Neev, a novel long non-coding RNA, is expressed in chaetoblasts during regeneration of Eisenia fetida.

Eisenia fetida, the common vermicomposting earthworm, shows robust regeneration of posterior segments removed by amputation. During the period of regeneration, the newly formed tissue initially contains only undifferentiated cells but subsequently differentiates into a variety of cell types including muscle, nerve and vasculature. Transcriptomics analysis, reported previously, provided a number of candidate non-coding RNAs that were induced during regeneration. We found that one such long non-coding RNA (lncRNA) is expressed in the skin, only at the base of newly formed chaetae. The spatial organization and precise arrangement of the regenerating chaetae and the cells expressing the lncRNA on the ventral side clearly support a model wherein the regenerating tissue contains a zone of growth and cell division at the tip and a zone of differentiation at the site of amputation. The temporal expression pattern of the lncRNA, named Neev, closely resembled the pattern of chitin synthase genes, implicated in chaetae formation. We found that the lncRNA has 49 sites for binding a set of four microRNAs (miRNAs) while the chitin synthase 8 mRNA has 478 sites. The over-representation of shared miRNA sites suggests that lncRNA Neev may act as a miRNA sponge to transiently de-repress chitin synthase 8 during formation of new chaetae in the regenerating segments of Eisenia fetida.

Prioritizing cardiovascular surgical care in COVID-19 pandemic: Shall we operate or defer?

BACKGROUND: The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care. METHODS: There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics. CONCLUSION: After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.

Digital cardiovascular care in COVID-19 pandemic: A potential alternative?

BACKGROUND: Cardiovascular patients are at increased risk of acquiring coronavirus disease 2019 (COVID-19) infection while their visit to healthcare facilities. There is a need for alternative tools for optimal monitoring and management of cardiovascular patients in the present pandemic situation. Digital health care may prove to be a new revolutionary tool to protect cardiovascular patients from coronavirus disease by avoiding routine visits to health care facilities that are already overwhelmed with COVID-19 patients. METHODS: To evaluate the role of digital health care in the present era of the COVID-19 pandemic, we have reviewed the published literature on digital health services providing cardiovascular care. RESULTS AND CONCLUSION: Digital health including telemedicine services, robotic telemedicine carts, use of artificial intelligence and machine learning, use of digital gadgets like smartwatches and web-based applications may be a safe alternative for the management of cardiovascular patients in the present pandemic situation.

Retrograde radial arteriovenous fistula, post coronary artery intervention.

BACKGROUND: Radial arteriovenous fistula (AVF) post coronary artery intervention is rare. METHODS AND CONCLUSION: Here we describe an extremely rare case of radial AVF with retrograde filling through the deep palmar arch and presenting as early ischemic changes.

Retrieval of a retained guide wire from the deltoid muscle-A rare and delayed presentation post cardiac resynchronization therapy lead replacement.

BACKGROUND AND AIMS: Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures. METHODS: A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed. RESULTS AND CONCLUSION: We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.

Large sternal exostoses presenting as stridor: A surgical and anesthetic challenge.

BACKGROUND AND AIMS: Large osteochondroma arising from chest wall and sternum is uncommon and presentation with airway compression is further uncommon. METHODS: Here we present a case of large chest wall osteochondroma as a part of hereditary multiple exostoses in a 9-year-old boy presented with a history of stridor and shortness of breath. The bony mass of the right chest wall was extending up to a suprasternal notch and compressing the trachea. RESULTS: The case was successfully managed by initial femoro-femoral cardiopulmonary bypass under local anesthesia before the induction of anesthesia to prevent respiratory collapse, followed by debulking surgery was done.

Informed choice in modern contraceptive method use: pattern and predictors among young women in India.

Research on informed choice in modern contraceptive method acceptance by young married women is pertinent in the broader context of individual freedom and reproductive rights, especially in countries where women continue to have limited control over their reproductive and contraceptive choices. This study in India asked: (1) is young married women's acceptance of specific modern contraceptive methods an informed choice? and (2) what are the enablers and barriers to informed choice? The study used data for currently married women aged 15-24 (N = 20,752) from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16. A Method Information Index (MII) was calculated as a measure of informed choice from the percentage of users who responded 'yes' to all three questions on: whether they were informed about methods other than the one they received, told about the method-specific side-effects, and advised what to do if they experienced side-effects. Binary logistic regression analysis was carried out to examine the adjusted effect of factors associated with the MII separately for female sterilization, the intrauterine device and the oral contraceptive pill, and a combined MII including all three methods plus injectables. One-fifth of the study women used any modern contraceptive method at the time of survey, of which only 36% had fully informed choice. The likelihood of being informed about the methods was significantly higher among those using the oral contraceptive pill (OR: 1.75, CI 1.58-1.94), IUD (OR: 2.23, CI 1.97-2.52) and injectables (OR: 1.37, CI 0.97-1.94) compared with those who were sterilized. Informed choice varied by region and the socioeconomic profile of the users. Inadequately informed choice violates the reproductive rights of young women and might result in higher post-use health problems, discontinuation of and unmet need for contraceptives, unintended pregnancies, induced abortions and regret, adversely affecting women's health. Training of health/family planning workers in India about the importance of reproductive rights is urgently required to enhance informed contraceptive choice and improve the health of young married women.

