Clinical characteristic, red blood cell indices, iron profile and prognosis of heart failure in females

Background: Heart failure is a leading killer worldwide, with concurrent anaemia and iron deficiency portending sepulchral prognosis. Anaemia is rampant, with 53% prevalence in Indian females, but iron deficiency can be present even without anaemia. Therefore, this study was planned to determine the clinical profile, red blood cell indices, and effects of iron deficiency, on the course and prognosis of heart failure in Indian females.

Materials and methods: This was a hospital-based observational study, conducted at a tertiary care teaching institute in India. Data from 147 females enrolled in the study between September 2017 to March 2020 was collected out of all patients enrolled in ongoing heart failure registry at the institute. Clinical characteristics at presentation, iron profile, red blood cell indices, treatment and mortality data was collected.

Results: Mean age of the subjects (n = 147) was 53.31 ± 17.1 years with 55% non-rheumatic and 45% with rheumatic heart disease. The patients with rheumatic heart disease were younger, with a higher prevalence of atrial fibrillation. Non-rheumatic patients had a higher prevalence of CV risk factors like diabetes, hypertension, renal failure, more patients in NYHA IV, and 83% patients had LVEF ≤40%. Anaemia was present in 49%, however iron deficiency was present in 89% (absolute iron deficiency in 80% and functional iron deficiency in 9%) with no significant difference between rheumatic and non-rheumatic group. Red blood cell indices showed no significant difference across the spectrum of iron deficiency and anaemia, except lower mean corpuscular volume in patients with both iron deficiency and anaemia. The mean survival time was 840 days, with no significant difference between groups. There was significantly higher mortality in patients with iron deficiency (log rank 0.045).

Conclusion: Iron deficiency–with or without anaemia–is very high in Indian females, worsening survival in heart failure. Proper diagnosis with iron supplementation will improve the prognosis.

Nephroprotective potential of Anogeissus latifolia Roxb. (Dhava) against gentamicin-induced nephrotoxicity in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Stem bark of Anogeissus latifolia Roxb. (Family: Combretaceae) is used traditionally and ethnomedicinally for correction of kidney disorders.

AIM OF THE STUDY

The present study demonstrates the nephroprotective potential of stem bark of A. latifolia Roxb.

MATERIALS AND METHODS

The HPTLC fingerprint and HPLC analysis were carried out to standardize the ethanolic extract of stem bark of A. latifolia (ALEE) using ellagic acid as a marker. Nephrotoxicity was induced in adult Wistar albino rats by gentamicin (100 mg/kg, intraperitoneally for 8 days) and they were treated with ALEE (100, 200 and 400 mg/kg, orally for 8 days), ellagic acid (10 mg/kg, orally for 8 days) and cystone syrup (5 ml/kg, orally), a standard reference a polyherbal formulation. Urine volume, serum and urine levels of creatinine, urea and uric acid, oxidative stress parameters (lipid peroxidation, catalase, superoxide dismutase and reduced glutathione), inflammatory markers (TNF-α and IL-6) and kidney weight along with its histological changes were studied in experimental animals.

RESULTS

HPTLC, HPLC and LC-MS analysis of ALEE revealed the presence of ellagic acid and other various phytoconstituents. Administration of gentamicin caused significant increase in urine output and kidney weight, elevated biochemical, inflammatory and oxidative stress parameters as well as caused histological damage in the kidney tissue. These parameters were attenuated by the concurrent treatment with ALEE and ellagic acid. The effects were comparable to cystone.

CONCLUSION

Present investigations concluded that ALEE exhibited nephroprotective potential and validated the traditional use of stem bark of A. latifolia in kidney disorders. The nephroprotective effect may be attributed to the antioxidant and anti-inflammatory phytoconstituents in ALEE.

Statin reload before off-pump coronary artery bypass graft: Effect on biomarker release kinetics

Objectives

Statins confer protection from ischemia/reperfusion through various pathways including pleiotropic mechanisms. Following chronic administration, activation of intrinsic cellular mechanisms causes attenuation of these pleiotropic effects.

Methods

Since coronary artery bypass surgery (CABG) represents a reversible ischemia-reperfusion sequence, we assessed if statin reload is effective in patients undergoing off-pump CABG (n = 100) in limiting myocardial injury. Patients received loading dose of rosuvastatin (40 mg initiated 7 days before surgery) while nonloaded patients continued whatever statin dose they were receiving and served as controls. Cardiac biomarkers (Troponin-I, creatine kinase muscle/brain [CK-MB], and B-type natriuretic peptide [BNP]) were measured at 8, 24, and 48 h postoperatively. The primary end-point was the extent of perioperative myocardial injury (area under the curve [AUC]: AUC of each biomarker).

