Tillage and crop establishment effects on weeds and productivity of a rice-wheat-mungbean rotation.

Weeds are one of the key threats in sustaining the productivity of the rice-wheat cropping system in the Indo-Gangetic Plains. The development of sound integrated weed management technologies requires knowledge of mechanisms that influence weed flora composition and weed seedbank dynamics. A long-term study was initiated in 2015 at Patna, Bihar, India to evaluate the effect of seven tillage and crop establishment methods on weed density, weed seedbank composition, and crop productivity in rice-wheat-mungbean rotation. All the treatments included zero-till mungbean after wheat. Tillage and crop establishment methods had differential effects on weed and weed seedbank composition. In rice, zero-till direct-seeded rice recorded 62% lower emergence of Cyperus iria, 82-90% of Echinochloa colona, and 81-83% of total weeds compared to tilled systems, but the system of rice and wheat intensification favoured E. colona. In wheat, the system of wheat intensification favoured the Phalaris minor and Solanum nigrum. Zero-till rice and wheat reduced the seedbank of Trianthema portulacastrum by 95%, and total weed seedbank by 62% compared to the system of rice and wheat intensification. Nearly, 72% of C. iria seeds, 62% of grasses, and 64% of broad-leaved weeds were in 0-15 cm soil layer. Zero-till direct-seeded rice produced a 13% lower rice grain yield than conventional puddled transplanted rice. Compared to the system of wheat intensification, zero-till wheat under triple zero-till systems produced an 11.5% higher grain yield. Managing weed seedbank is a long-term endeavour. The present study revealed that tillage and crop establishment methods influence weed density and diversity. Under zero-till rice-wheat system, rice yield decreases marginally, but the system productivity maintains due to improvement in succeeding wheat yield. This system is also helpful in reducing the weed flora density and soil weed seedbank. Regular monitoring and management of emerging pests such as armyworm (Mythimna separata) are, however, required. The study suggests that the adoption of triple zero-tillage can be a viable option for reducing the weed density and weed seedbank concurrently increasing the system productivity of the rice-wheat-mungbean cropping system in eastern Indo-Gangetic Plains.

Demographic, clinical and etiological profile of pericardial effusion in India: A single centre experience.

INTRODUCTION: Pericardial effusion (PE) is a life-threatening condition. However, there are very few Indian studies which determined etiological distribution. The current retrospective observational study was carried out to assess etiological factors responsible for PE in a tertiary care centre in India. METHODS: The study enrolled consecutive 55 patients with the diagnosis of moderate to large PE as established by echocardiography between January 2018 and December 2018. The echocardiography guided percutaneous pericardiocentesis was performed by the standard procedure. RESULTS: Amongst the enrolled PE patients in the study, 30 (54.55%) were males and 25 (45.45%) were females, with the average age of 43.00 ± 15.54 years. In clinical assessment, tamponade was found in 52 (94.54%) patients. Tuberculosis was the most common etiology for PE (n=35, 63.64%) followed by hypothyroidism (n = 6, 10.9%), and malignancies (n = 4, 7.27%). Among 12.72% patients, the PE was of recurrent type. Additionally, no death or any complication was encountered during pericardiocentesis. CONCLUSION: Pericardial disease and effusion is a major cause of morbidity in India. Despite developments in the healthcare facilities, tuberculosis was the most common etiology for PE. Additionally, the raised number of hypothyroid and malignant PE cases demonstrates the changing etiological trends, similar to western countries.

Silver-doped active carbon spheres and their application for microbial decontamination of water.

