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Paul M. Consequences and management of guidewire fracture-entrapment in the left circumflex artery: a case report. Eur Heart J Case Rep 2024; 8:ytae341. [PMID: 39104512 PMCID: PMC11299023 DOI: 10.1093/ehjcr/ytae341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 10/11/2023] [Accepted: 07/08/2024] [Indexed: 08/07/2024]
Abstract
Background Entrapment and fracture of the coronary guidewire are rare but major complications of percutaneous coronary intervention (PCI). The incidence of these complications is reported to be <1%. Case summary A 52-year-old male patient with diabetes and dyslipidaemia presented with posterior wall myocardial infarction. An angiogram revealed occlusion in the left circumflex (LCX) artery. Attempts to pass a guidewire through the lesion led to its entrapment and eventual fracture. Several techniques and manoeuvres failed to retrieve the fractured guidewire, which remained lodged in the LCX. An endovascular snare catheter also proved unsuccessful. The fragment was eventually removed using the triple-wire technique, although this caused coronary perforation and dissection. The perforation was identified and stented. A subsequent stent addressed a dissection in the left main/left ascending artery area, likely caused by the coronary snare. These interventions were crucial in stabilizing the patient's condition, leading to recovery with a left ventricular ejection fraction of 50% and a viable LCX artery. The patient exhibited an uneventful progression at the 1-year follow-up. Discussion Coronary guidewire fracture during PCI is a rare event often associated with coronary calcifications. Percutaneous removal remains the mainstay treatment for fragment removal; however, it carries risks. The triple-wire technique, a newer method that entangles and extracts the fractured guidewire without specialized equipment, was effective in removing the fragmented guidewire. If asymptomatic, leaving the wire in situ is documented as a favourable approach. This case highlights that the triple-wire technique can effectively be used for the extraction of fractured guidewire fragments from the coronary vessels.
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Affiliation(s)
- Mathews Paul
- Consultant Interventional Cardiologist, Moulana Hospital, Mysuru - Ooty Rd, Perintalmanna, Kerala 679322, India
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Chang JY, Makary MS. Evolving and Novel Applications of Artificial Intelligence in Thoracic Imaging. Diagnostics (Basel) 2024; 14:1456. [PMID: 39001346 PMCID: PMC11240935 DOI: 10.3390/diagnostics14131456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024] Open
Abstract
The advent of artificial intelligence (AI) is revolutionizing medicine, particularly radiology. With the development of newer models, AI applications are demonstrating improved performance and versatile utility in the clinical setting. Thoracic imaging is an area of profound interest, given the prevalence of chest imaging and the significant health implications of thoracic diseases. This review aims to highlight the promising applications of AI within thoracic imaging. It examines the role of AI, including its contributions to improving diagnostic evaluation and interpretation, enhancing workflow, and aiding in invasive procedures. Next, it further highlights the current challenges and limitations faced by AI, such as the necessity of 'big data', ethical and legal considerations, and bias in representation. Lastly, it explores the potential directions for the application of AI in thoracic radiology.
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Affiliation(s)
- Jin Y Chang
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Kejriwal S, Bulosan H, Nelken NA, Lim JH. Multidisciplinary Management of an Internal Carotid Artery Aneurysm Near the Skull Base. Cureus 2024; 16:e62086. [PMID: 38989364 PMCID: PMC11236212 DOI: 10.7759/cureus.62086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Extracranial carotid artery aneurysms (ECAAs) are rare in comparison to the total number of peripheral artery aneurysms. Although there are multiple treatment modalities, no clear guidelines exist for the optimal management of ECAA. We describe a case of a 59-year-old female with an incidental finding of a 2.6 cm right internal carotid artery (ICA) aneurysm on computed tomography (CT) that was eventually excised via transcervical approach followed by end-to-end anastomosis with great saphenous vein (GSV) graft. To our knowledge, this case demonstrates a novel multidisciplinary approach to an ECAA near the skull base involving head and neck surgery (HNS), vascular surgery (VS), and neuro-interventional radiology (NIR).