Results

Despite similar baseline levels, all biomarkers at 8, 24, and 48 h were significantly lower in the loaded group. The AUC for each biomarker was also significantly lower in the loaded group (cTnI 37.96 vs. 70.12 ng. hr/ml, CK-MB 229.64 vs. 347.04 ng. hr/ml, and BNP 5257.56 vs. 15606.68 pg. hr/ml, all P < 0.001). Delta cTnI (change from baseline to peak level) (1.00 ± 1.34 vs. 2.25 ± 2.59), delta CK-MB (4.54 ± 5.89 vs. 10.68 ± 9.95), and delta BNP (120.41 ± 172.48 vs. 449.23 ± 790.95) all P < 0.001 were also significantly lower in the loaded group. Those loaded with rosuvastatin had lower inotrope duration (22.9 ± 23.33 vs. 31.26 ± 25.39 h, P = 0.04) and ventilator support time (16.94 ± 6.78 vs. 23.8 ± 20.53 h, P = 0.03).

Conclusion

In patients undergoing off-pump CABG, statin reload can "recapture" cardioprotection in patients already on statins with favorable effect on release kinetics of biomarkers and postoperative outcomes.

Use of strain, strain rate, tissue velocity imaging, and endothelial function for early detection of cardiovascular involvement in young diabetics

Background:

Subtle structural and functional changes may precede the onset of overt global left ventricular (LV) dysfunction. Data pertaining to tissue velocity imaging (TVI)and strain imaging to assess regional myocardial function and flow mediated vasodilatation are limited in young patients with diabetes.

Materials:

Conventional echocardiography, TVI parameters along with strain (S), and strain rate (SR) were measured in 50 young diabetics (15.16 ± 2.95 years, mean HBA1c 8.15 ± 1.37 g %) and 25 controls (15.60 ± 2.51 years). Flow-mediated dilation (FMD), nitrate--mediated dilatation (NMD), and carotid intima–media thickness were also assessed.

Results:

Conventional echocardiography parameters were similar in patients and controls; however, deceleration time of the mitral inflow velocity (early deceleration time) was significantly shorter in patients when compared with controls (149.06 ± 31.66 vs. 184.56 ± 19.27 ms, P =0.001). Patients had lower strain values at the basal lateral LV (21.39 ± 4.12 vs. 23.78 ± 2.02; P =0.001), mid-lateral LV (21.43 ± 4.27 vs. 23.17 ± 1.92 P =0.02), basal septum (20.59 ± 5.28 vs. 22.91 ± 2.00; P = 0.01), and midseptum (22.06 ± 4.75 vs. 24.10 ± 1.99; P = 0.01) as compared to controls. SR at the basal and midsegments of the lateral LV wall and at the basal septum was also significantly lower in diabetic patients. Diabetic children also had endothelial dysfunction with significantly lower FMD (8.36 ± 4.27 vs. 10.57 ± 4.12, P = 0.04).

Conclusions:

LV strain indices and flow--mediated dilatation are impaired in asymptomatic children and adolescents with type 1 diabetes mellitus despite absence of overt heart failure and normal ejection fraction. Early detection of subclinical regional myocardial dysfunction by deformation analysis including strain and strain rate may be useful in the asymptomatic diabetic population.

Hypokalaemic Paralysis Associated with COVID-19 Infection

INTRODUCTION

COVID-19 is a pandemic affecting mainly respiratory and gastrointestinal system. Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) binds angiotensin converting enzyme 2 (ACE-2) of renin-angiotensin system (RAS) resulting in hypokalaemia. We hereby report the a of hypokalaemic paralysis induced by COVID-19.

CASE

A 56 years old male with no co-morbidities presented with fever (2days), weakness in bilateral lower limbs (1 day). His had severe hypokalaemia with serum potassium of 2.05 mEq/L. RT-PCR of nasopharyngeal swab for SARS-CoV- 19 was positive. He was diagnosed as a case of hypokalaemic paralysis induced by COVID-19 infection.

CONCLUSION

We suggest that during this pandemic era if a COVID-19 patient presents with paralysis, hypokalaemia induced paralysis should be kept in the differential diagnosis.

WHAT IS KNOWN

COVID-19 infection leads to hypokalemia.

