Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period.

METHODS

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

FINDINGS

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

INTERPRETATION

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

FUNDING

Bill & Melinda Gates Foundation.

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.

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%).

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.

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. 18F-FDG PET/CT revealed no hypermetabolism along RCA stent, with uptake along pericardium and inferior wall. 99mTc-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.

Comparative cryopreservation of indian wild orange (Citrus indica Tanaka) embryonic axes

BACKGROUND

Indian Wild Orange (Citrus indica Tanaka) is an endangered and endemic species from northeast India for which effective ex situ conservation strategies, including embryo cryopreservation, are urgently needed.

MATERIALS AND METHODS

Desiccation tolerance and cryopreservation ability for embryonic axes of Citrus indica was determined using three techniques (air desiccation-freezing, PVS2 vitrification-freezing and encapsulation-dehydration-freezing). Success was assessed as survival and recovery in vitro.

RESULTS

Successful cryopreservation of embryonic axes was achieved using all three methods, with the highest survival achieved when using air desiccation-freezing (90%) followed by encapsulation-dehydration (85%) and PVS2 vitrification cryopreservation (80%). Regeneration levels were lower than survival levels for all three proceedures. Post-cryo regeneration success was: encapsulation-dehydration (64%) > air desiccation-freezing (55%) > PVS2 vitrification (52%).

CONCLUSION

Although there was relatively high post-cryopreservation recovery growth obtained using all the three techniques, the air desiccation-freezing technique is preferred, as it is a simple, practical and reproducible technique for the long-term cryobanking of this important wild species. Doi: 10.54680/fr23310110512.

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.

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.

Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization

Background

The distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery.

Methods

Total of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization.

Results

The mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p < 0.001). Females had significantly smaller radial artery diameter as compared to males at right conventional access site (2.42 ± 0.36 mm vs 2.60 ± 0.34 mm; p < 0.001) and distal access site (2.09 ± 0.38 mm vs 2.27 ± 0.39 mm; p < 0.001). The diameter of the right dRA was not significantly correlated with age (r² linear = 0.002, p = 0.0475) but was positively correlated with height and weight (r² linear = 0.076, p = <0.001 and r² linear = 0.005, p = <0.001) and negatively correlated with BMI (r² linear = 0.076, p = 0.519).

Conclusions

This study has shown the size of right dRA 2.27 + 0.39 mm in males and 2.09 + 0.38 mm in females. Diabetes, hypertension, height and weight are important predictors of dRA diameter.

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.

MRI and MR Arthrography Imaging of the Pathologies of the Wrist: A Pictorial Essay

Magnetic Resonance Imaging (MRI) has a special advantage over radiographs and Computed Tomography (CT) in evaluating an anatomically complex structure like wrist, owing to its excellent soft-tissue resolution and multiplanar imaging functionality. MR arthrography further improves the diagnostic value of MRI by virtue of its meticulous depiction of even small tears involving the Triangular Fibrocartilage Complex (TFCC), intrinsic and extrinsic ligaments of the wrist. This article focuses on the MRI and MR arthrography illustration of various traumatic as well as non traumatic pathologies affecting the wrist region and is mainly intended to educate the residents by comprehensively reviewing the imaging features of the major afflictions of this complex joint in a systematic fashion using checklists.

A Prospective Clinical Study of Mesh Size required for Open Inguinal Hernia Repair

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein’s tensionfree mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race, and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15x7.5 cm2 ) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student’s t-test, respectively. Results: Areas of mesh actually applied in the study- mean (85.26±11.04 cm2 ), mean+2SD (107.34 cm2 ), most common (75-97.4 cm2 ) and maximum (102.75 cm2 )- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair.

The Effect of Photodynamic Therapy on Oral-Premalignant Lesions: A Systematic Review

Background

Material and Methods

Results

Conclusions

Impact of simplifications on numerical modelling of the shallow subsurface at city-scale and implications for shallow geothermal potential

Anthropogenic infrastructures in the shallow subsurface, such as heated basements, tunnels or shallow geothermal systems, are known to increase ground temperatures, particularly in urban areas. Numerical modelling helps inform on the extent of thermal influence of such structures, and its potential uses. Realistic modelling of the subsurface is often computationally costly and requires large amounts of data which is often not readily available, necessitating the use of modelling simplifications. This work presents a case-study on the city centre of Cardiff, UK, for which high resolution data is available, and compares modelling results when three key modelling components (namely ground elevation, hydraulic gradient distribution and basement geometry) are implemented either 'realistically', i.e. with high resolution data, or 'simplified', utilising commonly accepted modelling assumptions. Results are presented at a point (local) scale and at a domain (aggregate) scale to investigate the impacts such simplifications have on model outputs for different purposes. Comparison to measured data at individual locations shows that the accuracy of temperature outputs from numerical models is largely insensitive to simplification of the hydraulic gradient distribution implemented, while changes in basement geometry affect accuracy of the mean temperature predicted at a point by as much as 3.5 °C. At the domain scale, ground temperatures within the first 20 m show a notable increase (approximately 1 °C volume-averaged and 0.5 °C surface-averaged), while the average heat flux over the domain is about 0.06 W/m² at 20 m depth. These increased temperatures result in beneficial conditions for shallow geothermal utilisation, producing drilling cost savings of around £1700 per typical household system or about 9% increase in thermal energy potential. Simplifications of basement geometry and (to a lesser degree) the hydraulics can result in an overestimation of these temperatures and therefore over-predict geothermal potential, while the elevation simplification showed little impact.

