RESUMO
The frequency of advanced cardiopulmonary imaging has increased the incidence of diagnosis of coronary artery anomalies, but this poses an interesting management dilemma of what to do with them once these anomalies are found. We present the case of a 57-year-old female with a past medical history of postpartum cardiomyopathy, recovered heart failure with reduced ejection fraction (EF), and alcohol use disorder who presented with chest pain, shortness of breath, nausea, vomiting, and palpitations. A CT angiogram was performed to rule out pulmonary embolism. No pulmonary embolism was found; however, the CT scan revealed an anomalous right coronary artery originating from the left coronary cusp, which had a malignant interarterial course (ARCA-LCC-IA) with a right dominant pattern of myocardial circulation. Subsequent nuclear stress testing did not show evidence of ischemia. Echocardiogram revealed a recurrently reduced EF of 40%. Our patient poses a management dilemma since she presented with possible angina and was found to have an anomalous right coronary artery (ARCA) with a malignant course, but subsequently she had a negative exercise stress test with nuclear perfusion imaging. We will review the literature on ARCA-LCC-IA and its clinical manifestations both generally and with its connection to this case as well as its management. We discuss the incidence, diagnosis, and management of ARCA-LCC-IA, with a focus on incidentally found lesions.
RESUMO
BACKGROUND: Globally, approximately, one billion people lack access to safe drinking water and 1.59 million deaths per year are because of contaminated water, primarily in children age <5 years. WHO reported that more than 90% of diarrhea cases can be prevented by enhancing the availability of clean water and improving hygiene measures. METHODOLOGY: The study was conducted in an urban slum of Rohtak district. Investigator interviewed the mothers at their home having children age less than 5 years using study tools in their vernacular language. STUDY DESIGN: The study was a community based epidemiological study with cross-sectional design. STUDY PARTICIPANTS: 400 mothers having children less than 5 years. RESULTS: Most of subjects (59%) were in the age group of 15-25 years followed by in 25-35 years. One third of subjects belonged to upper caste and 29% of subjects from backward class. The study found that 80% of mother store water in earthen pitcher followed by plastic jug (14%). 78% of mothers said that their source of drinking water was tap while 12% had Hand pump. 83.5% of subjects said that they drink water as such ie without filtering, boiling or chlorination. CONCLUSION AND RECOMMENDATIONS: The study concluded that the prevalence of diarrhea is more among children < 5 years this is because of poor knowledge, poor attitude and inadequate storage water practices of water. The study recommends creating awareness how to diminish contamination of water at household level, creating community groups for women to learn about treatment of water at household level.
