Electrochemical Synthesis of 2-Aryl-3-(2-aminoaryl)quinoxalines via Oxidative Dearomatization/Ring-Opening/Cyclization Cascade Sequence of 2-Arylindoles with 1,2-Diaminoarenes.

A straightforward method has been developed to synthesize 2-aryl-3-(2-aminoaryl) quinoxalines from 2-arylindoles and 1,2-diaminoarenes under mild electrochemical conditions. The reaction proceeds through in situ generations of 2-arylindole-3-ones under electrochemical oxidative dearomatization of 2-arylindoles, followed by a ring opening-cyclization sequence with 1,2-diaminoarenes. A series of 2-aryl-3-(2-aminoaryl) quinoxalines have been prepared with moderate to good yields (up to 75%).

Electrochemical Oxidative Addition of Nucleophiles on 2-Arylindoles: Synthesis of C2-Heteroquaternary Indolin-3-ones.

An electrochemical method has been developed to synthesize 2,2-disubstituted indolin-3-ones under mild conditions. A series of nucleophiles have been added to the 2-arylindole-3-ones, generated in situ under metal-free electrochemical oxidative dearomatization of 2-arylindoles, to afford 2,2-disubstituted 3-carbonyl indoles with heteroquaternary centers in 57-79% yields.

Clinical features, diagnosis and treatment outcome of fungal endocarditis: A systematic review of reported cases.

The landscape of fungal endocarditis (FE) has constantly been evolving in the last few decades. Despite the advancement in diagnostic methods and the introduction of newer antifungals, mortality remains high in FE. This systematic review aimed to evaluate the epidemiology, clinical features, diagnostic and therapeutic interventions in patients with FE. We also aim to examine the aforementioned factors as a determinant of mortality in FE. A literature search was performed in PubMed, Google Scholar and Scopus, and all patients ≥18 years with proven fungal endocarditis were included. A total of 220 articles (250 patients) were included in the final analysis. Candida was the commonest aetiology (49.6%), followed by Aspergillus (30%) and Scedosporium species (3.2%). The proportion of prosthetic valve endocarditis (PVE) and intravenous drug users was 35.2% and 16%, respectively. The overall mortality rate was 40%. On multivariate analysis, Aspergillus endocarditis (HR 3.7, 95% CI 1.4-9.7; p = .009) and immunocompromised state (HR 2.8, 95% CI 1.24-6.3; p = .013) were independently associated with mortality. Patients treated with surgery along antifungals had better survival (HR 0.20, 95% CI 0.09-0.42; p < .001) compared to those treated with antifungals alone. Recurrence of FE was reported in 10.4% of patients. In conclusion, FE carries significant mortality, particularly in immunodeficient and Aspergillus endocarditis. We advocate the use of surgery combined with antifungals to improve clinical outcomes.

Electrochemical Oxidative Coupling Between Benzylic C(sp3)-H and N-H of Secondary Amines: Rapid Synthesis of α-Amino α-Aryl Esters.

An intermolecular electrochemical coupling between the benzylic C(sp3)-H bond and various secondary amines is reported. The electronic behavior of two electronically rich units viz the α-position of α-aryl acetates and amines was engineered electrochemically, thus facilitating their reactivity for the direct access of α-amino esters. A series of acyclic/cyclic secondary amines and α-aryl acetates were tested to furnish the corresponding α-amino esters with high yields (up to 92%) under mild conditions.

Possible Early Vertical Transmission of COVID-19 from an Infected Pregnant Female to Her Neonate: A Case Report.

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-19) has emerged as a public health emergency in recent times. The reported data on the mode of transmission of coronavirus disease 2019 (COVID-19) are largely through contact, droplet, airborne and fomite transmission methods with vertical transmission being a rare entity. We hereby report a case of a probable vertical transmission of SARS-CoV-19 from an infected pregnant female to her neonate. The transmission has been confirmed by a positive RT-PCR at 16 h of life along with a positive IgG antibody test for SARS-CoV-19 in the baby and after excluding the possible environmental contamination of the sample. The baby was asymptomatic during the course of hospital stay and was discharged from the facility on Day 9 of life.

Diagnostic utility of mitral annular displacement by speckle tracking echocardiography in predicting significant coronary artery disease in suspected chronic stable angina pectoris.