Highly efficient and durable, silver nanoparticles doped Active Carbon Spheres ACS(Ag) were synthesized by carbonization and activation of silver exchanged resins. The silver exchanged resins were prepared by exchanging H+ ions of polystyrene sulphonate resin with Ag+ ions of silver nitrate (AgNO3). The quantity of Ag+ in the spheres was controlled by varying the concentration of AgNO3, from 0.0125 to 0.1 M. With increasing molar concentration of AgNO3, the effective intake of Ag+ by the sphere increases from 1.1 to 8.1 weight percent (wt %). For activation, the spheres were incubated in the CO2 atmosphere for 6 h at fixed soaking temperature i.e. 1123 K. The characterization of synthesized silver doped ACS was performed by using different sophisticated instrumental techniques. The antimicrobial activity of silver doped ACS was studied against different bacterial strains like, E. coli, B. subtilis and Staphylococcus aureus. The study demonstrated that the zone of inhibition for E. coli was 16.9 ± 0.7 mm while for B. subtilis it was 17.1 ± 0.3 mm at a concentration of 8 mg of synthesized material. In addition, satisfactory results were obtained in shake flask and filtration test experiments also, even at a low concentration of 2 mg, showing growth inhibition of 94% for E. coli and 93% for B. subtilis. When the concentration of silver doped ACS was increased to 8 mg, complete removal of both the bacteria was observed after 24 h (100 % reduction for E. coli and B. subtilis). Furthermore, when silver doped ACS was tested against Staphylococcus aureus according to ASTM:E 2149-01 method, biocidal activity of up to 73% was observed. Therefore, the silver doped ACS can be considered as a potential biocidal material for the studied bacterial strains and hence find suitable application for decontamination of water.

Biosorptive and Biodegradative Mechanistic Approach for the Decolorization of Congo Red Dye by Aspergillus Species.

In this work, Aspergillus terreus GS28 and Aspergillus flavus CR500 isolated from industrial waste sludge examined for the decolorization of Congo red (CR) dye. The rate of CR decolorization raised due to optimum pH, temperature, carbon, nitrogen, and heavy metals. In the comparative study, A. terreus has the maximum ability (95%) to decolorize CR (≈ 100 mg L-1) as compared with A. flavus (92.96%) under optimized condition after 120 h. GC-MS and FTIR analysis of the fungal-metabolite and fungal-biomass shows bio-degradation and biosorption processes respectively. The degraded products were benzenepropanic (Rt-26.147), 3, 4-diaminonapthelene-1-sulfonic acid, and benzenedicarboxylic acid (Rt-26.660) by A. terreus, and benzenedicarboxylic acid (Rt-41.467) by A. flavus. The phytotoxicity assay revealed that a decrease in toxicity of the degraded product towards the growth and germination rate of two plant seeds compared to CR. Thus, the finding suggests that both the fungi act promising CR remediation candidates, induces restoration of CR polluted wastewater and save soil-land.

'Routine' versus 'Smart Phone Application Based - Intense' follow up of patients with acute coronary syndrome undergoing percutaneous coronary intervention: Impact on clinical outcomes and patient satisfaction.

BACKGROUND: Acute coronary syndrome (ACS) refers to the spectrum of clinical presentation of coronary artery disease (CAD). As a routine practice at our institute, following PCI, ACS patients are called for the first follow up after two weeks. This period of two weeks can be full of anxieties, concerns and medical issues. In this study, we planned to assess the feasibility/acceptability of smart phone application (app) based system for patient follow-up and its comparison to routine practice among patients with ACS who have undergone a PCI. METHODS: A randomized controlled trial (RCT) was conducted over a period of one year from January to December 2017. After the PCI was deemed successful, patients were recruited and enrolled based on the understanding of basic English language and operation of a smart phone. Those who consented to be part of study were then randomly allocated either the conventional follow up group or the intense follow up (routine + smart phone app based follow up) group. First co- primary outcome was composite of clinical outcomes (mortality, myocardial infarction, stroke, target vessel revascularisation, heart failure admission and emergency visit). Second co- primary outcome was patient satisfaction. The overall patient satisfaction was assessed by the patients using a five-point patient satisfaction survey instrument containing five questions with 5 marks each, in which higher scores meant more satisfaction. Secondary outcome was controlled hypertension in hypertensive patients. It was defined as systolic BP less than 130 and diastolic BP less than 80 mmHg. RESULTS: A cohort of 228 patients (109 in intense app-based arm; 119 in routine follow up arm) were analyzed. The result showed significant improvement in blood pressure control in hypertensive population in intense app based follow up group (76.2%) when compared to routine follow up group (45%) with p value 0.0062. The satisfaction score was significantly higher in the intense app based follow up (20.7 ± 1.29) as compared to routine follow up (16.5 ± 2.68); p value 0.0001. In the intense app based follow up 72.5% patient felt it was excellent tool (score 21-25) while 27.5% categorized it as good (score 16-20). While the routine follows up was perceived as good by most (91.6%) of the patients. Only 4.2% graded it as excellent and an equal number (4.2%) graded it as a poor way of follow up. CONCLUSIONS: App based system shows higher satisfaction rate and comparable clinical outcome when compared to traditional hospital based follow up protocol alone. It has a high acceptance rate and thus this system should be explored further to optimize long term patient care.

