Clinico-Radiological Profile and Outcome of Novel H1N1-Infected Patients During 2009 to 2014 Pandemic at Tertiary Referral Hospital in Rajasthan.

BACKGROUND: The 21st century Influenza A (H1N1) pandemic arrived during spring of 2009 and has posed a serious public health challenge world-wide. We describe the clinic-radiological profile and outcome of patients who were found H1N1 positive in Jawahar Lal Nehru Hospital, Ajmer of Rajasthan from 5th August 2009 to 31st May 2014. AIMS AND OBJECTIVES: Primary objective was to study clinical and radiological profile of the patients admitted with confirmed H1N1 infection. Secondary objective was to observe the risk factors and associated comorbid conditions with complications and need of mechanical ventilation and / or death among H1N1-infected patients MATERIALS AND METHODS: Hospitalized patient with laboratory-confirmed H1N1 flu by reverse transcriptase PCR during August 2009 to May 2014 in JLN Hospital, Ajmer, were included in this retrospective study. Data was collected from hospital isolation ward admission register. Statistical analysis was done by SPSS, version 16. Binary logistic regression was used to find out independent risk factors for morbidity. RESULTS: A total of 94 PCR-confirmed H1N1-infected patients were included in the study, of them 32 (34%) males and 62 (66%) females. Median age was 35 years and median duration of symptoms before hospitalization was 5 days. Common presenting symptoms include fever 83 (88%), cough 79 (84%), breathlessness 67 (71%), rhinnorrhoea/ common cold 25 (26.5%), throat pain 13 (13.8%), chest pain 5 (5.3%) and haemoptysis 4 (4.2%). Bilateral crepitations were audible in 86 (91.4%) and tachypnoea in 73 (78%) cases. Co-morbidities were seen in 75 (79.7%) patients. Ventilatory support was required in 57 (60.6%) patients. On presentation, chest x-ray showed pulmonary opacities in 72 (76.5%) patients. We observed no significant side effects of oseltamivir 150 mg twice day dose for 5-7 days. Forty-one (43.6%) patients were cured and discharged from hospital, 53 (56.3%) patients died. Development of ARDS, involvement of bilateral lower zones of lungs in chest skiagram, requirement of mechanical ventilator and associated pregnancy (third trimester) were independent predictors of mortality. CONCLUSION: During evaluation period from 2009 to 2014, H1N1 influenza caused severe illness requiring hospitalization, including pneumonia, acute respiratory distress and complications involving renal, liver and cardiac dysfunction. Maximum patients were between age group of 20-40 year. Fever and cough were most common presenting symptoms. Common comorbidities were pregnancy, diabetes, hypertension, and obesity. Mortality rate was high in H1N1-infected patients with development of ARDS, associated pregnancy and patients who required ventilatory support.

Echocardiographic assessment of left atrial volume index in elderly patients with anterior wall myocardial infarction.

Enlarged left atrium (LA) predicts outcomes in patients with heart failure, atrial fibrillation and stroke. Left atrial volume (LAV) especially when corrected for body size (LAVi), is a more accurate representation of true LA size. Therefore we studied left atrial volume index (LAVi) in elderly patients with left ventricle anterior infarction and correlated LAVi with left ventricle ejection fraction (LVEF) and transmitral Doppler flow. We found LAVi was significantly raised in elderly patients who suffered from AMI (26.7 + 2.1 vs 10.8 + 2.9) (p < 0.005). There was significant negative correlation of LAVi with LVEF, E wave peak velocity and decceleration time.

Tetralogy of Fallot with quadricuspid aortic valve.

We describe herein a 54 year female who had tetralogy of Fallot with quadricuspid aortic valve. This combination is very uncommon. Hence it was worth reporting this interesting case.

Surveillance of Antimicrobial Susceptibility Pattern of Chronic Suppurative Otitis Media in Tertiary Care Hospital of Southern Rajasthan.

The main aim of this work is to identify aerobic bacteriology and antibiotic sensitivity pattern of chronic suppurative otitis media in tertiary care hospital of southern Rajasthan. Two hundred and fifty clinically diagnosed cases of chronic suppurative otitis media of all age groups and both the sexes with the ear discharged of more than 6 weeks duration formed the subject of the study group. The specific identification of bacterial pathogens is done based on microscopic morphology, staining characteristics, cultural and biochemical properties using standard laboratory procedures. Antimicrobial susceptibility of the bacterial isolates to the commonly used antibiotics according to CLSI guideline is done by Kirby-Bauer disc diffusion method. Out of 250 cases, 226 (90.4%) were found to be smear positive and culture positive, 17 (6.8%) were found smear positive and culture negative, 7 (2.8%) were smear negative and culture negative. Pseudomonas spp was found the most common organism isolated was. Out of 244 isolates, 174 (71.3%) were found to be sensitive to Amikacin. In our study, Pseudomonas spp. 98% isolates were found to be most sensitive to Meropenem and 84.2% isolates were found to be most resistance to Ceftazidime. This study is useful to prevents the administration of unwanted antibiotics and in development of empirical policy. This may be helpful to medical practitioner for the prescribing antibiotics in the treatment of CSOM.

Isolated non-compacted right ventricular myocardium.

Ventricular non-compaction or spongy myocardium is a rare type of cardiomyopathy resulting from arrested myocardial development during embryogenesis. This rare entity is characterized by excessive prominent trabeculations and deep inter-trabecular recesses in the ventricular wall. The clinical manifestations include heart failure, arrhythmias and cardioembolic events. The usual site of involvement is the left ventricle. Rarely the right ventricle (RV) is affected. Here we report a case of 40 year old male patient presenting with isolated RV non-compaction.