BACKGROUND: More than 50% of patients currently referred for coronary angiography (CAG) with suspected chronic stable angina pectoris (CSAP) shows normal or nonobstructive CAD. Mitral annular displacement (MAD) is a function of global shortening deformation of left ventricle (LV) and mirrors sub-endocardial ischemia in CAD. The aim of this study was to ascertain if MAD can predict the presence of CAD in patient presenting with suspected CSAP. METHODS: This cross-sectional study was conducted on patients with suspected CSAP (n = 140) and preserved LV function without apparent wall motion abnormalities during the study period. We excluded patients with prior heart disease (valvular, ischemic), presenting with acute coronary syndrome, arrhythmia, heart failure, and poor imaging. All the patients were subjected to speckle tracking echocardiography (STE) and CAG. Average MAD and normalized MAD were calculated by automated function imaging (AFI), and receiver operating characteristic (ROC) curve was plotted for presence of significant CAD considering CAG as gold standard. RESULTS: The results showed that both average MAD (4 segment) and normalized MAD were significantly reduced (P = <.001) in patients with significant CAD (n = 81). In ROC analysis, area under curve (AUC) for predicting significant CAD in patients of CSAP was better for normalized MAD (0.88) compared to average MAD (4 segment, 0.85).The optimal cutoff of normalized MAD and average MAD for detection of significant CAD were ≤15.3% (sensitivity 90.1%, specificity 79.7%) and ≤11.19 (sensitivity 84%, specificity 69.5%), respectively. Normalized MAD showed week inverse correlation with SYNTAX score (-0.24, R2  = 0.058) and Hs CRP (-0.23, R2  = 0.057). CONCLUSION: MAD is a simple and rapid noninvasive diagnostic tool which accurately predicted the presence of significant CAD in patients with CSAP.

Management of cardiovascular emergencies during the COVID-19 pandemic.

BACKGROUND: It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic. METHODS: This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown. RESULTS: 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block. CONCLUSION: The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.

Quality of life of cancer patients.

OBJECTIVE: Cancer is a one of the major public health problem both in developed and developing countries around the globe. Quality-of-life (QOL) of a cancer patient before and after the treatment is an important issue especially for the cancer survivors, their families, and the care providers. In cancer prospective, Quality-of-life can been defined as a sense of well-being, it is a multidimensional perspective that includes dimensions such as physical, psychological, social, and spiritual, changes in one QOL dimension can influence perceptions in other dimensions also. Cancer patients should demand information related to adverse effects of chemotherapy and actions to be taken to reduce them, also there should be provision of providing sufficient information prior to beginning of the treatment procedure irrespective to type of treatment, so that patient is aware of all the treatment modalities and their side effects and self-care strategies so as to reduce treatment-related concerns.

Prevalence of dental caries in overweight school going children of 12-15 years in and around Jaipur city, Rajasthan, India

INTRODUCTION: Dental caries and obesity are both multifactorial disease with a complex etiology and both are associated with dietary habits. Prevalence of dental caries and an association between body mass index (BMI) and dental caries among school children METHODS: The present was done on 1500 school going children to assess the prevalence of dental caries in 12-15 year old overweight children. Weight and height were measured in light clothing and without shoes using an electronic weighing scale. Subjects' heights were measured using a stadiometre. Subjects were examined on an upright chair in adequate natural daylight and dental caries was measured by using DMF index. Chi-square test was used to analyze and compare qualitative data whereas unpaired 't' test was used to analyze and compare quantative data RESULTS: Amongst 1500 children, 156 were found to be overweight, 443 were normal weight. When mean BMI between overweight and normal weight were compared a highly significant difference was observed. When DMFT of overweight and normal weight were compared no significant difference was observed CONCLUSION: Dental caries was observed more in females as compared to males and no significant difference was observed between dental caries and weight gain

Fixed dose combination of aspirin and pantoprazole: Results of a multicenter, comparative, randomized, double-blind, double dummy, phase III study in Indian patients.

