Idiopathic Chylous Pericardial Effusion Due to Lymphatic Malformation of Mediastinum.

Chylopericardium can be due to a variety of secondary causes like trauma, radiation, tumors, following cardiac surgery, etc., or may be idiopathic due to abnormal lymphatic system and mediastinal lymphangiectasia, which is a rare entity. Here, we present a case of a 34-year-old previously healthy male presenting with idiopathic chylopericardium. 2D echocardiography revealed massive pericardial effusion without features of cardiac tamponade. Following pericardiocentesis, a CT scan of the thorax and MR lymphangiogram were done to arrive at a diagnosis of idiopathic chylopericardium. In addition to medical management, surgical treatment included partial pericardiectomy and sclerotherapy of the mediastinal lymphatic sac. The patient had an uneventful post-operative period.

A review on cardiac manifestation of parasitic infection.

Parasites are uncommon causes of heart diseases except in endemic areas, and very few data are available which deals with parasites infecting human heart. However, literatures demonstrated that certain parasites such as protozoan and helminths can lead to significant cardiac complications. Although all organs can be affected, the heart and the lungs are the most frequently affected organs either directly or indirectly. It may involve all layers of the heart including pulmonary vasculature, thus producing a wide variety of clinical manifestations, which may present as myocarditis, pericarditis, cardiomyopathy, endomyocardial fibrosis, and pulmonary hypertension.

Clinicopathological Profile of Immunoglobulin A Nephropathy: A Study from Northeast India.

Immunoglobulin A (IgA) nephropathy is the most common primary glomerulopathy, with wide variation in its prevalence as well as clinical symptoms. Among the laboratory parameters, increased serum creatinine (SCr) levels, mean arterial pressure (MAP), and a decreased estimated glomerular filtration rate (eGFR) point toward poorer renal function. The Oxford 2016 scoring system for IgA nephropathy identified various histopathological variables, which serve as indicators of renal outcomes. There is a paucity of studies on the prevalence as well as the various clinical laboratory parameters correlating with the 2016 Oxford scoring system in northeastern India. The present study showed that IgA nephropathy was more common in the second and third decades, more prevalent in females, and mostly presented with edema. Nephrotic proteinuria, higher SCr, MAP, and decreased eGFR levels at presentation suggested poorer renal function in most subjects. The endocapillary hypercellularity, segmental sclerosis, tubular atrophy, and crescent variables of the 2016 Oxford scoring system showed a statistically significant relationship with various laboratory parameters at presentation.

Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry.

AIMS: Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS: The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION: One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.

Acute Myocardial Infarction After COVID-19 Vaccination: A Case Report.

Following the coronavirus disease 2019 (COVID-19) pandemic, nations all over the world started vaccination programs against the SARS-CoV2 virus. With the widespread administration of the vaccine across the globe, various cases were reported with thrombotic events after vaccination. Here, we are presenting a case of acute anterior wall myocardial infarction (AWMI) after ChAdOx1 nCoV- 19 corona virus (recombinant) vaccination. A 68-year-old male who was a known case of hypertension, non-smoker on antihypertensive took COVISHIELD vaccination and presented with acute anterior wall myocardial infarction within 12 hours and was taken up for primary angioplasty. On coronary angiography, mid-left anterior descending artery (LAD) was 99% stenosed. Following angiography percutaneous transluminal coronary angioplasty (PTCA), deployment of a drug eluting stent was done. Post-procedure time was uneventful. He was started on intravenous fluids and amiodarone infusion. The patient recovered and was discharged in stable condition. The leading approach to handling COVID-19 pandemic is mass vaccination. In this case, the MI after vaccination might be coincidental. We want to highlight this case as that the complication can occur during the mass vaccination programs and hence adequate precautionary measures like basic life support, EKG monitoring, and emergency ambulance services should be present in all primary and community health centers (PHC and CHC). This will help in avoiding the COVID vaccination hesitancy among the general public.

Renal Subcapsular Hematoma Due to Reperfusion Injury Following Renal Angioplasty in Fibromuscular Dysplasia: A Dilemma in Diagnosis and Management.