WHAT IS NEW

Hypokalaemic paralysis as a manifestation of COVID-19.

Effect of statin on perioperative myocardial injury in isolated valve surgery

BACKGROUND

Statins have known pleiotropic effects that confer protection from ischemia-reperfusion injury. Because cardiopulmonary bypass is a potentially reversible ischemia-reperfusion sequence, we aimed to assess whether statin loading could help to limit myocardial injury in patients undergoing isolated heart valve replacement under cardiopulmonary bypass.

METHODS

One hundred patients with rheumatic valvular heart disease undergoing valve replacement received either a loading dose of rosuvastatin (40 mg initiated 7 days before surgery; loaded group) or no statins (non-loaded group). Cardiac troponin I, creatine kinase MB, and brain natriuretic peptide were measured at 8, 24, and 48 hours postoperatively. The primary endpoint was the extent of perioperative myocardial injury measured by the area under the curve for each biomarker.

RESULTS

Despite similar baseline levels, all biomarkers at 8, 24, and 48 h were significantly lower in the loaded group. The area under the curve of each biomarker was significantly lower in the loaded group than in the non-loaded group (troponin I: 31.43 vs. 77.21 ng·h·mL^-1, creatine kinase MB 309.31 vs. 429.12 ng·h·mL^-1, brain natriuretic peptide 5176.11 vs. 16119.31 pg·h·mL^-1, all p < 0.001). The mean changes from baseline to peak levels were also significantly lower in the loaded group. The loaded group had a shorter hospital stay but no significant difference was seen in ventilator time, inotrope time, aortic crossclamp time, cardiopulmonary bypass time, or intensive care unit stay.

CONCLUSION

In patients undergoing valve replacement, high-dose statin loading before surgery had a favorable impact on the release kinetics of various cardiac biomarkers.

Digital cardiovascular care in COVID-19 pandemic: A potential alternative?

BACKGROUND

Cardiovascular patients are at increased risk of acquiring coronavirus disease 2019 (COVID-19) infection while their visit to healthcare facilities. There is a need for alternative tools for optimal monitoring and management of cardiovascular patients in the present pandemic situation. Digital health care may prove to be a new revolutionary tool to protect cardiovascular patients from coronavirus disease by avoiding routine visits to health care facilities that are already overwhelmed with COVID-19 patients.

METHODS

To evaluate the role of digital health care in the present era of the COVID-19 pandemic, we have reviewed the published literature on digital health services providing cardiovascular care.

RESULTS AND CONCLUSION

Digital health including telemedicine services, robotic telemedicine carts, use of artificial intelligence and machine learning, use of digital gadgets like smartwatches and web-based applications may be a safe alternative for the management of cardiovascular patients in the present pandemic situation.

Metal removal and recovery using bioelectrochemical technology: The major determinants and opportunities for synchronic wastewater treatment and energy production

Microbial fuel cell (MFC) technology has emerged as a new and attractive bioelectrochemical approach in the last one and a half decade that offers an alternative to conventional treatment methods to remove and recover heavy metals and organics from wastewaters with simultaneous energy production. This technique has advantage over the conventional wastewater treatment techniques, which are energy intensive, sludge producing and with little effectivity at high concentrations. Significant work has been done in the recent years on MFC principle, electrode configuration, biofilm composition, application of MFC in wastewater treatment, metal removal or recovery and energy production. Basically, metal in the cathode chamber acts as acceptor of the electrons released from the oxidation of organic matter in the anode chamber by electrogenic microbes. Literature shows that efficacy of MFCs in removal and recovery of metals and power production is significantly influenced by redox potential of the metal, initial concentration, mix metal systems, carbon source in substrate, pH, biocathode, biofilm composition, gaseous environment in cathode, electrode modification and external resistance, which have been critically reviewed for the first time in the present paper to understand the role of the determinant factors that may be explored for improvement of the MFC performance. The paper provides further insights into the techno-economic aspects of MFC technology and suggests research needs for enhanced performance and reduced costs to increase its feasibility for application at commercial level.

