent ductus arteriosus, ventricular septal defect etc, over the span of one year between April 2022 and March 2023. Pre-procedure, all patients underwent detailed clinical evaluation followed by transthoracic echocardiography, 12-lead electrocardiogram, and Chest X-ray at the outpatient department. All patients were either symptomatic or had a hemodynamically significant lesion on echocardiography. The decision for transcatheter management was taken after discussing with surgical team in view of either high risk surgery or refusal from patients for surgical options. All patients were followed up post procedure at regular intervals with transthoracic echocardiograms and 12-lead electrocardiograms for a minimum period of 6 months. All these three cases mentioned in our study underwent a complete closure of their respective lesions with no evidence of residual shunt. None of these patients had any major complications, prolonged stay, or any vascular injuries. All patients completed minimum 6-month follow-up and were doing well without any residual flows. First case of ALCAPA, after procedure showed improvement in IVCD, QTc duration and also no significant ischemic changes were noted. Myocardial perfusion scintigraphy was done after 6 months of procedure which showed improvement in contractile function and perfusion of left ventricle. Second case of VSR device closure patient showed immediate significant symptomatic improvement. He was transferred to the coronary care unit, and discharged seven days later. As of now the patient is alive and feeling well with no residual shunt detected by transthoracic echocardiography. No procedure -related complications have been recorded during last two years. Third case of PVL device closure had uneventful recovery from anaesthesia. Prosthetic valve functioned normally during the 5 days of post-procedure hospitalization. The transthoracic 2D- echocardiography performed during follow-up at the end of one month showed no mitral PVL.During follow-up after 1 year, the patient improved symptomatically. Normal prosthetic valve function and no leakage documented on transthoracic echocardiography. Konar-MFO emerging as an important occluder with interesting attributes which makes it a very useful asset to have in catheterizations laboratory.

Catheter ablation in patients with electrical storm in early post infarction period (6 weeks): a single centre experience.

BACKGROUND: Electrical storm (ES) due to drug refractory ventricular tachycardia (VT) occurring within first few weeks of acute myocardial infarction (MI) has poor prognosis. Catheter ablation has been proposed for treating VT occurring late after MI, but there is limited data on catheter ablation in VT within first few weeks of MI. METHODS AND RESULTS: Five patients (4 males, mean age 54.2±12.11 years) between June 2008 to July 2012, referred for VT presenting as ES refractory to antiarrhythmic drugs in the early post infarction period (six weeks following MI) despite revascularization. Three patients had anterior wall MI and two inferior wall MI with left ventricular ejection fraction ranging from 26 to 35%.All underwent catheter ablation within 48 hours of being in VT except one who presented late. Clinical VT was induced in all five patients. Total number of VTs induced were 11 (2.2±1.09 per patient). Two patients needed epicardial ablation via pericardial puncture. Though acute success was 100%, one patient had recurrence of clinical VT the next day of procedure.One patient succumbed to sepsis with multiple organ failure. The remaining four patients are doing well without further clinical recurrence of VT over a period of 3.7 years of follow-up. CONCLUSION: Catheter ablation can be a useful adjunctive therapy for patients with recurrent VT in the early post infarction period. This procedure appears to be safe with acceptable success rate.

Effect of Flecainide on Multifocal Ectopic Purkinje-Related Premature Contractions in an R814W SCN5A Carrier.

Multifocal ectopic Purkinje-related premature contraction (MEPPC) is an autosomal dominant SCN5A channelopathy characterized by frequent multiform premature ventricular contractions originating from the His-Purkinje system. We present a patient with an MEPPC phenotype whose genetic testing identified a pathogenic SCN5A (HGNC:10593) variant amenable to precision antiarrhythmic therapy with flecainide.

Prevalence and correlates of depression, anxiety, and stress among adolescents in urban and rural areas of Mysuru, South India.

Background: Adolescence, a volatile period of growth between the ages of 10 and 19, is associated with increased vulnerability to mental health problems. Factors such as academic pressure can contribute to these challenges. Objectives: The current study aimed to evaluate the factors and prevalence of depression, anxiety, and stress among adolescents in the urban and rural areas of Mysuru district. Materials and Methods: A cross-sectional study was conducted in private high schools in both urban and rural regions. Prior permission and informed consent were obtained from participants and their legal guardians aged 18 years and older. Results: The gender distribution in urban areas was 60.2% female and 39.8% male, while in rural areas, it was 51% male and 49% female. The prevalence of depression was higher in rural (39.3%) than in urban areas (24.2%), while anxiety was more prevalent in urban (50.6%) than in rural areas (49%). Stress was also more common in rural (16.6%) than urban adolescents (14.6%). Factors significantly associated with mental health outcomes included monthly family income, parenting practices, academic pressures, and self-esteem. Key needs identified were mobile mental health applications, online counseling services, and access to school counselors. Conclusion: This study provides insights into the prevalence and correlates of common mental health issues among adolescents in this region of South India. The findings emphasize the necessity of providing mobile applications and offline counseling services to effectively support and meet the needs of adolescents in these settings.