Fibromuscular dysplasia (FMD) is a potentially treatable cause of renovascular hypertension and it typically affects young females. FMD usually involves distal two-thirds of the renal artery and percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice for FMD with resistant hypertension. PTRA is a safe procedure with minimal complications. However, renal subcapsular hematoma due to reperfusion injury is a rare complication following PTRA. A 32-year-old male presented with resistant hypertension. Arteriography of renal arteries showed >90% stenosis of ostial-proximal left renal artery with a string of beads appearance. PTRA was performed with the deployment of a 4 x 10 mm balloon-expandable stent in the stenotic segment of the left renal artery. However, computed tomography of the abdomen revealed massive left perinephric subcapsular hematoma without peritoneal collection. As the patient was hemodynamically stable, no invasive intervention was done, and discharged without requiring any anti-hypertensive medication. Putative reperfusion injury may provoke bleeding complications after renal angioplasty in a case of long-standing renal artery stenosis and can be managed conservatively with close surveillance in certain cases.

Concept design of the physical structure for ICU ventilators for COVID-19 pandemic.

A new disease known as COVID-19 caused by the SARS CoV2 virus has engulfed the entire world and led to a global pandemic situation. Till December 9, 2020, the disease has infected 68 million people worldwide and more than 1.56 million people have been killed. The origin of the COVID-19 disease has been traced back to the bats, but the intermediary contact is unknown. The disease spreads by respiratory droplets and contaminated surfaces. In most cases, the virus shows mild symptoms such as fever, fatigue, dyspnea, cough, etc. which may become severe if appropriate precautions are not adhered to. For people with comorbidities (usually elderly) the disease may turn deadly and cause pneumonia, Acute Respiratory Distress Syndrome (ARDS), and multi-organ failure, thereby affecting a person's ability to perform normal breathing which may put them on ventilator support. The virus causes Acute Respiratory Distress Syndrome (ARDS) that can lead to multi-organ failure in the most severe form. A patient suffering from ARDS must be put on a mechanical ventilator. These assistive devices help patients with respiratory disorders perform normal breathing. Presently nearly sixty thousand COVID-19 patients are in critical condition worldwide, fighting for survival requiring ventilator support. In India, the number stands close to eight thousand such individuals especially when the second wave of COVID-19 is expected to spread globally with initial signs arising from European and Middle East countries. With a large number of patients requiring ventilators, it puts a huge strain on the already weak health infrastructure of the developing countries. This is where some manufacturing and automobile companies have stepped in to help hospitals by developing ventilators at a faster rate and lower costs without comprising on the quality with the support of different government initiatives. This paper aims to study the basic requirements to be considered while designing the physical structure of an elementary level ICU ventilator for the hospital environment. The challenges related to research in electronic wiring of a mechanical ventilator, the overall structural design, and surrounding base could be appropriately done for different loads by simulating the conditions on tools like ANSYS software with accurate dimensions which could improve their future designs.

Candida albicans Isolates 529L and CHN1 Exhibit Stable Colonization of the Murine Gastrointestinal Tract.