Impact on particulate matters in India's most polluted cities due to long-term restriction on anthropogenic activities.

Our purpose of this research is to study the variation in air quality during lockdown (LD) and Post-lockdown (Post-LD) with respect to Pre-lockdown (Pre-LD) in most polluted cities of India by comparing the data of PM10 and PM2.5 in different periods: Pre-LD, LD and post-LD. We have selected top five cities of India out of the 20 most polluted cities across the world including Ghaziabad, Delhi, Noida, Greater Noida, and Lucknow (LKO). Historical data of atmospheric PM10 and PM2.5 for all cities were obtained from the Central Pollution Control Board (CPCB) online web portal of air quality data, except LKO. However, atmospheric PMs was monitored in LKO and samples of PM10 and PM2.5 were collected. During the LD and Post-LD period, due to anthropogenic emissions switch-off' a sharp decline was observed in concentrations of PM10 and PM2.5 in both circumstances (monthly and mean variation) as compared to Pre-LD in all selected cities. The Percentage changes (PCs) was found in mean concentrations of PM10 and PM2.5 during LD** and Post-LD*** with respect to Pre-LD at selected cities; Delhi -40.78%**, -58.42%*** and -57.60%**, -70.11%***; Ghaziabad -31.20%**, -53.91%*** and -57.29%**, -44.82%***; Noida -36.59&**, -53.95&*** and -58.36%**, -68.49%***; Greater Noida -39.39%**, -55.75%*** and -61.07%**, -71.56%***; LKO -57.95%**, -65.01%*** and -63.31%**, -59.95%*** respectively. The PCs of both pollutants exhibited a significant decrease in mean concentrations in all selected cities during LD and Post-LD with respect to Pre-LD period. Consequently, the results of current studies suggest that due to COVID-19 pandemic national LD restriction on anthropogenic activities, both coarse and fine pollutants have significantly reduced and air quality greatly improved during LD and Post-LD as compared to pre-LD period in all selected cities of India.

An impact of agronomic practices of sustainable rice-wheat crop intensification on food security, economic adaptability, and environmental mitigation across eastern Indo-Gangetic Plains.

In the eastern Indo-Gangetic Plains (EIGP), conventional rice-wheat system has led to a decline in productivity, input-use efficiency, and profitability. To address these, a four-year field study was conducted to evaluate the performance of tillage and crop establishment (TCE) methods in rice-wheat-greengram rotation. The treatments included: 1) random puddled transplanted rice (RPTR) - conventional-till broadcast wheat (BCW) - zero-till greengram (ZTG); 2) line PTR (LPTR) - conventional-till drill sown wheat (CTW) - ZTG; 3) machine transplanted rice in puddled soil (CTMTR) - zero tillage wheat (ZTW) - ZTG; 4) machine transplanted rice in zero-till wet soil (ZTMTR) - ZTW - ZTG; 5) system of rice intensification (SRI) - system of wheat intensification (SWI) - ZTG; 6) direct-seeded rice (DSR) - ZTW - ZTG; and 7) zero-till DSR - ZTW - ZTG. During the initial two years, conventional rice system (PTR) recorded a 16.2 % higher rice grain yield than DSR system. Whereas in the fourth year, the rice yields under DSR and PTR were comparable. As compared to SRI/SWI, the average wheat yield in ZT system was significantly high, whereas in rice, SRI/SWI system was comparable with CT system. ZTW after non-puddled rice was at par to CTW after PTR. The ZT wheat produced 4.6 % more yield than CT system. DSR production system consumed 6.8 % less water compared to transplanted system. On the system basis, 10.8 % higher net returns were recorded with CA-based system compared to conventional system. The system energy productivity under CA-based production system was 14-36 % higher than PTR-based systems. CA-based system also led to 8-10 % lower global warming potential (GWP) than conventional methods. The current study indicated that as compared to conventional system, a significant gain in productivity, profitability and energy-use efficiency, and reduction in the environmental mitigation are possible with emerging alternative TCE methods. Long-term expansion and further refinement of these technologies in local areas need to be explored for the second green revolution.

Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India.

BACKGROUND: Percutaneous mitral balloon valvotomy (PBMV) is an alternative to surgery for patients with severe mitral valve (MV) stenosis. However, the safety and feasibility of same-day discharge (SDD) in patients undergoing elective PBMV for severe MV stenosis is yet to be investigated. This study aimed to assess safety and feasibility of SDD in patients undergoing elective PBMV because of severe MV stenosis in a tertiary-care hospital in India. METHODS: From January 2018 to November 2018, patients with a diagnosis of severe MV stenosis were treated with PBMV at our institution. Among these patients, those suitable for SDD were prospectively included in this registry. Vascular access was achieved in forearm arteries and femoral veins. Clinical, echocardiographic and hemodynamic features were collected before and after PBMV. The primary outcome was 30-day mortality. The secondary outcome was incidence of in-hospital complications. Other outcomes of interest were arterial spasm and forearm haematoma. RESULTS: A total of 98 patients scheduled for SDD after elective PBMV were included in the registry. Mean MV area increased from 0.8 ± 0.1 to 1.6 ± 0.2 cm2 (p < .001). Severe MV regurgitation after PBMV occurred in 3 patients, and 1 patient developed pericardial tamponade. Severe arterial spasm occurred in 2 patients. None of the included patients developed a clinically relevant haematoma of forearm. A total of 94 (96%) were discharged on the same day. No patient died up to 30-day follow-up. CONCLUSION: PBMV from the venous access site can reduce the hospital stay of patients to less than a day with less local site complications.

Bioremediation mechanism and potential of copper by actively growing fungus Trichoderma lixii CR700 isolated from electroplating wastewater.

Present study investigated the Cu2+ removal potential of Trichoderma lixii CR700, isolated from enormously heavy metal polluted electroplating wastewater. In the batch study, actively growing CR700 was able to remove 84.6% of Cu2+ at the concentration 10 mg/L of Cu2+ within 120 h after incubation and the accumulated and surface adsorbed amount of Cu was 0.51 and 0.47 mg/g of dry biomass respectively. T. lixii CR700 also showed efficient Cu2+ removal potential in the pH ranges from 5.0 to 8.0, in the presence of other co-occurring contaminant such as heavy metal, anions and metabolic inhibitor as well from real tannery wastewater. Alteration on cell surface of Cu2+ treated mycelia of T. lixii CR700 was analyzed using scanning electron microscope. Fourier transform infrared spectroscopic analysis was performed to identify the role of surface functional group in Cu2+ adsorption which revealed that COO─ functional group lead Cu2+ adsorption onto the surface of T. lixii CR700. Thus, T. lixii CR700 uses simultaneous surface sorption and accumulation mechanism in Cu2+ removal and can be potentially applied for bioremediation of Cu2+ contaminated wastewater in ecofriendly, safe and sustainable way.

Hexavalent chromium stress response, reduction capability and bioremediation potential of Trichoderma sp. isolated from electroplating wastewater.

In the present study we are investigating the Cr(VI) reduction potential of a multi-metal tolerant fungus (isolate CR700); isolated from electroplating wastewater. Based on the ITS region sequencing, the isolate was identified as Trichoderma lixii isolate CR700 and able to tolerate As(2000 mg/L), Ni(1500 mg/L), Zn(1200 mg/L), Cu(1200 mg/L), Cr(1000 mg/L), and 100 mg/L of Pb and Cd evident from tolerance assay. Cr(VI) reduction experiment was conducted in Erlenmeyer flasks containing different concentration of Cr(VI) (0-200 mg/L) amended potato dextrose broth medium followed by inoculating with a disk (0.5 cm diameter) of 7 days grown isolate CR700, and achieved a maximum of 99.4% within 120 h at 50 mg/L of Cr(VI). However, the accumulation of total Cr by isolate CR700 was 2.12 ±â€¯0.15 mg/g of dried biomass at the same concentration after 144 h of exposure. Isolate CR700 showed the capability to reduce Cr(VI) at different physicochemical stress conditions such as pH, temperature, heavy metals, metabolic inhibitor and also in tannery wastewater. Fungus exhibited multifarious morphological and biochemical response under the exposure of Cr(VI); the scanning electron microscopic analysis revealed that Cr(VI) treated mycelia of isolate CR700 comparatively irregular, aggregated and swelled than without treated mycelia which might be due to the tolerance mechanism and vacuolar compartmentation of chromium. Moreover, energy dispersive spectroscopy and x-ray photoelectron spectroscopic analysis exposed the Cr(III) precipitation on the mycelia surface of isolate CR700 and Fourier-transform infrared spectroscopic analysis suggested the contribution of the protein associated functional group in the complexation of Cr(VI). The phytotoxicity test of fungal treated 100 mg/L of Cr(VI) supernatant on Vigna radiata and Cicer arietinum revealed the successful detoxification/remediation of Cr(VI).