"Simpson's right ventricle ejection fraction versus tricuspid annular plane systolic excursion in patients with isolated left ventricle anterior myocardial infarction".

BACKGROUND: Unlike left ventricular, right ventricular (RV) function has not been widely studied after anterior myocardial infarction. This is because standard 2 dimensional echocardiographic evaluation of RV volumes and ejection fraction is cumbersome due to difficulty in exact delineation of RV endocardial borders because of prominent trabeculations and crescentric shape of the chamber. METHODS AND RESULTS: 50 patients of isolated LV anterior myocardial infarction subdivided into two subgroups--Group-1 with stenosis of Left anterior descending artery (LAD) and Group-2 with stenosis of both LAD and left circumflex artery were studied. Any associated RV infarction was excluded in all patients by ECG, Echocardiography and Right Coronary Angiography .From apical four chamber view of echocardiography, right ventricular ejection fraction (RVEF) was measured by Simpson's method and the systolic motion of the tricuspid annulus (TAPSEx) was recorded with the use of 2 dimensional guided M-Mode tracings both at lateral and the septal side of annulus. There was no significant difference in RVEF between study patients and control subjects. (p > 0.05). However septal TAPSEx was significantly reduced in patients of anterior myocardial infarction as compared to healthy subjects. Reduction was more marked in subgroup-2 patients having stenosis of both LAD and LCx arteries.(p < 0.005). CONCLUSION: Our study results suggests that TAPSEx is simple, quick and better non geometric echocardiographic parameter than RVEF to assess RV functions in patients of anterior infarction.

Acute Atrial Fibrillation Complicating Organophosphorus Poisoning.

Organophosphorus (OP) pesticide poisoning is a major clinical and public health problem in a developing country like India. Cardiac injury is a strong predictor of death in these patients. Cardiac complications usually described include cardiac arrest, pulmonary edema, and arrhythmia. Rarely, myocardial infarction has also been reported. The possible mechanisms for myocardial injury include sympathetic/parasympathetic overactivity, hypoxemia, acidosis, dyselectrolytemia, and direct cardiotoxicity. We describe herein one case of OP poisoning, recently admitted in our emergency department and which was complicated by acute onset atrial fibrillation which reverted to sinus rhythm following detoxification of OP compound.

Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India.

Candida is a common opportunistic pathogen during the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of candidiasis and the Candida species prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern of Candida species prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited for Candida microbial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient's symptoms. A total of 128 Candida isolates were obtained from 88 cases and 7 different Candida species were identified. C. albicans (50%) was the most common species isolated followed by C. glabrata (17%) and C. dubliniensis (12.5%). Other species isolated were C. parapsilosis (7.8%), C. krusei, C. tropicalis (4.6% each), and C. kefyr (3%). Strong clinical suspicion along with optimal sampling of an accurate diagnosis of Candida species involved would go a long way in decreasing the morbidity associated with non-albicans Candida species.

Superdominant right coronary artery with double posterior descending artery.

Coronary artery anomalies are rare entities. All angiographers and cardiac surgeons need to be familiar with these anatomic variants for proper surgical revasularisation in the presence of coronary artery disease. We report here an interesting case of superdominant right coronary artery with double posterior descending artery.

Acute myocardial infarction complicating snake bite.

A case of acute myocardial infarction following viper snake bite is reported. Possible mechanisms are discussed.

Spotted dermopathy in a diabetic patient due to insulin allergy.

A rare case of diabetic patient who developed multiple cutaneous hyperpigmented spots following bovine isophane (NPH) insulin injection is described here.

Right Ventricle Myocardial Performance Index Versus Simpson's Right Ventricle Ejection Fraction in Patients with Isolated Left Ventricle Anterior Myocardial Infarction.

INTRODUCTION: Right ventricle (RV) dysfunction may be secondary to left ventricle (LV) dysfunction in patients of isolated left ventricle anterior myocardial infarction as a consequence of "Ventricular Interdependence". As RV dysfunction is associated with high in-hospital morbidity and mortality, early recognization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. AIMS AND OBJECTIVES: Our aim in the present study was to compare Simpson's right ventricle ejection fraction (RVEF) with right ventricle myocardial performance index (RV-MPI) to predict RV function in patients with isolated left ventricle anterior myocardial infarction (LV-AMI). MATERIALS AND METHODS: We conducted the present study at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer. The control group comprised of twenty five. Age, sex, BMI, pulse and blood pressure matched healthy subjects without history of heart disease, systemic hypertension, diabetes, any other systemic illness and with normal findings in resting and exercise ECG, Echocardiography and Coronary Angiography. Sub-group-1 consisted of 25 patients with hemodynamically significant stenosis of proximal left anterior descending artery (LAD) with patent first septal perforator (S1). Sub-group-2 was composed of s5 patients with hemodynamically significant stenosis of both LAD and left circumflex artery (LCx.). Both subgroups had fully patent right coronary artery (RCA) from proximal to distal end. RESULTS: RV-MPI value determined using pulsed doppler echocardiography was 0.40 ± 0.19 in healthy subjects. However RV-MPI was increased in both subgroups of LV-AMI with significant increase in subgroup-2 (P < 0.005) as compared to subgroup-1 patients (P < 0.01). Simpson's RVEF was not significantly different between the groups (P > 0.05). CONCLUSION: The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction. Early detection of RV dysfunction is important to reduce morbidity and mortality in these patients.