Socioeconomic and demographic predictors of high blood pressure, diabetes, asthma and heart disease among adults engaged in various occupations: evidence from India.

In India, non-communicable diseases (NCDs) accounted for nearly 62% of all deaths in 2016. Four NCDs - high blood pressure, diabetes, asthma and heart disease - together accounted for over 34% of these deaths. Using data from two rounds of the India Human Development Surveys (IHDSs), levels and changes in the prevalence rates of the four NCDs (based on diagnosed cases) among adults aged 15-69 years in India between 2004-05 and 2011-12 were examined by socioeconomic and demographic factors and for five broad occupation categories. The socioeconomic and demographic risk factors for each of these NCDs were determined using multiple linear logistic regression analysis of pooled data from two rounds of the IHDS. The results showed that while urban residence, age, female sex and education were associated with higher odds of high blood pressure, diabetes and heart disease, household economic status was associated with higher odds for all four NCDs. Furthermore, increased higher odds of high blood pressure, diabetes and heart disease were found for the legislator/senior official/professional occupation group compared with non-workers. Skilled agricultural/elementary workers had lower odds of high blood pressure, diabetes, asthma and heart disease. Craft/machine-related trade workers had higher odds of high blood pressure and diabetes, and reduced odds of asthma and heart disease. Compared with non-workers, the odds ratios for asthma were lower for all other occupational categories. During the two study decades, the Government of India implemented several programmes designed to improve the health and well-being of its people. However, more focused attention on the adult population is needed, and special attention should be paid to the issue of the occupational health of the working population through the strict implementation of work place safety protocols and the removal of potential health hazards.

Association of behavioral risk factors with self-reported and symptom or measured chronic diseases among adult population (18-69 years) in India: evidence from SAGE study.

BACKGROUND: The objective is to analyze the behavioral risk factors among the adult population and to identify the determinants of and their association with self-reported and symptom or measured chronic diseases in India. METHODS: The study utilized data from the Study on Global Aging and Adult Health (SAGE), Wave 1 (2007). Logistic regression was applied to examine the association of self-reported and symptom or measured chronic diseases with behavioral risk factors and socioeconomic-demographic covariates. RESULTS: The results show that the prevalence of the symptom or measured chronic diseases was higher (41.9%) than that of the self-reported chronic diseases (24.1%). The moderate and vigorous physical activity was less likely to be associated with self-reported depression, arthritis, and stroke, but more likely to be associated with the symptom or measured based arthritis and asthma compared to physical inactivity. Adequate intake of fruits and vegetables was significantly less likely to be associated with angina, COPD, and asthma; however, it was more than three times more likely to be associated (OR: 3.45; 95% CI: 1.99-5.97) with self-reported depression. Infrequent moderate alcohol drinking was statistically two times more associated (OR: 1.83; 95% CI: 1.04-3.21) with the symptom or measured based COPD than non-drinking. Likewise, any type of tobacco use was found to be about four times more associated (OR: 3.59; 95% CI: 1.07-12.13) with self-reported stroke. Both self-reported and symptom or measured hypertension, arthritis, and diabetes were associated with overweight, while hypertension was associated with obesity. Females and increased age came out as significant predictors of both self-reported and symptom or measured chronic diseases. CONCLUSION: The prevalence of chronic diseases and their association with BRFs and socioeconomic and demographic covariates differ markedly when assessed against self-reported criteria versus symptom or measured criteria. Adequate intake of fruits and vegetables is a crucial behavior that controls and delays the onset of chronic diseases. The study suggests that the National Program should remain focused on behavioral risk factors for maximum returns on health outcomes and that proper awareness and knowledge must be spread about healthy lifestyle behaviors throughout the country.

Effects of cooking fuel sources on the respiratory health of children: evidence from the Annual Health Survey, Uttar Pradesh, India.