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Affiliation(s)
- Sameer Kejriwal
- School of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Hannah Bulosan
- School of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Nicolas A Nelken
- Department of Vascular Surgery, Hawaii Permanente Medical Group, Kaiser Moanalua Medical Center, Honolulu, USA
| | - Jae H Lim
- Department of Otolaryngology-Head and Neck Surgery, Hawaii Permanente Medical Group, Kaiser Moanalua Medical Center, Honolulu, USA
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Kumar N, Allyhan P, Aggarwal A. Effect of Covid pandemic on immunization status of children in tertiary care Hospital of North India: reason for partial and non-immunization a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:8. [PMID: 38221618 PMCID: PMC10789037 DOI: 10.1186/s41043-023-00494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/25/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Low immunization coverage in India attributes to many factors including sociodemographic factors and people's behavior. COVID-19 pandemic resulted in disruptions in achieving optimum availability and utilization of immunization services. This study was carried out to find out the immunization status of children in the post COVID era and various factors responsible for non-immunization during the pandemic. METHODS This cross-sectional study included parents of 225 admitted children aged 1-6 years were interviewed using a semi-structured open-ended questionnaire. Children were classified as completely immunized, partially immunized and unimmunized on the basis of vaccines missed given under first year of life. Reasons for non-immunization and delay/missed vaccination during COVID-19 pandemic were recorded. RESULTS Of the 225 children, 162 (72%; 95% CI 66-78%) were completely immunized, 55 (24.4%; 95% CI 19-30%) were partially immunized and 8 (3.6%; 95% CI 1-6%) were unimmunized. Parents with hospital deliveries, higher education level and lesser birth order were more likely to have children with better immunization status (p < 0.05). First dose of measles scheduled at 9 months and 3rd dose of pentavalent vaccine/OPV/Rotavirus vaccine scheduled at 14 weeks were most commonly missed vaccines among partially immunized. Lack of awareness (n = 36, 57.1%; 95% CI 45-70%) was the common reason for partial and non-immunization followed by illness of child (n = 21, 33.3%; 95% CI 21-45%) and COVID-19 pandemic (n = 11, 17.4%; 95% CI 8-27%). Pandemic was reason for delay in 50 (22.2%; 95% CI 17-28%) children. Restrictions of movement (64%; 95% CI 50-78%), fear of being exposed to COVID-19 (52%; 95% CI 38-66%) were the most common reasons for delay during the pandemic. Of the 50 children who had delay due to pandemic, 39 children (17.3%; 95% CI 12-22%) received their catch-up immunization after the pandemic. No child remained completely unimmunized due to COVID-19 pandemic. CONCLUSIONS Although COVID-19 pandemic resulted in disruptions in routine immunization services, sociodemographic factors such as awareness for immunization, parental education and various beliefs for immunization were responsible for the children remaining unimmunized or partially immunized after the pandemic.
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Affiliation(s)
- Narender Kumar
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, 110095, India
| | - Pinki Allyhan
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, 110095, India
| | - Anju Aggarwal
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, 110095, India.
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5
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Shahzad MF, Xu S, Naveed W, Nusrat S, Zahid I. Investigating the impact of artificial intelligence on human resource functions in the health sector of China: A mediated moderation model. Heliyon 2023; 9:e21818. [PMID: 38034787 PMCID: PMC10685199 DOI: 10.1016/j.heliyon.2023.e21818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Artificial intelligence (AI) is rapidly transforming the way human resources (HR) functions are carried out in the health sector of China. This study aims to scrutinize the impact of artificial intelligence on the human resource functions operating in the healthcare sector through technological awareness, social media influence, and personal innovativeness. Additionally, this study examines the moderating role of perceived risk between technological awareness and human resources functions. An online questionnaire was administered to human resources professionals in the health sector of China to gather data from 363 respondents. Partial least squares structural equation modeling (PLS-SEM), a statistical procedure, is implemented to investigate the hypothesis of the projected model of artificial intelligence and human resource functions. The research findings reveal that artificial intelligence significantly influences human resource functions through technological awareness, social media influence, and personal innovativeness. Furthermore, perceived risk significantly moderates the relationship between technological awareness and human resource functions. The findings of this study have important implications for HR practitioners and policymakers in the health sectors of China, who can leverage artificial intelligence technologies to optimize and improve organizational performance. However, its adoption needs to be carefully planned and managed to reap the full benefits of this transformative technology.