OBJECTIVE: To compare the efficacy and safety of a fixed-dose combination of aspirin and pantoprazole with that of aspirin alone for the prevention of gastro duodenal mucosal damage in patients taking aspirin for secondary prevention of cardiovascular disease or cerebrovascular disease. METHODS: This was a comparative, double-blind, double-dummy, randomized, multicenter, phase III study conducted in patients taking aspirin ≤150 mg daily for ≥3 to ≤6 months and expected to require daily aspirin therapy for at least 6 months for the secondary prevention of cardiovascular disease or cerebrovascular disease. RESULTS: A total of 240 patients were randomized to receive either a fixed-dose combination of aspirin 150 mg and pantoprazole 20 mg or aspirin 150 mg alone in a 2:1 ratio. The proportion of non-responders (patients experiencing gastroduodenal events) was 9.7 % in the test group (fixed-dose combination of aspirin 150 mg and pantoprazole 20 mg) compared to 19.7 % in the comparator group (aspirin 150 mg) at week 12, while the proportions were 11.0 % in the test group and 22.4 % in the comparator group at the end of 24 weeks of treatment (p-value was <0.05 at week 12 and 24). GI injuries were significantly less in test group as compared to comparator group. Both drugs were well tolerated by all patients. CONCLUSION: The fixed-dose combination of aspirin 150 mg and pantoprazole 20 mg was found to be more efficacious and safer compared to aspirin 150 mg alone for the prevention of gastroduodenal mucosal damage in patients receiving aspirin.

Short-Term Outcomes of Patients With Hyponatremia Presenting to the Emergency Department: An Observational Study.

BACKGROUND: Hyponatremia is the predominant electrolyte imbalance disorder in the emergency department. It can manifest with a diverse array of symptoms, ranging from non-specific and moderate to severe and even life-threatening. There is a scarcity of literature addressing the clinical characteristics and prognosis of patients with hyponatremia presenting to the emergency department in the western part of Rajasthan. The objective of this study was to investigate the impact of hyponatremia on the outcomes of patients presenting to the emergency department. METHODS: In this prospective, cross-sectional, observational study, 200 patients aged more than 18 years who presented to the emergency department with serum sodium < 135 mEq/l were included. The triage of patients was determined by their primary complaints. The primary outcome was to study the clinical profile of patients with hyponatremia presenting to the emergency department. The secondary outcomes were to examine the etiology, i.e., hypovolemic, euvolemic, or hypervolemic, and the outcome of patients on the 7th day (patient admitted to the ward or intensive care unit) and the 28th day (discharged or death) with hyponatremia presenting to the emergency department. The clinical status of the patients was noted by telephonic follow-up in case they were not admitted for this period. RESULTS: Out of 200 patients, 66 (33%) had hypovolemic, 96 (48%) had euvolemic, and 38 (19%) had hypervolemic hyponatremia. We observed that seizures (84.2%), confusion (56%), and coma (77.7%) were the most common clinical features of patients with severe hyponatremia in the emergency, which was statistically significant than mild and moderate hyponatremia (p = 0.03, 0.023, and 0.029, respectively). On the 7th day of hospitalization, out of 181 (90.5%) admissions in the ward, 116 (64.08%) had severe hyponatremia, and out of 19 (9.5%) ICU admissions, 13 (68.4%) had severe hyponatremia. Death was seen in five (2.5%) patients, one (20%) in moderate and four (80%) in severe hyponatremia cases. CONCLUSION: Most cases of hyponatremia in this study were euvolemic. Most patients experienced severe hyponatremia, and seizures, confusion, and coma were the most prevalent symptoms. These disorders must be recognized early to properly diagnose and treat hyponatremia and prevent its morbidity and death.

The diagnostic accuracy of two-dimensional strain imaging echocardiography to detect the severity of coronary artery disease in non-ST segment elevation acute coronary syndrome.

OBJECTIVE: Strain imaging by two-dimensional speckle tracking echocardiography can detect severe coronary artery disease (CAD). This study aims to assess the diagnostic accuracy of various strain parameters in patients with non-ST segment acute coronary syndrome to detect the angiographic severity of CAD and also to compare among them. METHODS: This hospital-based observational study was conducted on 178 patients with NSTEACS and preserved left ventricular ejection fraction who presented in emergency or outdoor from July 2021 to December 2022. We excluded patients with prior coronary revascularization, heart failure, arrhythmia, more than trivial valvular heart disease, or poor acoustic window. Global longitudinal strain (GLS), peak systolic strain (SS), post systolic index (PSI), and systolic strain rate (SR) were calculated by speckle tracking with automated function imaging. Coronary angiography was done in all patients, and the syntax score was calculated. RESULTS: The strain parameters showed a significant correlation with the syntax score. There was a statistically significant difference in strain parameters between patients with left main (LM) or triple vessel disease (TVD) and others. Receiver operating characteristic (ROC) curve analysis showed that GLS had a better diagnostic accuracy for detecting LM or TVD than other strain parameters. GLS with a cut-off value of -11.2% had a sensitivity of 85.7% and specificity of 53.5% for detecting LM or TVD. CONCLUSION: Strain imaging can be a helpful bedside adjunct to conventional investigations for detecting severe CAD in patients with NSTEACS.