Hexavalent chromium reduction ability and bioremediation potential of Aspergillus flavus CR500 isolated from electroplating wastewater.

Hexavalent chromium reduction by microbes can mitigate the chromium toxicity to the environment. In the present study Cr[VI] tolerant fungal isolate (CR500) was isolated from electroplating wastewater, was able to tolerate 800 mg/L of Cr[VI. Based on the ITS region sequencing, the isolate was identified as Aspergillus flavus CR500, showed multifarious biochemical (reactive oxygen species, antioxidants response and non-protein thiol) and morphological (protrusion less, constriction and swelling/outwards growth in mycelia) response under Cr[VI] stress. Batch experiment was conducted at different Cr[VI] concentration (0-200 mg/L) to optimize the Cr[VI] reduction and removal ability of isolate CR500; results showed 89.1% reduction of Cr[VI] to Cr[III] within 24 h and 4.9 ±â€¯0.12 mg of Cr per gram of dried biomass accumulation within 144 h at the concentration of 50 mg/L of Cr[VI]. However, a maximum of 79.4% removal of Cr was recorded at 5 mg/L within 144 h. Fourier-transform infrared spectroscopy, energy dispersive x-ray spectroscopy and X-ray diffraction analysis revealed that chromium removal also happened via adsorption/precipitation on the mycelia surface. Fungus treated and without treated 100 mg/L of Cr[VI] solution was subjected to phytotoxicity test using Vigna radiata seeds and result revealed that A. flavus CR500 successfully detoxified the Cr[VI] via reduction and removal mechanisms. Isolate CR500 also exhibited efficient bioreduction potential at different temperature (20-40 °C), pH (5.0-9.0), heavy metals (As, Cd, Cu, Mn, Ni and Pb), metabolic inhibitors (phenol and EDTA) and in sterilized tannery effluent that make it a potential candidate for Cr[VI] bioremediation.

Syndrome 'Z': A Predictor of Angiographic Severity of Coronary Artery Disease in Patients of Acute Coronary Syndrome.

BACKGROUND: Owing to the growing evidence that the pathophysiology of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) overlap considerably and both adversely impact cardiovascular health, we hypothesised that the presence of OSA with MS additively and adversely affect the severity of coronary artery disease (CAD). Exploration and understanding of this may have direct implications for the development of targeted, preventive strategies for CAD. Thus, this prospective study was aimed to determine the prevalence of 'Syndrome Z' in patients of MS who present with an acute coronary event and to correlate it with the angiographic severity of CAD in these patients. METHODS: The present study was a single centre, cross sectional study conducted in a university teaching hospital. In a span of 6 months, 922 patients with acute coronary syndromes (ACS) were screened for the study. Among these, 861 patients had no evidence of MS. The remaining 61 patients who were diagnosed to have MS were then subjected to an overnight sleep study. Only 58 had good sleep data so were included for further analysis. Angiographic parameters in terms of number of vessels involved and culprit lesions were noted and correlated with presence and absence of OSA and also with its severity based on the Apnoea/Hypopnoea Index (AHI). RESULTS: The prevalence of OSA positivity in patients with MS who presented with ACS was 34.5% (n=20). Most of the patients in the OSA negative group (78.9%, n=30) had disease limited to only one vessel while in the OSA positive group only a minority (15%, n=3) of patients had their disease limited to a single vessel (p=0.001). The number of lesions in the culprit vessel was also significantly less in the OSA negative group compared to the OSA positive group. While in the OSA negative group 68.4% (n=26) patients had a solitary lesion, followed by two and three lesions in 15.8% (n=6) of the patients each, multiple lesions were more common in OSA positive patients, involving 80% of cases (45.0%, n=9 with two lesions; 35.0%, n=7 with three lesions; only 20%, n=4 had a solitary lesion). CONCLUSIONS: Prevalence of 'Syndrome Z' is high in patients having MS presenting with ACS and it correlates with the angiographic severity of CAD.