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.

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.

Reversible Unilateral Abducens Nerve Palsy in a patient with Scrub Typhus - A Clinical Diagnostic Dilemma

Scrub typhus is an acute febrile rickettsial disease caused by Orientia tsutsugamushi. It infects endothelial cells and causes vasculitis, the predominant clinico-pathological feature of the disease. This results in disseminated inflammatory perivascular lesions leading to damage to the blood vessels affecting multiple end organs. Abducens nerve palsy is a known but extremely rare and reversible complication of scrub typhus. We present a case of scrub typhus with sixth cranial nerve involvement which responded to treatment with doxycycline.

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.

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.

Storage Behavior and Cryopreservation of Citrus cavaleriei, an Endangered, Cold-resistant Species of Northeast India with Exceptionally Large Seeds

BACKGROUND

Ichang Papeda (Citrus cavaleriei H.Lév. ex Cavalerie) is a wild and endangered species of NE India that requires urgent preservation of its genetic resources.

OBJECTIVE

To characterize the storage physiology of the seeds and to cryopreserve the embryo and embryonic axis (EA).

MATERIALS AND METHODS

The morphology and storage physiology of the seeds were determined, and the cryopreservation of embryos and EA attempted using various techniques (viz., air desiccation-freezing, vitrification and encapsulation-dehydration).

RESULTS

Weighing up to 4 g, seeds of Citrus cavaleriei are the largest known in the genus. Based on estimates using the seed coat ratio - seed mass (SCR-SM) model there was a very high probability of seed desiccation intolerance, which was validated physiologically; seeds lost vigour on drying below 30% moisture content (MC) and no seeds germinating after drying to <12% MC. Embryos and EAs could be air dried to 25-30% MC and cryopreserved with c. 50% survival. In contrast, EA optimally exposed to PVS2 (20 min) or encapsulated, sucrose pretreated (0.5 M, 24 h) and dehydrated (6 h) had c. 40% survival after cryopreservation.

CONCLUSION

Citrus cavaleriei produces large, recalcitrant seeds that can, nevertheless, be cryopreserved as embryos or isolated EA after air drying to c. 25-30% MC; encapsulation-dehydration and vitrification provide alternative options for the cryopreservation of EA.

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.

Potential use of hydroxychloroquine, ivermectin and azithromycin drugs in fighting COVID-19: trends, scope and relevance

Alarming situation has been caused due to the emergence of COVID-19 infection around the world. There is an urgency of developing a therapeutic strategy in order to control the spread of COVID-19. Towards that initiative, potential drugs like hydroxychloroquine, ivermectin and azithromycin have been tested by diverse group of researchers worldwide for their potential against novel coronavirus. The present report presents together the comprehensive knowledge derived from the major researches about the above drugs altogether in context of the current health emergency around the world. Hydroxychloroquine and ivermectin were known to act by creating the acidic environment and inhibiting the importin (IMPα/β1) mediated viral import. Azithromycin was found to act similar to the hydroxychloroquine as an acidotropic lipophilic weak base. All the three categories of drugs seemed to potentially act against novel coronavirus infection. However, their efficacies need to be studied in detail individually and in combination in-vivo in order to combat COVID-19 infection.

Attitude towards oral hygiene among different socio-economic groups in Jaipur city, Rajasthan

Background

Socio-economic status is a total measure of a person’s work experience and of an individual or family economic and social position in relation to others, based on income, education and occupation.

Objective

The study was conducted to determine the differences in attitudes of people from different socioeconomic statuses towards their oral hygiene.

Method

A cross sectional study was conducted among subjects of various socioeconomic groups. Socioeconomic status and oral hygiene data was collected using Aggarwal scale having 22 items questionnaire addressing various aspects of knowledge and attitude of subjects towards oral health, and simplified Oral Hygiene Index (OHI- S), respectively. Statistical analysis was done using chi- square test and frequency distribution (P< 0.05 taken as significant).

Results

Among 500 subjects, 260 (52%) were found to have good oral hygiene, and most of them (43.46%) were from lower middle class group. A highly significant association was found between the oral hygiene and socioeconomic status (p=0.000).

Conclusion

It could be concluded that the socioeconomic status is not the only factor that determines a person’s attitude towards oral hygiene, but other factors such as lack of awareness, lack of availability of dentist nearby, fear and anxiety also play an important role.

Chest pain and exercise induced left bundle branch block – A clinical dilemma

Exercise-induced left bundle branch block is a rare electrocardiographic phenomenon. We present two patients with angina pectoris who developed left bundle branch block on ECG during treadmill test. The first patient had non-obstructive coronary arteries with slow flow and is a rarely reported entity. The second patient had typical chest pain with single vessel Coronary Artery Disease. Left bundle branch block occurred in stage I of Treadmill Testing and persisted for approximately 4 hours and then reverted spontaneously. These two interesting cases of this rare phenomenon are presented here with review of relevant literature.

Quality of life of cancer patients

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