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Affiliation(s)
| | - Shuo Xu
- College of Economics and Management, Beijing University of Technology, Beijing 100124, PR China
| | - Waliha Naveed
- Institute of Business & Management, University of Engineering and Technology, Lahore 54000, Pakistan
| | - Shahneela Nusrat
- College of Environment and Life Science, Beijing University of Technology, Beijing 100124, PR China
| | - Imran Zahid
- Department of Mechanical Engineering and Technology, Government College University Faisalabad, Pakistan
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Leibundgut G, Achim A, Krivoshei L. Safe and predictable transcatheter removal of broken coronary guidewires: the 'knuckle-twister' technique: a case series report. Eur Heart J Case Rep 2023; 7:ytad311. [PMID: 37539349 PMCID: PMC10394303 DOI: 10.1093/ehjcr/ytad311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/22/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
Background Guidewire fracture and loss is a rare but well-known and feared complication of percutaneous coronary interventions. With the increasing number of complex coronary interventions and procedures for chronic total occlusions, operators face new challenges and boundaries, and the need for solutions to otherwise rare complications is increasing. Case summary We have developed a simple and practical method for retrieving fractured and lost guidewires, called the 'knuckle-twister' technique. This article summarizes seven cases in which guidewires lost in the coronary vasculature have been successfully removed and describes this technique in detail. The goal was to gather different clinical scenarios: free wire lost in situ, wire jailed behind stent struts, wire in small branches, part of the wire protruding into the aorta, 'invisible' guidewire microfilaments/coils, etc. Discussion The innovation of the knuckle-twister consists in folding a polymer-jacketed guidewire and transforming it into an open lasso that tightens when twisted. In vitro, its grip strength and pulling force was tested and exceeded 1.5 kg. Moreover, in all in vivo cases, the lost material could be efficiently and quite rapidly retrieved with this simple and highly reproducible technique. Key clinical message Broken guidewires that were lost in the coronary vasculature can be safely retrieved with this novel and simple technique requiring no special safety equipment.
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Affiliation(s)
| | - Alexandru Achim
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, Liestal 4410, Switzerland
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Chakrabarti A, Bair EF, Thirumurthy H. Routine child immunizations in India during the COVID-19 pandemic. SSM Popul Health 2023; 22:101383. [PMID: 36974277 PMCID: PMC10014501 DOI: 10.1016/j.ssmph.2023.101383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Disruptions in health service delivery and utilization during the COVID-19 pandemic may have caused many children worldwide to not receive vital preventative health services. We investigate the pandemic's effects on routine childhood vaccinations in India, which has the world's largest child immunization program. Using data from the Government of India's health management information system and interrupted time series analyses, we estimate district-level changes in routine child vaccinations during the pandemic relative to typical monthly vaccinations in the pre-pandemic period. Our results indicate there were significant reductions in child vaccinations during the pandemic, with declines being extremely large in April 2020 when a strict national lockdown was in place. For example, district-level administration of the final required dose in the polio series declined by about 60% in April 2020 relative to the typical monthly vaccination levels observed prior to the pandemic. Vaccinations subsequently increased but largely remained below levels observed before the outbreak of COVID-19. Additional declines in vaccinations occurred in 2021 during the second wave of COVID-19 infections in India. Heterogeneity analyses suggest that vaccinations declined the most in districts with the strictest lockdowns and in districts with low health system capacity at baseline. There is a vital need for corrective actions, such as catch-up vaccination campaigns, to limit the deleterious consequences that will arise for the children who missed routine immunizations during the COVID-19 pandemic.
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Affiliation(s)
- Averi Chakrabarti
- American Institutes for Research, 201 Jones Road, Suite 100, Waltham, MA, 02451, USA
| | - Elizabeth F. Bair
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104-4884, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104-4884, USA
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Anagun Y. Smart brain tumor diagnosis system utilizing deep convolutional neural networks. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-27. [PMID: 37362644 PMCID: PMC10140727 DOI: 10.1007/s11042-023-15422-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/12/2023] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
The early diagnosis of cancer is crucial to provide prompt and adequate management of the diseases. Imaging tests, in particular magnetic resonance imaging (MRI), are the first preferred method for diagnosis. However, these tests have some limitations which can cause a delay in detection and diagnosis. The use of computer-aided intelligent systems can assist physicians in diagnosis. In this study, we established a Convolutional Neural Network (CNN)-based brain tumor diagnosis system using EfficientNetv2s architecture, which was improved with the Ranger optimization and extensive pre-processing. We also compared the proposed model with state-of-the-art deep learning architectures such as ResNet18, ResNet200d, and InceptionV4 in discriminating brain tumors based on their spatial features. We achieved the best micro-average results with 99.85% test accuracy, 99.89% Area under the Curve (AUC), 98.16% precision, 98.17% recall, and 98.21% f1-score. Furthermore, the experimental results of the improved model were compared to various CNN-based architectures using key performance metrics and were shown to have a strong impact on tumor categorization. The proposed system has been experimentally evaluated with different optimizers and compared with recent CNN architectures, on both augmented and original data. The results demonstrated a convincing performance in tumor detection and diagnosis.
