Left ventricular global longitudinal strain in COVID-19 recovered patients.

OBJECTIVES: Myocardial injury during active coronavirus disease-2019 (COVID-19) infection is well described; however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients and its correlation with various parameters. METHODS: A total of 134 subjects within 30-45 days post recovery from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. RESULTS: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID-19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID-19 illness. Asymptomatic COVID-19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients, respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease, respectively. LVGLS was significantly lower in patients recovered from severe illness(mild: -21 ± 3.4%; moderate: -18.1 ± 6.9%; severe: -15.5 ± 3.1%; p < 0.0001). Subjects with reduced LVGLS had significantly higher interleukin-6 (p < 0.0001), C-reactive protein (p = 0.001), lactate dehydrogenase (p = 0.009), serum ferritin (p = 0.03), and troponin (p = 0.01) levels during index admission. CONCLUSIONS: Subclinical LV dysfunction was seen in nearly a third of recovered COVID-19 patients while 10.5% had RV dysfunction. Our study suggests a need for closer follow-up among COVID-19 recovered subjects to elucidate long-term cardiovascular outcomes.

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India.

BACKGROUND: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. OBJECTIVE: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. METHODS: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. RESULTS: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. CONCLUSION: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Sun exposure and Vitamin D in rural India: A cross-sectional study.

BACKGROUND: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. OBJECTIVES: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. METHODS: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. RESULTS: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. CONCLUSION: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.

Diagnostic value of 3D contrast-enhanced magnetic resonance angiography in Takayasu's arteritis--a comparative study with digital subtraction angiography.

OBJECTIVE: To assess the diagnostic value of 3D CEMRA in TA compared with DSA. METHODS: Twenty-two patients with clinically suspected TA based on 1990 ACR criteria for the classification of TA, were included in this study. There were 16 female and 6 male patients with ages ranging from 11 to 50 years (mean age 25 years). CEMRA and DSA were performed in all patients within 4 weeks of each other, for detection of stenosis, occlusion and aneurysm in the arch vessels, renal arteries and aortic segments. RESULTS: (1) TA was confirmed by CEMRA in all patients. (2) 147 arteries did not reveal any steno-occlusive lesion on CEMRA compared with 158 on DSA. (3) 75 stenoses, (excluding occlusions) were detected on CEMRA compared with DSA, which revealed 65 stenotic lesions, with sensitivity, specificity, PPV, NPV and DA for detection of a significant (>50%) stenotic lesion being 98.33%, 97.25%, 92.18%, 99.43% and 97.52% respectively. (4) Aneurysmal dilatation was detected in 13 arteries on CEMRA compared with 16 on DSA. CONCLUSIONS: Diagnostic value of CEMRA is comparable to that of DSA with a very strong and statistically significant correlation between DSA and CEMRA in detection and grading of characteristic steno-occlusive lesions of TA.

Mechanical suction through wide bore catheters for nonsurgical management of Gharbi type III hepatic hydatid cysts.

AIM: To present our experience with management of complex hepatic hydatid cysts (Gharbi type III), using percutaneous large bore catheter drainage followed by active mechanical suction of cyst contents. METHODS: Eleven patients (6 males and 5 females with a mean age of 43.2 years), with 13 complex Gharbi type III hepatic hydatid cysts were included in the study. Under sonography guidance the complex heterogeneous hepatic hydatid cysts were treated percutaneously using large bore drainage catheter and active mechanical suction. RESULTS: Successful drainage of all 13 complex Gharbi type III hepatic hydatid cysts was achieved in all patients (n = 11). The mean duration of catheter placement was 11.3 days (range 7 to 40 days). The most common problem encountered was biliary fistula (n = 3), which was effectively managed with prolonged catheter drainage and/or endoscopic intervention. No serious complications or deaths were encountered. Minor complications were seen in 7 patients including, urticaria in 3, fever in 2 and reactive pleural effusion in 3. All patients responded to symptomatic treatment. Follow up serial ultrasound was performed on all patients, that showed near complete healing in 9 and formation ofpseudotumour in 4 patients. There was no recurrence with a mean follow up of 15.23 months (6 months - 2 years). CONCLUSION: Percutaneous suction and large bore catheter drainage of Gharbi type III hepatic hydatid cysts is a safe and effective alternative therapy.

Vitamin D Insufficiency Risk Score for Screening for Vitamin D Insufficiency.