Evaluation of long-term conservation agriculture and crop intensification in rice-wheat rotation of Indo-Gangetic Plains of South Asia: Carbon dynamics and productivity.

In the context of deteriorating soil health, stagnation of yield in rice-wheat cropping system (RWCS) across Indo- Gangetic plains (IGP) and environmental pollution, a long term field experiment was conducted during 2009-2016 taking four crop scenarios with conservation agriculture (CA), crop intensification and diversified cropping as intervening technology aiming to evaluate the sustainability of the systems. Scenario 1 (S1) represented conventional farmers' practice of growing rice and wheat with summer fallow. In scenario 2 (S2) and scenario 3 (S3), legume crop was taken along with rice and wheat with partial CA and full CA, respectively. Conventional RWCS was replaced with rice-potato + maize- cowpea cropping system with partial CA in scenario 4 (S4). The S3 scenario registered highest total organic carbon (TOC) stock of 47.71 Mg C ha-1 and resulted in significant increase of 14.57% over S1 (Farmer's practice) in 0-30 cm soil depth after 7 years of field trial. The S4 scenario having intensified cropping systems recorded lowest TOC of 39.33 Mg C ha-1 and resulted in significant depletion of 17.56% in C stock with respect to S3 in 0-30 cm soil depth. The TOC enrichment was higher in S2, S3 and S4 scenario in the surface soil (0-10 cm) compared to S1. At lower depth (20-30 cm), the TOC enrichment was significantly higher in S2 (12.82 Mg C ha-1) and S3 (13.10 Mg C ha-1 soil) over S1 scenario. The S2 and S3 scenario recorded highest increased allocation of TOC (3.55 and 6.13 Mg C ha-1) to passive pool over S1. The S2 (15.72 t ha-1), S3 (16.08 t ha-1) and S4 (16.39 t ha-1) scenarios recorded significantly higher system rice equivalent yield over S1 (10.30 t ha-1). Among the scenarios, S3 scenario had greater amount of total soil organic carbon, passive pool of carbon and higher system rice equivalent yield, thus, is considered the best cropping management practice to maintain soil health and food security in the middle IGP.

Clinical presentation, management, and outcomes in the Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF) registry.

AIM: A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. METHODS: A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed. RESULTS: The average age of Indian AF patients was 54.7 years. There was a marginal female preponderance - 51.5% females and 48.5% males. At baseline, 20.4% had paroxysmal AF; 33% had persistent AF; 35.1% had permanent AF and 11% had first AF episode. At one-year follow-up, 45.6% patients had permanent AF. Rheumatic valvular heart disease (RHD) was present in 47.6% of patients. Hypertension, heart failure, coronary artery disease, and diabetes were seen in 31.4%, 18.7%, 16.2%, and 16.1%, respectively. Rate control was the strategy used in 75.2% patients, digoxin and beta-blockers being the most frequently prescribed rate-control drugs. Oral anticoagulation (OAC) drugs were used in 70% of patients. The annual mortality was 6.5%, hospitalization 8%, and incidence of stroke 1%. CONCLUSIONS: In India, AF patients are younger and RHD is still the most frequent etiology. Almost two-third of the patients have persistent/permanent AF. At one-year follow-up, there is a significant mortality and morbidity in AF patients in India.

Efficacy of multi-detector coronary computed tomography angiography in comparison with exercise electrocardiogram in the triage of patients of low risk acute chest pain.

OBJECTIVES: To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain. BACKGROUND: Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED). METHODS: Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (≥ 50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy. RESULTS: A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%. CONCLUSION: CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients.

Comparative assessment of platelet GpIIb/IIIa receptor occupancy ratio with Eptifibatide/Tirofiban in patients presenting with ACS and undergoing PCI.