OBJECTIVES: India is predominantly a rural country, where more than two-thirds of the population live in rural areas. The majority of the rural population use crop residue, firewood, and dung cake as cooking fuel sources. Combustion of these fuels emits life-threatening pollutants that contaminate the household environment, which can have serious health consequences, especially for young children. This study examines the use of cooking fuel sources and their association with acute respiratory infections (ARIs) in children aged 0-59 months. STUDY DESIGN: This study used data from the second update of the Annual Health Survey (2012-13). The prevalence rate was measured in terms of the number of children per 1000 children suffering from ARIs. Bivariate analysis was used to analyze the use of different cooking fuels (in percentage) and the prevalence of ARIs in Uttar Pradesh. METHODS: District-level variations in the cooking fuels used were assessed by simple bivariate analysis for all districts of Uttar Pradesh. A logistic regression was used to examine the association of household environment and pollutants with ARIs. RESULTS: In total, 89 per 1000 children suffered from ARIs in Uttar Pradesh. Infants (0-11 months) were significantly more likely to suffer from ARIs than older children (12-59 months). Households using dung cake for cooking and kerosene and other oils for lighting were found to have significantly higher odds for ARIs (odds ratio [OR]: 1.21; 95% confidence interval [CI]: 1.17-1.25 and OR: 1.07; 95% CI: 1.05-1.10, respectively). A considerable interdistrict difference was observed in the cooking fuel used and the prevalence of ARIs among children aged 0-59 months. CONCLUSIONS: The type of cooking fuel and lighting source used were found to be significant predictors of ARIs among children aged 0-59 months. These results highlight the need for targeted efforts for the provision of clean cooking fuels (liquid petroleum gas/biogas/electricity) and for the improvement in knowledge and awareness of ARIs and exposure to cooking and lighting pollution.

Use of roller pump in venovenous extracorporeal membrane oxygenation as an emergency rescue procedure.

A 41 years old male patient, having acute respiratory distress syndrome (ARDS) due to viral pneumonia, was put on venovenous (VV) extracorporeal membrane oxygenation (ECMO). After 3 h of initiation, the ECMO pump malfunctioned. The patient was initially managed on a hand crank for 5 h. However, as another machine would be available after 12-24 h, we decided to use a roller pump with a conventional cardiopulmonary bypass (CPB) circuit. We successfully manage this crisis with this technique without any complications. This technique can be lifesaving in catastrophic situations such as ECMO console or pump failures when there are neither backup machines nor service engineers available.

An Unusual Presentation of Ludwig's Angina with Empyema Thoracis and External Carotid Artery Pseudoaneurysm.

Ludwig's angina is a rapidly spreading soft-tissue infection and commonly occurs following odontogenic infection. A 30-year-old male presented to the emergency department, 7 days after the extraction of molar teeth with a sudden onset of mandibular swelling. He was diagnosed with Ludwig's angina with empyema thoracis and external carotid artery (ECA) pseudoaneurysm. He was successfully managed with video-assisted thoracoscopic surgery-guided drainage and endovascular embolization of ECA pseudoaneurysm. We share our experience of challenges faced during the management of unusual presentation of complicated Ludwig's angina.

Successful open surgical repair of large ilio-caval fistula presenting with congestive heart failure.

Ilio-caval arteriovenous fistula is a rare sequel of lumbar disc surgery or penetrating injury. We report a case of 40-year gentleman presenting with symptoms of congestive heart failure and continuous murmur heard over right iliac fossa. His past history was significant for lumbar disc surgery done twice 1 year back. Computed tomography angiogram confirmed a large fistulous communication between right common iliac artery and inferior vena cava. Open surgical repair was performed as the fistula was not well suited for endovascular repair. We successfully managed this case by open surgical ligation of right common iliac artery proximal and distal to fistula and continuity restored with interposition Dacron graft. He was relieved of symptoms and performing well on follow-up.

Cascade of Complications Following Carotid Body Tumor Excision.

Carotid body tumor excision can lead to various complications including vascular injury and pseudoaneurysm formation. Here we describe a case of carotid body tumor excision followed by series of complications including pseudoaneurysm formation, failure of primary surgical repair, carotid stump syndrome following parent artery occlusion, and persistent hypotension.

Extracranial carotid artery pseudoaneurysm due to Mycobacterium tuberculosis.

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.

Correlates of tobacco quit attempts and missed opportunity for tobacco cessation among the adult population in India.

INTRODUCTION: Tobacco cessation is crucial to reduce tobacco-related diseases and premature deaths. Quitting efforts can be enhanced through brief routine interventions at health facilities because healthcare providers are highly trusted, resulting in stronger adherence to their advice. MATERIALS AND METHODS: This study used data on tobacco users aged 15-49 years (n = 93,522) collected as part of the fourth round of the National Family Health Survey (NFHS) 2015-16. Bivariate and multivariate analyses were carried out using STATA (version 13) to understand the socioeconomic and demographic correlates of tobacco quit attempts and advice to quit by healthcare providers. GIS map has been used to show inter-state variations in quit attempts and advice. RESULTS: Thirty per cent of the tobacco users were found to have attempted to quit tobacco. Education, mass media exposure, economic status, and chronic disease emerged as enablers, while alcohol use and social backwardness came out as barriers to quit attempts. Quit advice from the healthcare providers was found not to be given frequently (51%) and varied significantly by the socioeconomic and demographic profile of the users. Not all of the tobacco users attempting to quit had been advised to quit, indicating a missed opportunity to intervene and reinforce quitting at a health facility. CONCLUSIONS: Fewer attempts to quit among the adolescents, the less educated, and the users from the poorest households may increase the burden of tobacco-attributable diseases unless timely interventions are made. Better training of the healthcare providers in administering and recommending tobacco cessation and emphasizing on the value of cessation counselling is urgently required to enhance quitting practices and improve health.