Prevalence and Determinants of Avian Allergic Manifestation in a Selected Rural Population in Mysuru: A Cross-Sectional Survey.

Background: Avian diseases should be known to people who raise birds as pets or for commercial purposes. Exposure to high levels of airborne dust and endotoxins is known to cause allergies. This study, therefore, intends to assess avian allergy and its associated factors among poultry workers and bird fanciers in urban Mysuru. Methods: A cross-sectional study was done over three months among 60 poultry workers and 60 bird fanciers in a selected rural population of the Mysuru district. The participants were selected by simple random sampling method and their data were obtained by interview method using a pre-tested semi-structured questionnaire. Chi-square test/Fisher's exact test was used to check the associations between the demographic variables' avian allergy. Results: The survey revealed that 31.67% of poultry workers and 53.33% of bird fanciers had symptoms. The majority of the study participants were illiterate and were not using personal protective equipment (PPE) regularly. The results showed a significant association between education (P = 0.013) and the use of PPE (P = 0.020) with avian allergy. Observing the health hazards, 42.10% had respiratory problems, 42.10% had skin problems, and 26.31% had eye problems. Further, a significant association was also found between education and knowledge about diseases (P = 0.001). Conclusion: The avian allergy among the bird fanciers was higher when compared to poultry workers. It is necessary to organize routine counseling, awareness, and training programs about diseases and prevention strategies related to their work and living environments and keep them updated.

Development and validation of a comprehensive needs assessment tool to assess the burden of cancer chemotherapy patients attending a tertiary care hospital.

INTRODUCTION: In India in 2020, there were an estimated 1.39 million cancers present in the country. Chemotherapy patients experience several problems such as ADRs (adverse drug reactions), and because of this, many dropouts have been happening. Also, there is a lack of communication between the patient and care providers (doctors). OBJECTIVES: Development and validation of a comprehensive needs assessment tool to assess the burden of chemotherapy on patients attending tertiary level health care facilities. MATERIALS AND METHODS: Development and validation of comprehensive needs assessment in cancer chemotherapy involve several steps, including problem statement and literature review regarding the problem, domain generation, development of the preliminary questionnaire, face validation, statistical validation, and final draft of the tool. RESULTS: A total of 10 experts are involved in face validation. The majority (80%) of the experts agreed with the grammar, clarity, and content of the tool. A few experts (20%) disagreed regarding the construction of the questionnaire, the appropriate level of understanding for the participants, and the content of the tool and suggested changes in the physical and psychological domains. The questionnaire has been re-structured according to the expert's suggestion before going for statistical validation. Internal consistency of the CNAT-CC was optimal, with a satisfactory Cronbach's alpha of 0.7 for the total scale. DISCUSSION: The current study was focused on the development and validation of needs assessment in cancer chemotherapy patients. The CNAT-CC promises to be a comprehensive needs assessment tool that applies to a comparatively vast majority of patients undergoing cancer chemotherapy.

Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study").

OBJECTIVES: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. METHODS: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. RESULTS: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. CONCLUSION: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

Did this pandemic trigger a spike in mothers' hesitancy over their children's routine immunizations? -A cross sectional study.

Back ground: The COVID-19 pandemic has created a lot of disruptions for delivery of health care services like routine immunization. Delayed immunization can lead to outbreak of many vaccine preventable diseases. The current pandemic created confusions and fear among mothers to vaccinate their children. This study was an initiative to understand the struggles faced by them during the pandemic. Objective: To estimate the prevalence of hesitancy for routine immunization among urban mothers during COVID-19 pandemic and to determine the factors responsible for their hesitancy. Methodology: It was a community based cross-sectional study which was done for three months, data were collected from 246 mothers (sample size calculated by assuming 20% as prevalence based on pilot study) having children whose age was less than 6 years by administering a pre-tested semi structured questionnaire. Result: It was found that 38% of mothers were having vaccine hesitancy during the pandemic mainly due to the factors like fear of exposure to COVID-19 and due to lockdown.Out of 6 variables 5 variables(except religion) was found to be statistically significant.On the multivariate analysis only prior to pandemic hesitancy retained statistical significance. Conclusion: From our study we infer that the pandemic has increased hesitancy among mothers, hampering routine immunization. Thus, this domain deserves more consideration by health care officials and policy makers, to prevent disruption of the immunization programme.