BACKGROUND AND AIMS: Vitamin D Deficiency/Insufficiency (VDD/VDI) is now recognized as a pandemic. Vitamin D is a versatile yet crucial factor which is vital for many metabolic functions in our body. Till now there is no screening tool for VDD/VDI. The aim of this study is to develop and validate a screening tool Vitamin D Insufficiency Risk Score (VDIRS). METHODS: This study was a rural community based cross-sectional study. It was done during May 2016 to April 2017 among 197 adults residing in rural West Bengal. After a thorough literature review and discussion with the field experts, four characteristics (BMI, Physical activity, Daily Sun exposure, Diet) were considered for VDIRS. Data was collected after taking informed consent. After interviewing every individual was examined for height, weight and blood was collected for vitamin 25-(OH) D. Weights were given to VDIRS characteristic according to Adjusted Odds' Ratio. Receiver Operating Characteristics (ROC) curves were utilized to validate and find out optimum cut off for VDIRS using Youden's index for VDD/VDI with the use of R software. RESULTS: Only 133 (67.5%) had Vitamin D insufficiency. On ROC curves for VDIRS for VDI and VDD, AUC was 0.83 and 0.77 which signifies VDIRS as a good screening and predictive tool. A score of VDIRS ≥14 had sensitivity of 78.2% and specificity of 75.0% for VDI. CONCLUSION: Use of the VDIRS can make mass screening for undiagnosed VDI/VDD in India more cost effective. Researchers strongly believe and perceive a necessity of such validated score in the present scenario.

A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study.

CONTEXT: Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. AIMS, SETTING, MATERIALS AND METHODS: A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. RESULTS: Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. CONCLUSION: There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.

A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study

Context: Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. Aims, Setting, Materials and Methods: A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. Results: Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. Conclusion: There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.

Perception of Prevention of Japanese Encephalitis with Emphasis on Its Vaccination Programme: A Community Based Study in a Slum of Kolkata

Japanese Encephalitis (JE) is a mosquito borne disease with epidemic potential. There is no specific treatment available till date and apart from vector control, vaccination of individuals is considered as a safe and effective measure for prevention. Vaccination campaign among 1-15 years is being carried out with full vigour from 2015 onwards in West Bengal. This study was conducted to assess the knowledge of the care givers of 1-15 years old children about JE and its prevention and to find out the factors associated with vaccination status of the children. A cross sectional, community based study was conducted from May-June 2016 in a slum of Chetla, Kolkata, which is within the service area of Urban Health Unit and Training Centre (UHU&TC), Chetla of All India Institute of Hygiene and Public Health, Kolkata, where the campaign prior to the study was completed in March 2016. Care givers of 90 children of aged 1-15 years were interviewed with a pre-designed, pre-tested, structured schedule. Mean age of the surveyed children was 6.34 years (SD 3.76) and 88% of them were vaccinated during the campaign. 56.7% of the caregivers had poor knowledge about JE and 84.95% were sensitized about the campaign by relatives/friends followed by health workers (33.7%). Low socio-economic status and good knowledge of JE had significant association with vaccination of the child after adjusting with other factors (age and sex of the child, education and occupation of parents, type of family). Enhancement of knowledge and awareness about JE with appropriate health education programmes and special emphasis on sensitization campaigns for JE vaccination at both mass and individual level would prevent emergence of JE epidemics in future.​

Anomalously placed suprahepatic gall-bladder: A case detected on F-18 FDG PET/CT.

The purpose of this study was to appraise the imageologists of a possible mislocalization of tracer accumulation to anomalously placed gallbladder during positron emission tomography-computed tomography (PET/CT) examination. PET/CT is increasingly playing an important role in staging and restaging of the disease process in cancer patients. With the advent of fusion imaging, the tracer accumulation can be correctly localized to a structure or lesion on CT. We did a staging PET/CT scan of a patient with hepatocellular carcinoma for liver transplant evaluation. Fluorine-18 fluorodeoxyglucose (F-18 FDG) was used as a tracer and the scan was performed on SEIMENS Biograph-mCT PET/CT machine. We noted the tracer accumulation at the superior surface of liver, which was localized to the anomalously placed gallbladder in suprahepatic subdiaphragmatic location. The anomalously placed gallbladder can create localization confusion. Keeping the possibility of ectopically placed gallbladder in mind, the imageologist can better localize the tracer uptake.

Mechanical suction through wide bore catheters for nonsurgical management of Gharbi type III hepatic hydatid cysts.

Aim: To present our experience with management of complex hepatic hydatid cysts (Gharbi type III), using percutaneous large bore catheter drainage followed by active mechanical suction of cyst contents. Methods: Eleven patients (6 males and 5 females with a mean age of 43.2 years), with 13 complex Gharbi type III hepatic hydatid cysts were included in the study. Under sonography guidance the complex heterogeneous hepatic hydatid cysts were treated percutaneously using large bore drainage catheter and active mechanical suction. Results: Successful drainage of all 13 complex Gharbi type III hepatic hydatid cysts was achieved in all patients (n = 11). The mean duration of catheter placement was 11.3 days (range 7 to 40 days). The most common problem encountered was biliary fistula (n = 3), which was effectively managed with prolonged catheter drainage and/ or endoscopic intervention. No serious complications or deaths were encountered. Minor complications were seen in 7 patients including, urticaria in 3, fever in 2 and reactive pleural effusion in 3. All patients responded to symptomatic treatment. Follow up serial ultrasound was performed on all patients, that showed near complete healing in 9 and formation of pseudotumour in 4 patients. There was no recurrence with a mean follow up of 15.23 months (6 months – 2 years). Conclusion: Percutaneous suction and large bore catheter drainage of Gharbi type III hepatic hydatid cysts is a safe and effective alternative therapy.