Background Dermatopolymyositis (DPM) is an autoimmune disease that primarily affects the skin and muscles, but it can also involve internal organs, including the heart. Cardiac involvement in DPM is of particular concern, as it may lead to complications such as myocarditis, arrhythmias, and ultimately heart failure (HF). While DPM is traditionally associated with muscle weakness and skin rashes, its impact on inpatient outcomes for patients admitted with heart failure has been insufficiently studied. The presence of dermatopolymyositis in HF patients may exacerbate clinical outcomes, potentially increasing length of stay, mortality, and hospital charges. This study aims to evaluate the in-hospital outcomes of patients with heart failure who also have DPM, with a specific focus on mortality rates and other key clinical outcomes. Methods This retrospective cohort study analyzed data from the U.S. National Inpatient Sample Database (2018-2022) to identify patients hospitalized with heart failure using ICD-10 codes. The cohort was divided into two groups: those with and without a diagnosis of dermatopolymyositis (DPM). In-hospital outcomes, including mortality, cardiac arrest, use of pressors, cardiogenic shock, total charges (TOTCHG), and length of stay (LOS), were analyzed using a multivariate regression model adjusted for demographic and comorbidity variables. Results Among 6,074,232 patients hospitalized for heart failure, 0.045% (N=2,750) had dermatopolymyositis (DPM). DPM patients are younger (mean age 65.77 years vs. 70.86 years, p < 0.000) and have a higher proportion of females (67.09% vs. 52.96%) and Black patients (35.54% vs. 21.72%). They also exhibit more severe comorbidities (Charlson comorbidity index, p = 0.000). Concomitant DPM in hospitalized HF patients significantly increases mortality risk (OR = 2.13, 95% CI: 1.46-3.11, p = 0.000). Each one-year increase in age raises mortality risk by 2.63% (OR = 1.03, p = 0.000). Females have lower mortality odds (OR = 0.88, p = 0.000), while Black patients have slightly lower odds (OR = 0.92, p = 0.000). The Charlson comorbidity index increases mortality risk (OR = 1.11, p = 0.000). Diabetes (OR = 0.69, p = 0.000), smoking (OR = 0.61, p = 0.000), obesity (OR = 0.72, p = 0.000), CKD (OR = 0.82, p = 0.000), and ESRD (OR = 1.80, p = 0.000) also affect mortality, with AKI strongly increasing risk (OR = 3.37, p = 0.000). Concomitant DPM in hospitalized HF patients imparts a longer length of stay (LOS) (6.72 days vs. 5.64 days, p = 0.043) and higher total charges ($83,794 vs. $63,521, p = 0.051).Concomitant DPM in hospitalized HF patients increases the odds of cardiac arrest (OR = 2.06, p = 0.030), cardiogenic shock (OR = 2.06, p = 0.030), and using pressors (OR = 2.28, p = 0.002). Conclusion In conclusion, patients with dermatomyositis (DPM) hospitalized for heart failure are generally younger, have a higher proportion of females and Black individuals, and exhibit more severe comorbidities compared to those without DPM. Concomitant DPM in hospitalized HF patients significantly increases the risk of mortality, with age, gender, race, and comorbidity burden further influencing mortality outcomes.
Introduction: In rural India, one-third of women have not heard about breast cancer. This lack of awareness often leads to late diagnosis of the disease. Providing health education to Self -help Group (SHG) women could increase awareness within the community, thereby facilitating early diagnosis of the disease. Aim: To measure the effectiveness of health education on knowledge about breast carcinoma among SHG women of reproductive age in a rural area of North Chennai. Materials and Methods: This community-based interventional study was conducted among 80 SHG women, aged between 20 to 50 years, in a randomly selected village of Ponneri Taluk, Minjur Block, Tiruvallur District, Tamil Nadu, over a period of 12 months from December 2018 to December 2019. After collecting baseline data using a validated semi-structured questionnaire, all participants received education on breast cancer and breast self-examination through a structured teaching program conducted at an anganwadi centre. A post-intervention assessment was conducted after three months. Data were analysed using International Business Machine (IBM) Statistical Packages for the Social Sciences (SPSS) statistics version 21.0. Descriptive statistics summarised demographic characteristics and baseline knowledge scores. To assess the effectiveness of the structured teaching program, McNemar’s chi-square test was applied to evaluate changes in dichotomous knowledge responses before and after the intervention. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of participants was 36.68±9.96 years {mean±Standard Deviation (SD)}. Post-intervention, awareness that breast cancer is the most common cancer among women Increased from 28.8% to 56.3%. Recognition of the 35-50 age group as the most common for breast cancer occurrence rose from 28.8% to 52.8%. Understanding of the hereditary nature of breast cancer improved from 17.5% to 66.3% and awareness that breast cancer can be detected early increased from 10% to 65%. Knowledge of risk factors and signs of breast cancer improved significantly, with overall knowledge increasing by 1.3% to 63.7% for risk factors and from 0% to 83.7% for signs of breast carcinoma. These changes were statistically significant (p<0.05). Conclusion: The results of the present study suggest that there was poor awareness about breast cancer, its risk factors, signs, and symptoms among rural women, which could be improved through health education. However, to ensure this improvement, it is essential for women to undergo regular breast cancer screening.