Candida albicans is a pathobiont that colonizes multiple niches in the body including the gastrointestinal (GI) tract but is also responsible for both mucosal and systemic infections. Despite its prevalence as a human commensal, the murine GI tract is generally refractory to colonization with the C. albicans reference isolate SC5314. Here, we identify two C. albicans isolates, 529L and CHN1, that stably colonize the murine GI tract in three different animal facilities under conditions where SC5314 is lost from this niche. Analysis of the bacterial microbiota did not show notable differences among mice colonized with the three C. albicans strains. We compared the genotypes and phenotypes of these three strains and identified thousands of single nucleotide polymorphisms (SNPs) and multiple phenotypic differences, including their ability to grow and filament in response to nutritional cues. Despite striking filamentation differences under laboratory conditions, however, analysis of cell morphology in the GI tract revealed that the three isolates exhibited similar filamentation properties in this in vivo niche. Notably, we found that SC5314 is more sensitive to the antimicrobial peptide CRAMP, and the use of CRAMP-deficient mice modestly increased the ability of SC5314 to colonize the GI tract relative to CHN1 and 529L. These studies provide new insights into how strain-specific differences impact C. albicans traits in the host and advance CHN1 and 529L as relevant strains to study C. albicans pathobiology in its natural host niche. IMPORTANCE Understanding how fungi colonize the GI tract is increasingly recognized as highly relevant to human health. The animal models used to study Candida albicans commensalism commonly rely on altering the host microbiome (via antibiotic treatment or defined diets) to establish successful GI colonization by the C. albicans reference isolate SC5314. Here, we characterize two C. albicans isolates that can colonize the murine GI tract without antibiotic treatment and can therefore be used as tools for studying fungal commensalism. Importantly, experiments were replicated in three different animal facilities and utilized three different mouse strains. Differential colonization between fungal isolates was not associated with alterations in the bacterial microbiome but rather with distinct responses to CRAMP, a host antimicrobial peptide. This work emphasizes the importance of C. albicans intraspecies variation as well as host antimicrobial defense mechanisms in defining the outcome of commensal interactions.

Assessment of the impact of heart failure on household economic well-being: a protocol.

Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups.  After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male.

Cannabis usage is increasing throughout the world for both medicinal and recreational purposes. Several countries and states have legalized cannabis, and physicians can expect to encounter more patients who use or abuse cannabis. Adverse cardiovascular effects of cannabis like myocardial infarction, cardiomyopathy, and arrhythmias have been well described but bradyarrhythmia is rare and the mechanisms are not well pronounced. A 26-year-old male with a history of chronic cannabis smoking presented with complaints of dizziness and recurrent syncope. The heart rate at presentation was 42 beats per minute and the rest of the physical examination was unremarkable. There was an atrioventricular (AV) block in the ECG and a subsequent electrophysiological study (EPS) showed a high-grade supra-Hisian (nodal) AV block with prolonged His-ventricular (HV) interval. The urinary screen was positive for tetrahydrocannabinol metabolite (11-Nor-9-carboxy THC). After ruling out other possible causes, a diagnosis of high-grade AV block due to chronic cannabis use was made. A dual-chamber pacemaker was implanted and the patient was discharged in stable condition. The arrhythmia did not improve completely at the three-month follow-up. We report a novel finding in cannabis-induced bradyarrhythmia. High-grade AV block with the electrophysiologic determination of the site of conduction blockade has not been reported previously. The mechanism of bradyarrhythmia is thought to be mediated by increased vagal tone. However, prolonged HV interval and persistent nature of block indicate that direct toxic effects of cannabis, through cannabinoid receptors 1 (CB1R), on the cardiac conduction system cannot be ruled out. Also, the possibility of cannabis arteritis involving microvasculature should be kept.

Giant Coronary Aneurysm Causing Ostial Occlusion of Coronary Artery by Mass Effect: A Case Report.

Coronary atherosclerosis can rarely lead to complications like giant coronary aneurysm (GCA), and acute myocardial infarction (AMI) due to thrombosis in the GCA is even rarer. Multimodality imaging is preferred over relying solely on selective coronary angiogram in such cases due to the limitations of invasive coronary angiogram in visualizing thrombosed aneurysms. We report a rare case of a patient with ST-elevation myocardial infarction caused by ostial occlusion of a right coronary artery (RCA) due to mass effect created by thrombosis in a GCA, thereby highlighting a mechanism of AMI that has not been previously described in GCA. Multimodality imaging led to the correct diagnosis and detection of the underlying mechanism, which had been completely missed by invasive coronary angiography (ICA). We also discuss the utility of multimodality imaging in such cases.

The microbial and host factors that govern Candida gastrointestinal colonization and dissemination.

Candida species are among the most prevalent and abundant members of the gut mycobiota, with Candida albicans (CA) being the most prominent member. CA colonizes numerous mucosal surfaces, most notably the gastrointestinal (GI) and genitourinary tracts. In a healthy host, CA is a pathobiont that exists as a commensal but can become pathogenic if the host's immune system becomes suppressed. The microbial and/or host factors that dictate CA's ability to colonize mucosal surfaces and its ability to disseminate remain of great interest. Here, we review the recent advances and insights regarding Candida colonization and dissemination of the mammalian GI tract.