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Affiliation(s)
- Yildiray Anagun
- Department of Computer Engineering, Eskisehir Osmangazi University, Eskisehir, Turkey
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Reis HC, Turk V, Khoshelham K, Kaya S. MediNet: transfer learning approach with MediNet medical visual database. MULTIMEDIA TOOLS AND APPLICATIONS 2023; 82:1-44. [PMID: 37362724 PMCID: PMC10025796 DOI: 10.1007/s11042-023-14831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/06/2022] [Accepted: 02/06/2023] [Indexed: 06/28/2023]
Abstract
The rapid development of machine learning has increased interest in the use of deep learning methods in medical research. Deep learning in the medical field is used in disease detection and classification problems in the clinical decision-making process. Large amounts of labeled datasets are often required to train deep neural networks; however, in the medical field, the lack of a sufficient number of images in datasets and the difficulties encountered during data collection are among the main problems. In this study, we propose MediNet, a new 10-class visual dataset consisting of Rontgen (X-ray), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound, and Histopathological images such as calcaneal normal, calcaneal tumor, colon benign colon adenocarcinoma, brain normal, brain tumor, breast benign, breast malignant, chest normal, chest pneumonia. AlexNet, VGG19-BN, Inception V3, DenseNet 121, ResNet 101, EfficientNet B0, Nested-LSTM + CNN, and proposed RdiNet deep learning algorithms are used in the transfer learning for pre-training and classification application. Transfer learning aims to apply previously learned knowledge in a new task. Seven algorithms were trained with the MediNet dataset, and the models obtained from these algorithms, namely feature vectors, were recorded. Pre-training models were used for classification studies on chest X-ray images, diabetic retinopathy, and Covid-19 datasets with the transfer learning technique. In performance measurement, an accuracy of 94.84% was obtained in the traditional classification study for the InceptionV3 model in the classification study performed on the Chest X-Ray Images dataset, and the accuracy was increased 98.71% after the transfer learning technique was applied. In the Covid-19 dataset, the classification success of the DenseNet121 model before pre-trained was 88%, while the performance after the transfer application with MediNet was 92%. In the Diabetic retinopathy dataset, the classification success of the Nested-LSTM + CNN model before pre-trained was 79.35%, while the classification success was 81.52% after the transfer application with MediNet. The comparison of results obtained from experimental studies observed that the proposed method produced more successful results. Graphical abstract
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Affiliation(s)
- Hatice Catal Reis
- Department of Geomatics Engineering, Gumushane University, 2900 Gumushane, Turkey
| | - Veysel Turk
- Department of Computer Engineering, University of Harran, Sanliurfa, Turkey
| | - Kourosh Khoshelham
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, 3052 Australia
| | - Serhat Kaya
- Department of Mining Engineering, Dicle University, Diyarbakir, Turkey
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Yuan WX, Yan B, Li W, Hao LY, Yang HM. Blockchain-based medical health record access control scheme with efficient protection mechanism and patient control. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 82:16279-16300. [PMID: 36404935 PMCID: PMC9640907 DOI: 10.1007/s11042-022-14023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/28/2021] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The patient's medical health record (PMHR) has always provided a large amount of research data to medical institutions and pharmaceutical companies, etc., and has contributed to the development in medical research. However, such PMHR data contains the patient's personal privacy and should be shared under the control of the patients, not the hospital where this data is acquired. In order to protect the privacy of PMHR data while realizing efficient data sharing, this paper proposes a blockchain-based sharing and protection scheme. In this solution, the PMHR data are encrypted and stored in a cloud server, which is equipped with an access control scheme implemented as a smart contract on a blockchain. Different from previous works, in order to ensure efficient access and reduce the workload of patients, the types of users who can apply for access are limited to hospitals and pharmaceutical companies. In order to resist the potential Man-in-the-middle (MITM) attack, we have introduced an improved proxy re-encryption scheme to ensure the secrecy of PMHR data while reducing the computational complexity. The whole system is implemented using Solidity and tested on 10 nodes for function verification. Experimental result shows that the proposed system is more efficient than previous systems. Security under the MITM attack is also ensured by security analysis.