Effects of mobile Health (mHealth) application on cervical cancer prevention knowledge and screening among women social support groups with low-socioeconomic status in Mysuru city, Southern India.

BACKGROUND: Cervical cancer is an important area of action because of the mortality and morbidity of the disease, and the potential for effective prevention by screening. Involving the social support groups by health education improves cervical cancer screening and early detection of the disease in the community. In the ongoing efforts to strengthen cervical cancer prevention, control, and management, digital health and technology will have a significant role to play. OBJECTIVE: To assess the effectiveness of the mHealth-based intervention on cervical cancer preparedness among women social support groups. MATERIALS & METHODS: A pre-post interventional study was conducted among women social support groups from lower socio-economic status, identified from the field practice area. Purposive sampling technique was employed. A Cervical Cancer Awareness Measure (CAM) instrument was used to assess the cancer preparedness among the social support group women After taking inputs from the stakeholders' mobile health application was developed. The mHealth educational intervention was given to 102 women. Both pre-and post-test questionnaires were administered through mHealth application to assess the change in knowledge after a gap of 1 month to 2 months. The data obtained was coded and entered into Microsoft Excel worksheet 2016 and was later imported and analyzed using SPSS version 22 (licensed to the Institute). The difference in median scores of knowledge and practice were interpreted as statistically significant at p value of < 0.05. RESULTS & CONCLUSION: Before the intervention only 13 (12.7%) of them had heard about cervical cancer. There was a significant increase in the knowledge about warning signs & symptoms, risk factors of cervical cancer, and HPV vaccination. Around 5% increase in Pap smear test uptake.

Hypertension as a silent epidemic among late adolescent girls, its associated demographic factors, and pregnancy outcome: A report from national family health survey (NFHS) IV data.

Background: Hypertension is predominantly considered to be a disease frequently occurring after the fifth decade of life, its occurrence among adolescents has not received much public health attention. Pathophysiological and epidemiological evidence suggests that essential hypertension initiate in childhood and often goes unnoticed unless explicitly observed for this age group. Aim: The current study estimates the prevalence of hypertension, its predictors, and pregnancy outcome among late adolescent girls (15-19 years). Material and Methods: The study used secondary data from the NFHS 4 from January 2015 to December 2016. The sample of 1,24,878 adolescent girls out of 6,99,686, national women's data was obtained through a stratified two-stage sample using a population proportionate to size sampling methodology. Descriptive statistical tests and inferential statistics were performed to find the relation of hypertension with the independent variables and Chi-square analysis to study association of hypertension during pregnancy and its adverse pregnancy outcomes. Results: The prevalence of hypertension among the late adolescents was 16.4% [CI: 16.2-16.6] (n=20,532). On multivariable logistic regression (after adjusting for all the variables) only age [AOR: 1.09 (1.08-1.11)]; education [AOR: 1.09 (1.006 - 1.2)], and wealth index [AOR: 1.17 (1.11 - 1.24)] retained the significance with hypertension. A significant association was seen between hypertension status of the adolescents and adverse pregnancy outcomes (χ2 = 4.550, P = 0.033). Conclusion: Nearly 1/6th of late adolescents found to be hypertensive, significantly contribution to disease burden. Also, a significant association is seen between hypertension status of adolescents and adverse pregnancy outcomes. Hence, it is imperative to make the National Programme inclusive for adolescents and have a focused approach to health promotion, prevention, and management of non-communicable diseases.

Expert Opinion on the Use of Novel Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation for the Primary Care Setting in India: A Literature Review.

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia encountered in clinical practice, is linked with substantial morbidity and mortality due to accompanying risk of stroke and thromboembolism. Patients with AF are at a five-fold higher risk of suffering from a stroke. Anticoagulation therapy, with either vitamin K antagonists or novel oral anticoagulants (NOACs), is a standard approach to reduce the risk. Consultant physicians (CPs) in India are the primary point of contact for the majority of patients before they approach a specialist. The CPs may face challenges in screening and diagnosing AF patients. The apprehensions associated with managing AF patients with anticoagulants, further add to the challenges of a CP. This review aimed to identify the key decision points for the CPs to diagnose AF and initiate anticoagulation in patients with non-valvular AF (NVAF) and bring to the table a simplified recommendation supported by expert opinion and guidelines for stroke prevention in NVAF patients.