Otitis due to mucorales is very rare. Saksenaea causing mucormycosis is even more uncommon. Till date, there have been only two reports of otitis due to S. vasiformis globally. Herein, we report a case of necrotizing otitis externa in a 75-year-old diabetic woman complicated with facial nerve palsy due to a non sporulating mucorales which was identified as S. vasiformis using D1D2 sequencing. Despite initiation of antifungal therapy, her clinical condition deteriorated, likely reflecting delayed diagnosis and partially optimized treatment. To the best of knowledge this is the first case of necrotizing otitis externa due to S. vasiformis from India.
Granulomatosis with polyangiitis (GPA) is a necrotizing small-vessel vasculitis characterized by granulomatous inflammation and antineutrophil cytoplasmic antibody (ANCA) positivity. Sinonasal involvement is common, but cerebrospinal fluid (CSF) rhinorrhea is exceedingly rare. We present a rare case of a 44-year-old woman with established GPA who developed CSF rhinorrhea secondary to erosion of the cribriform plate. Her initial disease manifestations included episcleritis, septal perforation, atrophic turbinates, and saddle-nose deformity, with high PR3-ANCA titers and biopsy-proven small-vessel vasculitis. After achieving remission on corticosteroids and methotrexate, she presented four years later with watery nasal discharge that was triggered by bending forward. CT cisternography confirmed a CSF leak originating from a defect in the right anterior cribriform plate. She underwent successful endoscopic surgical repair using tensor fascia lata grafting, followed by immunosuppressive therapy and clinical improvement. This report highlights the potential for localized erosive disease in GPA despite apparent systemic remission and underscores the importance of timely recognition and multidisciplinary management.
Aim:Hepatitis C Virus (HCV) infection promotes insulin resistance, and metabolic dysfunction-associated fatty liver disease (MAFLD). HCV per se leads to impairment in host lipid metabolism and causes a deranged lipid profile. This study aims to analyze the prevalence of MAFLD and determine the levels of lipid profile parameters, surrogate markers of insulin resistance, liver fibrosis, and steatosis in patients with HCV infection. Methods:This study used data from the Centers for Disease Control - National Health and Nutritional Examination Survey (CDC-NHANES) 2017-2020. Those who tested positive on HCV RNA PCR were included in HCV group (n=89). Propensity score-based age- and gender-matching was done among those tested negative for HCV to select controls (n=89). Homeostatic Model Assessment of Insulin Resistance (HOMAIR), Homeostatic Model Assessment of Beta-cell Function (HOMAB), and the lipid-based insulin resistance markers such as Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Triglyceride-Glucose Index (TyG) were calculated using the standard formulae. Results:Serum triglycerides, total cholesterol and low-density lipoprotein cholesterol were significantly lower in HCV. HOMAIR, HOMAB were similar, and the lipid-based insulin resistance markers such as VAI, LAP and TyG index were significantly lower in HCV. FibroScan showed less steatosis, but increased fibrosis in the HCV patients. The surrogate markers of insulin resistance showed a significant association with the presence of MAFLD. Conclusion:HCV patients showed hypocholesterolemia, hypotriglyceridemia and the levels of lipid-based insulin resistance markers were significantly lower. TyG index showed a strong positive association with the presence of MAFLD. These observations could be due to association between HCV replication and host lipid metabolism.