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Affiliation(s)
- Wen-Xin Yuan
- College of Electronic and Information Engineering, Shandong University of Science and Technology, Qingdao, 266590 People’s Republic of China
| | - Bin Yan
- College of Electronic and Information Engineering, Shandong University of Science and Technology, Qingdao, 266590 People’s Republic of China
| | - Wen Li
- Confidentiality Administration Bureau of Ji-Ning, Ji-Ning, People’s Republic of China
| | - Liu-Yao Hao
- China Mobile Communications Research Institute, Beijing, People’s Republic of China
| | - Hong-Mei Yang
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao, 266590 People’s Republic of China
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Falope O, Nyaku MK, O'Rourke C, Hermany LV, Plavchak B, Mauskopf J, Hartley L, Kruk ME. Resilience learning from the COVID-19 pandemic and its relevance for routine immunization programs. Expert Rev Vaccines 2022; 21:1621-1636. [PMID: 36063485 DOI: 10.1080/14760584.2022.2116007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. AREAS COVERED We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. EXPERT OPINION Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats.
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Affiliation(s)
| | | | | | | | | | | | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nimavat N, Hasan MM, Charmode S, Mandala G, Parmar GR, Bhangu R, Khan I, Singh S, Agrawal A, Shah A, Sachdeva V. COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review. World J Virol 2022; 11:186-197. [PMID: 36159611 PMCID: PMC9372784 DOI: 10.5501/wjv.v11.i4.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/19/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.
AIM To understand the challenges faced by the healthcare system during a pandemic.
METHODS The literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.
RESULTS The Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.
CONCLUSION Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.
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Affiliation(s)
- Nirav Nimavat
- Department of Community Medicine, Dr. Kiran C Patel Medical College and Research Institute, Bharuch 392001, India
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | - Sundip Charmode
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot 360006, Gujarat, India
| | - Gowthamm Mandala
- Independent Researcher, Centre Groove High School, Greenwood, IN 46143, United States
| | | | - Ranvir Bhangu
- Department of Medical, Caribbean Medical University, Des Plaines, IL 60018, United States
| | - Israr Khan
- Shifa International Hospital, Islamabad 999010, Pakistan
| | - Shruti Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Patna 801507, India
| | - Amit Agrawal
- Department of Paediatrics, Gandhi Medical College, Bhopal 462001, India
| | - Ashish Shah
- Department of Pharmacy, Sumandeep Vidyapeeth, Vadodara 391760, India
| | - Vishi Sachdeva
- Department of Medical, Adesh Institute of Medical Sciences and Research, Bathinda 151009, India
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13
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Dementia classification using MR imaging and clinical data with voting based machine learning models. MULTIMEDIA TOOLS AND APPLICATIONS 2022. [DOI: 10.1007/s11042-022-12754-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kirov H, Tkebuchava S, Faerber G, Diab M, Sandhaus T, Doenst T. Lost in circulation. J Card Surg 2020; 35:1885-1890. [PMID: 32643849 DOI: 10.1111/jocs.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent. METHODS We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014. RESULTS From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular-assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left-sided minithoracotomy (n = 2). The operations were performed on-pump in five (62.5%) and off-pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained-device-related right heart failure. The other patients survived and had uneventful postoperative courses. CONCLUSIONS Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Sophio Tkebuchava
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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15
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Santamaria V, De Bellis A, Landino P, Biondi-Zoccai G, Frati G, Greco E. Surgical rescue of guidewire in-stent entrapment during coronary angioplasty. Asian Cardiovasc Thorac Ann 2019; 28:52-54. [PMID: 31333046 DOI: 10.1177/0218492319865443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During a percutaneous coronary procedure, the device may become stuck and break in the coronary circulation. This complication occurs in 0.1% of all procedures. Even with technological improvements, this event still happens because percutaneous coronary interventions are frequently used to treat complex lesions. We report a case of a patient undergoing a percutaneous stenting procedure in which the 0.014″ guidewire was caught in the right coronary artery. Removal of the guidewire was impossible, and it broke in the brachiocephalic artery. Emergency coronary artery bypass grafting was performed.