Effectiveness of COVID-19 Vaccines against SARS-CoV-2 Infection among Persons Attending the RT-PCR center at a Medical College Hospital in Telangana: A Case- Control Study.

Background: In January 2021, India's drug regulator issued restricted emergency approval for COVISHIELD and COVAXIN, which were manufactured in India. In mid-January 2021, in India, there were 10.5 million confirmed cases and 0.15 million deaths. The objectives were to evaluate vaccine effectiveness (VE) of coronavirus disease 2019 (COVID-19) vaccines made in India against severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection. Materials and Methods: A test-negative case-control study was conducted from May 2021 to December 2021 for a duration of 8 months among people attending a reverse transcriptase polymerase chain reaction (RT-PCR) center at a medical college hospital for RT-PCR test for SARS-CoV-2. The baseline characteristics and RT-PCR report were collected from the RT-PCR center. The exposure to COVID-19 vaccines was enquired via phone call or was checked with data available with the health authorities. Results: After applying inclusion and exclusion criteria and case and control definitions, a total of 380 participants (95 cases and 285 controls) were included. The adjusted VE of two doses of COVISHIED vaccine against symptomatic SARS-CoV-2 infection was 52.2% (41.7 to 62.1), and that of a single dose was 40.88% (31.26 to 51.29). The adjusted VE of two doses of COVAXIN vaccine against SARS-CoV-2 infection was 39% (29.40 to 49.27). The overall VE was 48.20% (37.90 to 58.22) for two doses of any vaccines. Conclusions: Vaccines made in India were nearly 50% effective. Further new studies should be conducted as new variants of SARS-CoV-2 are emerging. We do not know the VE against the variants, and whether booster doses are required or not is not yet established.

Geographic information system and foldscope technology in detecting intestinal parasitic infections among school children of South India.

BACKGROUND: Effective and efficient use of technological advances will ease public health interventions and also help in reaching a larger population. Geographic Information System (GIS) and Foldscope are two such technologies, which have promising utilities in public health. Identifying intestinal parasitic infections early through feasible technologies will help in their effective management. With this objective, this study was conducted to assess the prevalence of intestinal parasitic infections among school children in southern districts of Karnataka, India. METHODS: This cross-sectional study was conducted among randomly selected 10 urban, 10 rural, and 5 tribal schools of southern districts of Karnataka. A total of 1052 children studying in these schools were selected. Stool samples were collected and examined under Foldscope for parasitic infestation. The schools where children with worm infestations present were plotted in the GIS map. FINDINGS: Among 1052 children included in this study, 139 (13.2%) were found to have an intestinal parasitic infestation. Among these children, 24.6% were in the age group of 5-9 years, 12.2% were males, and 14.4% were females. Urban students had higher odds (2.765) of parasitic infections compared to rural students. Mean age, height, and weight were significantly lesser among subjects with a worm infestation. INTERPRETATION: Utility of Foldscope and GIS was found to be feasible and effective in the detection and mapping of parasitic infestations. The prevalence of parasitic infestation was found to be high among urban school children. Age, weight, height, and urban residence were found to be the major predictors of outcome.

Cooperative and FRET-Assisted Brightness Enhancement in Oligo(phenylene ethynylene): Quantum Dot Organic-Inorganic Nanohybrids.

Herein, we combine the ideas of concerted emission from fluorophore ensembles and its further amplification through FRET in an organic-inorganic hybrid approach. Spherical and highly fluorescent organic nanoparticles (FONPs, Φf =0.38), prepared by the self-assembly of oligo(phenylene ethynylene) (OPE) molecules, were selected as a potential donor material. This organic core was then decorated with a shell of fluorescent CdSe/ZnS core-shell quantum dots (QDs; ≅5.5 nm, Φf =0.27) with the aid of a bifunctional ligand, mercaptopropionic acid. Its high extinction coefficient (ϵ≈4.1×105 m-1 cm-1 ) and good spectral match with the emission of the FONPs (J(λ)≈4.08×1016 m-1 cm-1 nm4 ) made them a better acceptor candidate to constitute an efficient FRET pair (ΦFRET =0.8). As a result, the QD fluorescence intensity was enhanced by more than twofold. The fundamental calculations carried out indicated an improvement in all the FRET parameters as the number of QDs around the FONPs was increased. This, together with the localization of multiple QDs in a nanometric dimension (volume≈1.8×106  nm3 ), gave highly bright reddish luminescent hybrid particles as visualized under a fluorescence microscope.