Childhood Multisystem Inflammatory Syndrome: An Emerging Disease with Prominent Cardiovascular Involvement-A Scoping Review.

Multisystem inflammatory syndrome in children (MIS-C) or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is an emerging disease in children affected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and thought to be an immune-mediated post-infectious complication of SARS-CoV-2. The disease presentation is similar to Kawasaki disease but has certain distinguishing features. The exact pathogenesis is still not clear but an aberrant immune response, antibody-mediated vascular damage and virus-mediated abnormal type I and III interferon-gamma response are thought to be responsible. Most children who are previously healthy present after 2-4 weeks of SARS-CoV-2 infections with febrile illness of short duration with prominent gastrointestinal, cardiac and hematologic manifestations, progressing to vasoplegic shock, requiring vasopressor therapy. Cardiovascular involvement is prominently marked by acute myocardial injury/myocarditis and the development of coronary artery aneurysms. Laboratory markers of inflammation are elevated uniformly. Most children require intensive care, and few need invasive ventilation. The treatment mainly consists of anti-inflammatory and immunomodulatory therapy like intravenous immunoglobulins and steroids. The overall prognosis is good and reported mortality rates are 0-4%.

Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer and cancer related deaths worldwide. Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor thrombus invasion through the major hepatic veins and of vena cava inferior with continuous extension into the right cardiac cavity. Right heart metastasis without invasion of inferior vena cava (IVC), which may be caused by haematogenous spread of cancer cells, is rarely reported. We report a case of HCC with IVC and right atrium (RA) thrombus in a patient who presented to us with decompensated cardiac failure. Strikingly, the patient was young and with negative serum HBsAg, and anti-HCV results. Our case highlights a rare presentation of metastatic intracardiac tumor thrombus involving the RA in advanced HCC without any symptoms of cardiac failure, and henceforth, the role of screening echocardiography for all patients with advanced HCC especially with vena caval involvement to rule out intracardiac thrombus.

Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients: Ibutilide with magnesium for chemical cardioversion of atrial fibrillation or flutter.

BACKGROUND: Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm is lacking. AIM: We aimed to study the efficacy of adjunctive supplementation of intravenous magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm and to define a definite level of serum magnesium which leads to significant increase in rates of such conversion. METHODS AND RESULTS: This was a prospective study including 33 Rheumatic heart disease patients (13 males and 20 females) with mean age of 49.27 ± 11.4 years and persistent AF or AFl. All patients received intravenous magnesium to raise serum magnesium level in range of 4 mg/dl to 4.5 mg/dl prior to administration of Ibutilide. 25 out of 33 (76%) patients converted to sinus rhythm. Upon univariate analysis, presence of background beta blocker therapy, serum potassium and magnesium at time of Ibutilide injection were found to have significant relation with conversion to sinus rhythm. Upon multivariate analysis serum magnesium level at the time of Ibutilide injection was found to have significant contribution on post injection rhythm reversal (p-value = 0.006). The level of magnesium at 3.8 mg/dl was found to have maximum sensitivity of 96% and specificity of 62.5% for conversion to sinus rhythm by ibutilide with magnesium (p-value< 0.05). CONCLUSIONS: Ibutilide is highly effective in cardioversion of persistent rheumatic atrial fibrillation/flutter patients. Raising Serum Magnesium levels above 3.8 mg/dl significantly improves efficacy of ibutilide.

Study and overview of the novel corona virus disease (COVID-19).