BACKGROUND: The level of platelet inhibition by a Glycoprotein IIb/IIIa (GpIIb/IIIa) antagonist therapy necessary to minimize thrombotic complications in patients undergoing percutaneous coronary intervention (PCI) is a subject of debate. The degree of platelet inhibition obtained 10 min after start of GpIIb/IIIa antagonist therapy predicts adverse events after PCI. The aim of this study was to look at platelet inhibition and to compare platelet GpIIb/IIIa receptors occupancy ratio (GpRO) with Eptifibatide and Tirofiban using various dose regimens and correlate with 30-day clinical outcomes in patients presenting with high-risk acute coronary syndromes (ACS) and undergoing PCI. METHODS: The patients were divided into four sub groups: (1) Eptifibatide two intracoronary bolus (180 µg/kg) alone (E(B)); or (2) two intravenous bolus (180 µg/kg) followed by infusion at 2 µg/kg/min for 24 h (E(B + Inf)); and (3) Tirofiban standard bolus dose (0.4 µg/kg) over 30 min followed by infusion at 0.1 µg/kg/min (T(Std)); or (4) at ADVANCE dose bolus (25 µg/kg) over 3 min, followed by infusion at 0.1 µg/kg/min (T(Adv)). Number of GpIIb/IIIa receptors was assessed by flow cytometry at baseline and 10 min after the bolus and percentage of free receptors was determined to calculate the GpRO. Patients were followed for 30 days for any major adverse cardiac events (MACE). RESULTS: 200 consecutive patients (including 74% with ST-elevation ACS) were enrolled. GpRO in groups E(B) (n = 48) and E(B + Inf) (n = 44) were 62.7% ± 27.2% and 61.4% ± 6.1% respectively while in the groups T(Std) (n = 96) and T(Adv) (n = 12) groups were 35.1% ± 17.74% and 68.8% ± 27.3% respectively. The GpRO was similar in E(B), E(B + Inf) and T(Adv) groups and was significantly higher than T(Std) group (p < 0.0001). The 30-day MACE rates in E(B) (4.2%), E(B + Inf) (4.5%) and T(Adv) (4.2%) were significantly lower than T(Std) group (12.5%) (p < 0.01). CONCLUSIONS: Standard dose Tirofiban results in significantly lower rates of GpIIb/IIIa receptor occupancy ratio and this correlated with higher incidence of 30-day MACE in high-risk ACS patients undergoing PCI.

Prognostic value of Angiographic Perfusion Score (APS) following percutaneous interventions in acute coronary syndromes.

INTRODUCTION: Identifying reperfusion and predicting post procedure risk is important following Percutaneous Coronary Interventions (PCI). An Angiographic Perfusion Score (APS) combining TIMI flow (TFG) and myocardial perfusion (TMPG) grades before and after PCI can accurately measure both epicardial and myocardial perfusion and predict Major Adverse Cardiac Events (MACE). PATIENTS AND METHODS: APS was calculated in 226 (88 ST elevation Myocardial Infarction (STEMI) and 138 Non STEMI) patients. Maximum score being 12, reperfusion was defined as failed: 0-3, partial: 4-9, and full APS: 10-12. Thirty day MACE were observed. RESULTS: APS identified reperfusion significantly more than TMPG alone (STEMI: 50.6% vs 11.8% (p < 0.001); Non STEMI, early reperfusion: 69.4% vs 52.8% (p < 0.01) and Non STEMI late reperfusion: 38.2% vs 7.8%; (p ≤ 0.001) respectively. A significantly lower incidence of MACE was observed in the full as compared to the failed APS group (1.8% vs 22.5%) (p < 0.001). No differences were noted between TMPG 0-2 (9.8%, 9.4%, 7.3%, respectively) (p = NS). CONCLUSION: Compared to MPG alone APS detects more low risk reperfused patients, post PCI.

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion.

Malignant disease with pericardial metastasis is one of the most common causes of recurrent pericardial effusion (PE) with tamponade. While surgical pericardiotomy in these patients is very morbid and may not be a viable option, a palliative treatment percutaneously with percutaneous balloon pericardiotomy (PBP) can be a preferred treatment. We report herewith a case of PBP technique done using our day-to-day catheterisation laboratory equipment.