Diagnosis and treatment of tuberculous pleural effusion in 2006.

Tuberculous (TB) pleural effusion occurs in approximately 5% of patients with Mycobacterium tuberculosis infection. The HIV pandemic has been associated with a doubling of the incidence of extrapulmonary TB, which has resulted in increased recognition of TB pleural effusions even in developed nations. Recent studies have provided insights into the immunopathogenesis of pleural TB, including memory T-cell homing and chemokine activation. The definitive diagnosis of TB pleural effusions depends on the demonstration of acid-fast bacilli in the sputum, pleural fluid, or pleural biopsy specimens. The diagnosis can be established in a majority of patients from the clinical features, pleural fluid examination, including cytology, biochemistry, and bacteriology, and pleural biopsy. Measurement of adenosine deaminase and interferon-gamma in the pleural fluid and polymerase chain reaction for M tuberculosis has gained wide acceptance in the diagnosis of TB pleural effusions. Although promising, these tests require further evaluation before their routine use can be recommended. The treatment of TB pleural effusions in patients with HIV/AIDS is essentially similar to that in HIV-negative patients. At present, evidence regarding the use of corticosteroids in the treatment of TB pleural effusion is not clear-cut.

Bilateral multifocal choroiditis and optic neuropathy in a patient with AIDS: a diagnostic dilemma.

A rare case of bilateral multifocal choroiditis and optic neuropathy as the result of disseminated cryptococcal infection in a person with AIDS is described. A 30-year-old HIV-positive man presented with fever, headache, vomiting, and altered sensorium Ophthalmological examination revealed bilateral multifocal choroiditis and optic neuropathy. Laboratory examination and imaging suggested a presumptive diagnosis of disseminated Cryptococcus neoformans infection. Therapeutic response confirmed the diagnosis.

A rare malady with a rarer complication.

Isolated ventricular noncompaction (IVNC) is an unclassified cardiomyopathy characterized by prominent intraventricular trabeculations separated by deep intertrabecular recesses. Although microvascular dysfunction is known, myocardial infarction is rare and usually seen as a consequence of coincidental coronary artery disease. We report the case of a 19-year-old male patient who presented to us with symptoms and signs of heart failure. Echocardiography revealed IVNC with severe left ventricular dysfunction. He was put on medical treatment including oral anticoagulants. Six months later, he came to our emergency department with anterior wall STEMI. Coronary angiogram revealed thrombotic occlusion of distal LAD, which resolved completely with tirofiban and heparin. Coronary thromboembolism due to blood stasis in the left ventricular cavity has not been previously documented in IVNC.

A stepwise approach to the induction of idiopathic fascicular ventricular tachycardia.

PURPOSE: Noninducibility of the clinical tachycardia is a major limitation while mapping and ablating idiopathic fascicular ventricular tachycardia (FVT). There is very little data on systematic induction protocols in this entity. Our aim was to study the role of systematic induction protocols in patients with clinically documented ventricular tachycardia (VT). METHODS: Programmed electrical stimulation was performed at baseline from high right atrium, right ventricular apex, right ventricular outflow tract and from left ventricle as per the protocol. Programmed ventricular stimulation was performed at two drive cycle lengths up to three extrastimuli and short-long-short sequence. If FVT remained non inducible at baseline, pharmacological provocation with isoprenaline/atropine/phenylephrine was used based on the baseline atrio-ventricular Wenckebach cycle length. RESULTS: This systematic induction protocol was studied in 68 patients with clinically documented FVT and sustained FVT was inducible in 64 patients (94 %). Of these 64 patients, pharmacological provocation was required in 18 patients (28 %) while in the remaining, sustained VT was induced at baseline. This high induction rate allowed ablation during tachycardia, which resulted in 100 % acute procedural success in the patients where sustained tachycardia could be induced. At a follow up of 29 ± 13 months, two patients (3 %) had recurrence. CONCLUSIONS: Systematic induction protocol along with the appropriate use of pharmacological agents results in a high induction rate of FVT. This may result in more defined and limited ablation during tachycardia with better success rates and lesser recurrence.