Emission characteristics of ultrafine particles from bare and Al2O3 coated graphite for high temperature applications

Owing to its exceptional properties at high temperature, graphite is used in several applications such as structural material and fuel block in high temperature nuclear reactors. Air ingress is one of the serious safety concerns in these reactors. Oxidation of graphite leading to increased porosity affects its mechanical strength and may lead to core collapse resulting in a severe accident. During such a scenario, generation of graphite particles could be the main hazard. Once generated, these particles often in fine and ultrafine sizes, may carry radioactivity to large distances and/or for long times. These particles owing to their higher surface to volume ratio possess an additional inhalation hazard. Ultrafine particles have the potential to enter into respiratory tract and cause damage to body organs. Coating of graphite components is preferred to reduce the oxidation induced damages at high temperatures. In the present work, effect of alumina (Al2O3) coating on the emission characteristics of particles from graphite under high temperature conditions has been investigated. Bare and Al2O3 coated graphite specimens were heated within a closed chamber at varying temperatures during these experiments. Temporal evolution of concentrations of gases (CO and CO2) and particles were measured. The results reveal that Al2O3 coating on the graphite delayed the oxidation behavior and the structure of graphite remained largely intact at high temperatures. A significant reduction in aerosol formation and CO emission was also noticed for the coated specimens.

Nano-enabled biosensing systems for intelligent healthcare: towards COVID-19 management

Biosensors are emerging as efficient (sensitive and selective) and affordable analytical diagnostic tools for early-stage disease detection, as required for personalized health wellness management. Low-level detection of a targeted disease biomarker (pM level) has emerged extremely useful to evaluate the progression of disease under therapy. Such collected bioinformatics and its multi-aspects-oriented analytics is in demand to explore the effectiveness of a prescribed treatment, optimize therapy, and correlate biomarker level with disease pathogenesis. Owing to nanotechnology-enabled advancements in sensing unit fabrication, device integration, interfacing, packaging, and sensing performance at point-of-care (POC) has rendered diagnostics according to the requirements of disease management and patient disease profile i.e. in a personalized manner. Efforts are continuously being made to promote the state of art biosensing technology as a next-generation non-invasive disease diagnostics methodology. Keeping this in view, this progressive opinion article describes personalized health care management related analytical tools which can provide access to better health for everyone, with overreaching aim to manage healthy tomorrow timely. Considering accomplishments and predictions, such affordable intelligent diagnostics tools are urgently required to manage COVID-19 pandemic, a life-threatening respiratory infectious disease, where a rapid, selective and sensitive detection of human beta severe acute respiratory system coronavirus (SARS-COoV-2) protein is the key factor.

Prevalence of Abnormal Liver Function Tests in COVID-19 Patients at a Tertiary Care Centre

BACKGROUND AND AIM

Coronavirus disease 2019 (COVID 2019) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is observed to cause liver dysfunction. We aimed to observe abnormal liver function tests (LFTs) in COVID-19 patients admitted in our hospital.

METHODS

It was a cross- sectional study involving 105 COVID-19 patients who were admitted in our Hospital from 03-04-2020 to 02-05-2020. The COVID-19 positivity was defined on basis of real-time PCR. Thorough clinical examination and laboratory investigations including Complete Blood Count, Renal function Tests, Liver Function Tests, Chest X-ray, ECG, etc. were done.

RESULTS

The total number of male and female patients were 64 and 41. Out of total 105 patients, 62 i.e. 59.04% had abnormal LFTs at time of admission. Out of these 62 patients, 44(70.9%) were Male and 18(29.03%) were female. Only 5(4.76%) patients had abnormal LFTs on repeat testing. Median Age of patients was 33years. Average stay of patients with Abnormal LFTs was 15 days (10-16 days) as compared to 10 days (7-11days) for patients with normal LFTs.

CONCLUSION

The prevalence of Abnormal Liver function tests in patients of COVID-19 is 59.04%. Abnormal liver functions were more in males. The average stay in hospital for COVID-19 patients with abnormal LFTs was longer than those with normal LFTs.

COVID-19 pandemic and stent thrombosis in a post percutaneous coronary intervention patient-a case report highlighting the selection of P2Y12 inhibitor

The current pandemic of novel coronavirus disease 2019 (COVID-19) has posed a great threat to people's health worldwide, with specific implications on patients with underlying heart diseases. During this challenging period, nearly all major societies have recommended for conservative approach, even for patients with relatively stable acute cardiovascular diseases. Selection of specific antiplatelet therapy in an uncomplicated post percutaneous coronary intervention (PCI) patient can, at times, be crucial issue in such strained circumstances. We report a case of 64-year-old male, who was taken for urgent coronary angiogram (CAG) in view of non ST elevation acute coronary syndrome. Successful PCI with implantation of drug eluting stent was done for right coronary artery (RCA) and left anterior descending (LAD) artery lesions. On day 5th post-PCI, he developed acute inferior wall STEMI due to subacute stent thrombosis (ST), and despite all efforts, patient could not be saved as he didn't receive timely intervention. Increased travel time to emergency department due to lockdown because of COVID-19 and along with extra time required for donning of personal protection equipment (PPE) and other COVID-19 related safety measures prolonged the ischemic time. Potent P2Y12 inhibitor based dual antiplatelet therapy might have prevented this subacute ST, and thus mortality, as the patient was discharged on clopidogrel after PCI. While selecting specific P2Y12 inhibitor in a post PCI patient, apart from clinical condition of patient and complexity of procedure, we should also consider current COVID-19 pandemic. Current circumstances may favour ticagrelor over other P2Y12 inhibitors in view of its potent, rapid, and reversible antiplatelet action along with its optimistic effect in pneumonia.