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Affiliation(s)
- Valeria Santamaria
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio De Bellis
- Department of Cardiology and Cardiac Surgery, Casa di Cura San Michele, Maddaloni, Caserta, Italy
| | - Pietro Landino
- Department of Cardiology and Cardiac Surgery, Casa di Cura San Michele, Maddaloni, Caserta, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Department of Angio Cardio Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Department of Angio Cardio Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
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16
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Meledin V, Perkhulov V, Gandelman G, George J, Shimoni S. Fractured Guidewire Entrapped in the Ostium of Right Coronary Artery Mimicking Aortic Flap. JACC Cardiovasc Interv 2019; 12:890-891. [PMID: 30981570 DOI: 10.1016/j.jcin.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Valery Meledin
- Heart Institute and Radiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Vladimir Perkhulov
- Heart Institute and Radiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Gera Gandelman
- Heart Institute and Radiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Jacob George
- Heart Institute and Radiology Department, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Sara Shimoni
- Heart Institute and Radiology Department, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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17
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Patil S, Setty N, Ramalingam R, Mambally J, Manjunath CN. Successful device retrieval using simple balloon method during cardiac procedures. Interv Med Appl Sci 2019; 10:186-190. [PMID: 30792910 PMCID: PMC6376354 DOI: 10.1556/1646.10.2018.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives Although rare, incidents of broken/dislodged fragment of various angioplasty hardwares, including catheters, guidewires, angioplasty balloons, and stents, are being increasingly reported in recent years. Since these broken fragments may cause life-threatening consequences for a patient, it is vital for an interventional cardiologist to be acquainted with different retrieval techniques. Here, we are reporting our observations of several incidents of device dislodgement/fracture during cardiac interventions and their retrieval using simple balloon method. Methods We present a study of eight patients in whom we attempted to retrieve dislodged/fractured cath-lab hardwares during cardiac interventions, using simple balloon method. These cases include two cases of balloon, three cases of stent, and three cases of guidewire dislodgement/fracture. Results Fractured/dislodged cath-lab hardwares were successfully retrieved using a simple balloon method in six out of eight cases (75%), without any need of other retrieval hardwares. We observed no major complications in any patient. Conclusions The balloon-assisted retrieval method is a simple, safe, and cost-effective way to avoid complications of endothelial injury, myocardial infarction, emergency coronary artery bypass graft, and sudden cardiac death. This study, particularly the context of retrieval technique used in each case, will offer valuable information to fellow interventional cardiologists.
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Affiliation(s)
- Shivanand Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Natraj Setty
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Rangaraj Ramalingam
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Jayasheelan Mambally
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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18
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Consequences and treatment of guidewire entrapment and fracture during percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:129-33. [DOI: 10.1016/j.carrev.2015.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
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19
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Patil S, Ramalingam R, Kharge J, Nayak M, Manjunath CN. Successful Retrieval of Uncoiled Coronary Guidewire Using Simple Balloon Method. J Clin Diagn Res 2015; 9:OD01-3. [PMID: 26557557 DOI: 10.7860/jcdr/2015/15323.6599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/31/2015] [Indexed: 11/24/2022]
Abstract
Breakage of angioplasty device in coronary artery can cause panic in the catheterization laboratory. These broken fragments may serve as a nidus for thrombus formation; hence, removal of these fragments becomes mandatory. Since the incidence of guidewire fracture during angioplasty are rarely reported, evidence-based approaches are not available for the management of such incidental conditions. Here, we report an interesting case of entrapment and unravelling of guidewire. We successfully retrieved unravelled guidewire using a noncompliant balloon inflated in the guiding catheter. Subsequently, the procedure was completed successfully with an implantation of a stent in the culprit lesion. We are of opinion that this novel technique is quite easy and less cumbersome than other described techniques reported earlier.
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Affiliation(s)
- Shivanand Patil
- Associate Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research , Bangalore, India
| | - Rangraj Ramalingam
- Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research , Bangalore, India
| | - Jayashree Kharge
- Associate Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research , Bangalore, India
| | - Mohan Nayak
- Chief Technician, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research , Bangalore, India
| | - Cholenahally Nanjappa Manjunath
- Director, Professor and Head, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research , Bangalore, India
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20
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Nomura T, Higuchi Y, Kato T, Keira N, Tatsumi T. A rare instructive complication of balloon catheter fracture during percutaneous coronary intervention. Cardiovasc Interv Ther 2015; 31:70-4. [PMID: 25708708 DOI: 10.1007/s12928-015-0322-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/12/2015] [Indexed: 11/27/2022]
Abstract
The entrapment, fracture, and dislodgement of catheterization devices during percutaneous coronary intervention (PCI) are rare complications, for which cardiac surgery is sometimes required. Here, we encountered a rare but instructive case of balloon catheter fracture during PCI. Although there have been some reports of guidewire fracture in PCI, reports on balloon catheter fracture are very rare to our knowledge. A simulation test to examine the mechanism of balloon catheter fracture revealed that overuse of the balloon catheter, both for kissing balloon inflation and balloon anchor, was highly likely to have been the cause of the fracture.
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Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan.
| | - Yusuke Higuchi
- Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan
| | - Taku Kato
- Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan
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