Large scale changes in the transcriptome of Eisenia fetida during regeneration.

Earthworms show a wide spectrum of regenerative potential with certain species like Eisenia fetida capable of regenerating more than two-thirds of their body while other closely related species, such as Paranais litoralis seem to have lost this ability. Earthworms belong to the phylum Annelida, in which the genomes of the marine oligochaete Capitella telata and the freshwater leech Helobdella robusta have been sequenced and studied. Herein, we report the transcriptomic changes in Eisenia fetida (Indian isolate) during regeneration. Following injury, E. fetida regenerates the posterior segments in a time spanning several weeks. We analyzed gene expression changes both in the newly regenerating cells and in the adjacent tissue, at early (15days post amputation), intermediate (20days post amputation) and late (30 days post amputation) by RNAseq based de novo assembly and comparison of transcriptomes. We also generated a draft genome sequence of this terrestrial red worm using short reads and mate-pair reads. An in-depth analysis of the miRNome of the worm showed that many miRNA gene families have undergone extensive duplications. Sox4, a master regulator of TGF-beta mediated epithelial-mesenchymal transition was induced in the newly regenerated tissue. Genes for several proteins such as sialidases and neurotrophins were identified amongst the differentially expressed transcripts. The regeneration of the ventral nerve cord was also accompanied by the induction of nerve growth factor and neurofilament genes. We identified 315 novel differentially expressed transcripts in the transcriptome, that have no homolog in any other species. Surprisingly, 82% of these novel differentially expressed transcripts showed poor potential for coding proteins, suggesting that novel ncRNAs may play a critical role in regeneration of earthworm.

Severe primary hypothyroidism presenting as polymorphic ventricular tachycardia / Hipotiroidismo primario grave que se presenta como taquicardia ventricular polimórfica

Abstract Introduction: Hypothyroidism may have various cardiovascular manifestations due to morphological, functional and electrical alterations in the heart. The usual electrocardiographic findings being sinus bradycardia, low voltage complexes, and slowed intraventricular conduction. Hypothyroidism manifesting as polymorphic ventricular tachycardia has only been reported in a few case reports. Clinical case. A 60-year-old lady presented to us in the emergency department in an unresponsive and unconscious state and electrocardiogram showed a polymorphic ventricular tachycardia. After initial resuscitation with direct current cardioversion and supportive care, she found to have severe hypothyroidism and responded well to thyroid replacement therapy. Conclusion. Polymorphic ventricular tachycardia is a life threatening emergency that can have various etiologies. Polymorphic ventricular tachycardia secondary to primary hypothyroidism is a rare presentation but it is treatable and reversible with thyroid replacement therapy. In patients presenting with QT interval prolongation and ventricular tachycardia, hypothyroidism should be one of the differential diagnosis.

Resumen Introducción: El hipotiroidismo puede presentar diferentes manifestaciones cardiovasculares dadas por alteraciones morfológicas, funcionales y eléctricas en el corazón, siendo los hallazgos electrocardiográficos usuales son la bradicardia sinusal, los complejos de bajo voltaje y la conducción intraventricular lenta. El hipotiroidismo manifestado como taquicardia ventricular polimórfica solo se ha descrito en unos pocos reportes de caso. Caso clínico: Se trata de una mujer de 60 años que acudió que acurdió al servicio de urgencias en un estado inconsciente y sin respuesta a estímulos, y el electrocardiograma reveló taquicardia ventricular polimórfica. Luego de la reanimación inicial con cardioversión con corriente directa y tratamiento sintomático se le encontró un hipotiroidismo grave, el cual se trató con terapia de reemplazo con hormona tiroidea. y se obtuvo una buena respuesta Conclusión. La taquicardia ventricular polimórfica es una emergencia vital que puede tener varias etiologías. La taquicardia ventricular polimórfica secundaria a un hipotiroidismo primario es una presentación poco común, pero es tratable y reversible con la terapia de reemplazo con hormona tiroidea. En los pacientes que presentan una prolongación del intervalo QT y taquicardia ventricular, es pertinente incluir el hipotiroidismo en el diagnóstico diferencial.