Prioritizing cardiovascular surgical care in COVID-19 pandemic: Shall we operate or defer?

BACKGROUND

The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care.

METHODS

There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics.

CONCLUSION

After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.

Paediatric morphoea: a holistic review. Part 1: epidemiology, aetiopathogenesis and clinical classification

Morphoea, also known as localized scleroderma, is a debilitating fibrosing disorder of uncertain aetiology, affecting the skin and subcutaneous tissues. Paediatric-onset disease is not uncommon and is associated with frequent relapses. The disease has complex pathogenetic mechanisms and multiple clinical subtypes, and affects children of all ages. Recent research has focused on elucidating the disease pathophysiology and identifying measures of disease activity. We performed a literature search on PubMed, MEDLINE and Google Scholar, using keywords such as 'pediatric morphea', 'juvenile localised scleroderma' and 'juvenile systemic sclerosis'. Relevant studies, including randomized trials, reviews of standard current guidelines and original research articles, were selected, and results were analysed before being summarized. In the first of this two-part review, we provide a bird's-eye view of the current literature concerning the epidemiology, aetiopathogenesis and clinical classification of paediatric morphoea; in Part 2, we review the diagnosis, markers of disease activity, management and natural history.

Paediatric morphoea: a holistic review. Part 2: diagnosis, measures of disease activity, management and natural history

Paediatric morphoea is a debilitating fibrosing disorder of uncertain aetiology, affecting the skin and subcutaneous tissues. Defining optimum management strategies in paediatric morphoea remains an ongoing challenge, owing to the varied presentations and a relative paucity of paediatric-specific studies. We performed a literature search on PubMed, MEDLINE and Google Scholar, using keywords such as 'pediatric morphea', 'juvenile localised scleroderma' and 'juvenile systemic sclerosis'. Relevant studies, including randomized trials, reviews of standard current guidelines and original research articles, were selected and results analysed before summarizing them. In Part 1 of this review, we described the epidemiology, aetiopathogenesis and clinical classification; in this part, we discuss the diagnosis, markers of disease activity, management and natural history in paediatric morphoea.

Analgesic, anti-inflammatory and antipyretic activities of ethanolic extract of stem bark of Anogeissus latifolia Roxb

Background

Stem bark of Anogeissus latifolia Roxb (family: Combretaceae) is used traditionally and ethnomedicinally to alleviate pain, inflammation and fever conditions. The current study investigates the analgesic, anti-inflammatory and antipyretic activities of ethanolic extract of stem bark of Anogeissus latifolia Roxb.

Method

The HPLC studies were carried out to standardize the stem bark ethanolic extract of Anogeissus latifolia (ALEE) using ellagic acid as a marker. ALEE was screened for analgesic (formalin-induced pain and acetic acid induced writhing) and anti-inflammatory (formalin and carrageenan-induced paw oedema) activities in Wistar rats. Before 1 h of acetic acid or formalin or carrageenan injection, rats were orally fed with ALEE (100, 200 and 400 mg/kg), Aspirin (100 mg/kg) or Indomethacin (10 mg/kg). Antipyretic effect was studied in brewer’s yeast-induced pyrexia model in rats using Paracetamol (100 mg/kg) as a standard drug.

Results

HPLC analysis of ALEE revealed the presence of ellagic acid. ALEE treatment (200 and 400 mg/kg) significantly inhibited pain response in both models. ALEE treatments prevented the raise of paw volume in both in-vivo models with percent inhibition of 44.40 and 46.21, respectively at 5 h. ALEE also showed a significant reduction of yeast-induced pyrexia till 4 h of treatment.

Conclusion

ALEE exhibited analgesic, anti-inflammatory and antipyretic property in experimental models and validates traditional use of ALEE in pain, inflammation and fever.