Role of Mycobacterium w for the Treatment of COVID-19: An Observational Study.

BACKGROUND: COVID-19 has taken a big toll on the world in terms of morbidity and mortality. The disease may progress in some of the patients leading to trigger of "cytokine storm" which is shown to be associated with adverse outcomes. Heat killed Mycobacterium w (Mw) is a known immunomodulator which is approved for the treatment of gram negative sepsis. This study was carried out to evaluate the role of Mw in the treatment of COVID-19 early in the course of the disease. METHOD: In this retrospective observational study, 117 (84 males, 33 females) COVID-19 patients admitted between July 3, 2020 and Aug 26, 2020 in the covid ward of Fortis Hiranandani hospital, Mumbai, were enrolled. Patients were tested COVID-19 positive on RTPCR and were treated with standard of care treatment along with Mw 0.3 ml intradermal injection per day for 3 consecutive days. Patients were evaluated for live discharge as well as changes in the levels of inflammatory markers. RESULTS: Use of Mw was seen to be associated with rapid recovery in 116/117 patients from COVID-19 who were discharged from the hospital within 10 days. A decrease in the levels of CRP and IL6 was observed after the administration of Mw. This decrease was associated with improvement in the patients' condition. The use of Mw was seen to be associated with no systemic side effects. CONCLUSION: The patients of COVID-19 may deteriorate due to exaggerated production of cytokines which may result in adverse outcomes. Mw used earlier in the disease not only effectively prevents excessive cytokine production but also contribute to rapid recovery. Mw was also found to be safe in use. Larger randomized controlled trials are recommended to assess the role of Mw in COVID-19.

Morphological analysis of peripheral arterial signals in Takayasu's arteritis.

Takayasu's arteritis disease (TA) remains a rarely studied chronic inflammatory disease. Our objective is to analyze peripheral pulse using photoplethysmography (PPG) as a new assessment method for diagnosing TA. So far no literature reports detailed morphological analysis of TA PPG signals. PPG signals of twenty normal and twenty TA patients at five different regions such as left and right thumbs, left and right toes and neck have been acquired simultaneously. Morphological parameters of peripheral signals such as peak-to-peak time, the crest time (CT), reflection index (RI), maximum systolic slope (MSS), maximum diastolic slope, pulse height, area under pulse and pulse transit time are obtained from PPG and electro cardiogram of normal and TA patients. Surprisingly RI is different in all the five locations of TA patients, whereas it is same for normal in all five locations. Mean MSS are significantly lesser than normal subjects. Mean CT of normal subjects is always lesser than normal subject. Morphological parameters based classification method has sensitivity of 80-100 and specificity of 86-100 in all limbs/all parameters. Bilateral dissimilarity in morphological parameters of multi site peripheral signals in the TA patients can be used to diagnose TA patients and find the pathological site. Less population is studied which reflects the rarity of the TA disease.

Recent trends in reperfusion in ST elevation myocardial infarction in a South Indian tier-3 city.

AIMS: In India, larger proportions of patients with ACS present with STEMI. We sought to study the recent trends of reperfusion in patients of acute STEMI. METHODS AND RESULTS: 1905 patients presenting with acute STEMI enrolled. 1636 (86%) received some form of reperfusion therapy. Streptokinase, 1235 (65%) patients, was the most common mode of reperfusion therapy used followed by primary PCI (205, 10.7%) and tenecteplase (196, 10%). 269 (14%) did not receive any form of reperfusion therapy, the most common reason being late presentation in 230 (85.7%). Patients presenting with STEMI increased from 297 to 446 comparing first and last half-year of study period. The PCI and tenecteplase numbers increased from 19 to 68 and 27 to 97 respectively. CONCLUSION: There was 20% increase in STEMI every year. Younger patients are least likely to receive primary PCI or tenecteplase. 1 in 8 patients of STEMI did not receive any form of reperfusion therapy.

Large Isolated Major Aortopulmonary Collateral Artery Causing Severe Pulmonary Hypertension in an Infant: A Rare and Challenging Diagnosis.

Major Aortopulmonary Collateral Artery (MAPCA) as an isolated congenital anomaly, without evidence of any structural heart disease, is a very rare observation. Previously published reports indicate that symptomatic infants with large isolated MAPCA usually present with congestive heart failure or recurrent respiratory tract infections. To the best of our knowledge, the present case of an infant with large isolated MAPCA is a unique case with a diagnostic dilemma due to presentation with severe pulmonary hypertension as a predominant sign. The infant was managed successfully by percutaneous obliteration with amplatzer vascular plugs, along with perioperative and postoperative sildenafil.

Catheter-Assisted Balloon-Supported Retrieval of a Broken Semi-Compliant Balloon from a Coronary Artery.

Incidents of broken balloon in a coronary vasculature during percutaneous coronary angioplasty are very rare. Such events in cath-lab may create panic and can be life threatening for patients. Hence, immediate retrieval of broken balloon becomes vital. Here, we report an unusual complication of broken balloon in the mid portion of the left anterior descending coronary artery, which had a calcified and totally occluded in-stent restenotic lesion. The broken balloon was retrieved successfully with no eventual complication using a simple catheter-assisted balloon-supported retrieval technique. The present case highlights the need for interventional cardiologist to be acquainted with different retrieval techniques.

Transseptal guidewire stabilization for device closure of a large pulmonary arteriovenous malformation.

A 46-year-old man presenting with massive hemoptysis was found to have a large pulmonary arteriovenous malformation (PAVM) in the right lung. Closure of the PAVM with an Amplatzer-type duct occluder was hampered by inability to advance the device delivery sheath into the PAVM due to vessel tortuosity and inadequate guidewire support. Atrial septal puncture was performed and a femorofemoral arteriovenous guidewire loop through the right pulmonary artery, PAVM, and left atrium was created. Traction on both ends of the guidewire loop allowed advancement of the device delivery sheath into the PAVM and successful completion of the procedure. Transseptal guidewire stabilization can be a valuable option during device closure of large PAVMs when advancement, stability, or kinking of the device delivery sheath is an issue.