Origin of all Three Coronaries from Single Ostium: A Rare Case Report.

Origin of coronary arteries from the opposite sinus of Valsalva is rare and origin from a single ostium is extremely rare. Patients with these anomalies may have myocardial ischemia because of altered ostial configuration, exit angulation from the aorta, the course between great arteries, and atherosclerosis. Usually, these anomalies are diagnosed during coronary angiography either by computed tomography or catheter-based. Management depends upon the coronary anomaly and associated clinical condition.

FDG PET/CT in Dressler Syndrome.

ABSTRACT: Nuclear imaging has paramount role in the evaluation of 4I (infective, inflammatory, innervation, infiltrative) cardiac diseases. We present a case of persistent pyrexia post-percutaneous transluminal coronary angioplasty with a history of inferior wall myocardial infarction 2 months back. Repeat coronary angiogram revealed that Right Coronary Artery (RCA) thrombus and IV antibiotics were started in suspicion of coronary stent infection. 18 F-FDG PET/CT revealed no hypermetabolism along RCA stent, with uptake along pericardium and inferior wall. 99m Tc-MIBI myocardial perfusion study showed perfusion defect in RCA territory corresponding to hibernating viable myocardium. Eventually patient was diagnosed with Dressler syndrome. Thus, molecular imaging helped in narrowing differentials in post cardiac intervention pyrexia and precise diagnosis.

Noninvasive assessment of pulmonary congestion in heart failure: Need of the hour.

Early pulmonary congestion detection and surveillance in acute heart failure patients can prevent decompensation, minimize hospitalizations, and improve prognosis. In India, the warm and wet types of HF are still the most common types and residual congestion at discharge is still a significant concern. Thus, there is an urgent need for a reliable and sensitive means of identifying residual and subclinical congestion. Two such monitoring systems are available and approved by US FDA. These include CardioMEMS HF System (Abbott, Sylmar, California) and ReDS System (Sensible Medical Innovations, Ltd., Nanya, Israel). CardioMEMS is a wireless pressure-sensitive implantable device, while ReDS is a wearable noninvasive device for measurement of the lung fluid and hence direct detection of PC. This review discusses the role of noninvasive assessment in PC monitoring in patients with heart failure and its implications from an Indian perspective.

Association of Novel Hematological Indices with Severity of Coronary Artery Disease using SYNTAX Score in Patients with Acute Coronary Syndrome.

INTRODUCTION: Recent evidence suggests that systemic inflammation not only plays an important role in the pathogenesis of Acute Coronary Syndrome but also correlates with disease severity. Monocyte-to-high-density lipoprotein cholesterol ratio (MHR), Neutrophil-Lymphocyte Ratio (NLR), and Monocyte-Lymphocyte Ratio (MLR) are novel systemic inflammation markers used for predicting the burden of coronary artery disease (CAD) based on SYNTAX Score. This single-center, cross-sectional, observational study compared the association of these novel hematological indices with CAD severity using the SYNTAX Score in ACS patients and aimed to determine the best predictor of the severity of CAD. METHODS: A total of 403 consecutive patients with ACS who underwent coronary angiography were enrolled. On the basis of the SYNTAX Score, patients were divided into three groups: Low: <22, Moderate 22 - 32 and High ≥ 32. MHR, MLR, and NLR were calculated and correlated with SYNTAX Score. RESULTS: All three indices: MHR (r=0.511; p <0.001), MLR (r=0.373; p <0.001), and NLR (r=0.292; p =0.001) showed significant correlation with SYNTAX Score. The MHR ROC was significantly higher than that of MLR (difference between area: 0.158; 95% CI: 0.079-0.259) and NLR (difference between area: 0.279; 95% CI: 0.172-0.419) for the SYNTAX Score. Analysis showed a strong correlation between these indices with SYNTAX Score >22 compared to low scores <22 and that these also related to the LAD as an infarct artery. Multiple regression analysis showed that diabetes mellitus, eGFR, Infarct-related artery left anterior descending (IRALAD), MHR, MLR, and NLR were predictors of the severity of CAD in ACS patients based on SYNTAX Score. CONCLUSION: In ACS patients MHR, MLR, and NLR showed significant correlation with SYNTAX score >22 which may be indicative of severity of disease. MHR is a better predictor of the severity of CAD than MLR and NLR in ACS patients.