In December 2019, a new disease with pneumonia-like symptoms was spreading throughout Wuhan in China which was entitled as novel coronavirus disease or COVID -19 caused by the virus SARS CoV-2. Within a span of a few days, this disease became a global threat and was termed as a pandemic by the World Health Organization (WHO) on March 11, 2020, since then the disease has affected more than 1.5 crore people worldwide and around 6.9 lakh people in India as of July 5, 2020. The origin of the COVID-19 disease has been traced back to the bats, but the intermediary contact is unknown. The disease spreads by respiratory droplets and contaminated surfaces. In most cases, the virus shows mild symptoms like fever, fatigue, dyspnea, cough, etc. which may become severe if appropriate precautions are not adhered to. For people with comorbidities (usually elderly) the disease may turn deadly and cause pneumonia, Acute Respiratory Disease Syndrome (ARDS), and multi-organ failure, thereby affecting a person's ability to breathe leading to being put on the ventilator support. The reproduction number (Rℴ) of COVID-19 is much higher than its predecessors and genetically similar diseases like SARS-CoV and MERS-CoV. This paper discusses the epidemiological characteristics of the SARS-CoV-2 virus, its phylogenetic relationship with the previous pandemic causing viruses such as SARS-CoV-1 and MERS-CoV and analyzes the various responses to this global pandemic worldwide, focusing on the actions taken by India and their outcomes.

Development of Viroreaper sanitization chamber for COVID 19.

The whole world at present is dealing with the COVID 19 pandemic. As per studies worldwide SARS-CoV-2 by sequencing analysis is 95% homogenous similar to the bat coronavirus and almost 70% similar to the SARS-CoV-1. SARS CoV 2 is a respiratory problem which in its worst form of disease causes ARDS and hampers the patient's ability to breathe on his own and has to be put on Ventilator. As per WHO (World Health Organization) guidelines, sanitization is an effective way of prevention from the infection. The proper sanitization being not feasible and time consuming in certain cases, faster and effective alternatives of sanitization processes are necessary. As per recently published study by researchers in Beijing, China, it was observed that with each degree rise in temperature and percent humidity, the contagiousness of the disease caused by the Coronavirus, named COVID 19 goes down significantly. R-naught or RO can be referred as the average number of people that gets infected from one sick person among a population which is not immune to the virus. The closer to zero an RO value the better the results indicating less spread of the disease. A lower RO means the outbreak is slowing or declining while a higher one means its swelling or growing at faster rate. The RO of the coronavirus hovers between 2 and 2.5 as per World Health Organization or WHO meaning that each new person spreads the disease to about 2.2 people on an average. The chamber being developed is aimed at lowering the Ro value so that the infection rate slows down. RO is not a fixed value, it changes depending on various factors such as proximity among people, the environmental surroundings and climatic conditions. The higher temperatures (38 °C) at 80-90% relative humidity decreases the virus activity within 24 h. Moreover, in a condition where the virus that was dried was stored at higher temperature (>38 °C) and high relative humidity (>95%), there was observed an additional degradation in virus activity at each point in time. Taking into consideration the above research, we developed a COVID De-Incubator chamber to disinfect the clothes and commonly used daily wear items. Our results were exciting as the disinfection proved to be effective at temperatures of 75 °C-80 °C and humidity levels at 80%-90%. Moreover, the chamber was developed at significantly lower costs. In this study, an attempt has been made to fabricate a chamber with temperature and humidity-controlled environment to disinfect daily used material. Using fins and momentum source, a homogenous environment is created inside the chamber for better results, with the help of numerical simulation to decide the optimum angle for the inclination of fins and location of the momentum source.

Applications of paper as a support material in biomedical sciences: A decadal review.

In human history, the paper has long been used as a platform to record and preserve information. However, over the decades, paper has found its application in Biomedical Sciences, too. Both paper-based microfluidic devices (µPADs) and paper-based cultures and scaffolds have shown immense potential to be used as a sensor as well as a supporting material for in vitro tissue engineering. µPADs can be used to perform low-cost and fast biomolecular assays at Point-Of-Care (POC). They are being used to detect various biomarkers like viral proteins, metabolites, oncogenes, and antigens; and conditions like Venous Thromboembolism (VTE). On the other hand, the paper has also been used to develop paper-based 3D cultures and scaffolds to test drugs, and monitor cytotoxic effects in vitro cell microenvironments and also as implantable tissues. In this review, we intend to enumerate the development in the field of µPADs, paper-based cell cultures, and paper-based scaffolds and their plethora of applications over the last decade.