Background:Preoperative anxiety in paediatric patients triggers a neuroendocrine stress response, elevating catecholamines and cortisol, potentially affecting cardiovascular stability. Midazolam is a standard premedication but may cause paradoxical agitation and respiratory depression. Intranasal dexmedetomidine offers anxiolysis with stable hemodynamic.Objective:To compare intranasal dexmedetomidine and oral midazolam for preoperative anxiolysis in children, focusing on cardiovascular parameters, sedation, and postoperative analgesia. Methods: In this prospective, randomized, double-blind study, 60 ASA I–II children (5–12 years) scheduled for elective surgery were allocated to: Group I (oral midazolam 0.5 mg/kg + intranasal saline) or Group II (intranasal dexmedetomidine 0.8 µg/kg + oral placebo). Heart rate (HR), systolic blood pressure (SBP), SpO₂, anxiety (mYPAS), sedation (Ramsay scale), and postoperative analgesic requirement were recorded.Results: Baseline demographics and HR/SBP were comparable. Significant reductions in HR and SBP were observed in Group II at 40 min, 60 min, and postoperatively (p < 0.05). SpO₂ remained >95% in all patients. mYPAS scores were lower in Group II at the same time points (p < 0.05). Sedation scores were comparable between groups. Postoperative fentanyl requirement was lower in Group II (p < 0.05). No significant adverse events occurred.Conclusion:Intranasal dexmedetomidine provides superior anxiolysis and cardiovascular stability compared to oral midazolam, without compromising sedation or safety, making it a suitable alternative for paediatric premedication with potential benefits in cardiovascular outcomes
Background: Free radicals are involved in many physiological functions of chondrocytes, such as intracellular signaling, apoptosis, cytokine production and extracellular matrix remodeling. However, increased oxidative stress due to the imbalance of antioxidants and oxidants can be harmful to the chondrocytes. Aims: To evaluate the efficacy of Vitamin E, an antioxidant, as a therapeutic agent in reducing pain severity and improving clinical outcomes in patients experiencing pain. Materials & Methods: The present study was Randomized Controlled Trial study. This Study was conducted from Jan 2024 to Dec 2024 for one year at Department of Orthopaedics of Calcutta National Medical College and Hospital. Total 100 chronic pain patients were included in this study. Result: Post-intervention clinical scores were significantly higher in Group B (Vitamin E) (33.52 ± 16.96) compared to Group A (Placebo) (25.31 ± 14.33), with a p-value of <0.01.Post-intervention functional scores were significantly higher in Group B (Vitamin E) (51.61 ± 19.60) compared to Group A (Placebo) (41.43 ± 16.11), with a p-value of 0.02. Conclusion: This study highlights the potential therapeutic role of Vitamin E, a powerful antioxidant, in managing chronic pain. Supplementation with Vitamin E significantly reduced pain severity, decreased the number of painful days and analgesic use, and improved clinical and functional outcomes.
Background: Tobacco use is one of the important preventable causes of death and a leading public health problem all over the world. Globally, it kills nearly 7 million people. If current trends continue, by 2030 tobacco use is estimated to kill more than 8 million people worldwide each year. The present study was carried out to determine prevalence and pattern of tobacco usage among urban slum dwellers of Burla NAC. Materials and Methods: A community based cross-sectional study was conducted in urban slums of Burla, NAC under the field practice area i.e. Urban Health & Training Centre of VIMSAR, Burla. 350 participants were selected by simple random sampling among adults aged 18 years and above. Results: 48.2% were using some or other forms of tobacco. Among users,62.4% were consuming smokeless form while 12.9% were consuming smoking form & 24.7% were using both forms. Most of the tobacco users were in the age group of 38-47 years. Males outnumbered females in all the three forms of tobacco use. Prevalence of current tobacco users is 41% of which 18% are daily users. The commonest cause for starting tobacco was to pass time (21%) and peer pressure (19.8%). Cigarettes (7.4%) and Bidis (8.3%) were common smoking forms of tobacco. Most common smokeless form of tobacco consumed were Gutkha (14.86%) and Khaini (11.7%). Conclusions: We observed a high prevalence of tobacco usage as compared to national average. A focussed and effective health education strategy is needed according their age, gender and education status to increase the knowledge and awareness about harmful effects of tobacco and its products in urban slums of Burla.
Background: Sepsis represents a significant public health concern, occurring when the body's response to an infection damages its own organs and tissues. Without early recognition and timely treatment, sepsis can progress rapidly to shock and potentially death. Physiological and immunological changes during pregnancy, labor and post-partum increase the susceptibility to infections as well as may mask signs of infection and sepsis, leading to delays in diagnosis and treatment. Material and Methods: This prospective observational study was conducted in the department of obstetrics and gynecology at Baba Raghav Das Medical College , Gorakhpur, Uttar Pradesh from 1/05/2023 to 30/04/2024. 164 patients admitted with diagnosis of obstetric sepsis and who met the inclusion criteria were included in the study. A semi-structured proforma with patient’s particulars, clinical profile and relevant investigations was used . q-SOFA and omq-SOFA scores were calculated on the day of admission and subsequently on multiple days for each patient. Results In our study, the most common microbial agent identified was Escherichia coli in 34(42.5%) participants followed by Group B Streptococcus in 18 (22.5%) participants and others. Assessment (q-SOFA) and obstetric-modified quick SOFA (omq-SOFA) with maternal mortality among the study participants (N = 164). For the q-SOFA score, 21.4% (n = 9/42) of participants with a score of 0 experienced maternal mortality, while this increased significantly to 70.0% (n = 21/30) for those with a score of 1, 73.0% (n = 54/74) for a score of 2, and 77.7% (n = 14/18) for a score of 3. Similarly, the omq-SOFA score showed that 21.4% (n = 10/46) of participants with a score of 0 experienced maternal mortality, which rose to 44.2% (n = 19/43) for a score of 1, 81.6% (n = 53/65) for a score of 2, and 100% (n = 10/10) for a score of 3. Conclusion: Our study concludes omq-SOFA score is better than q-SOFA score with superior predictive accuracy of both adverse maternal outcome and mortality in patients with obstetric sepsis and should be incorporated into clinical practice for early risk stratification and timely management leading to improved patient outcomes.
Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) was introduced to improve healthcare accessibility by providing financial support for various medical interventions, including cardiovascular procedures. This study evaluates the impact of PMJAY implementation on the volume of Cardiac interventions including coronary angioplasties, intra-cardiac device implantation and electrophysiology studies with radiofrequency ablation (EPS/RFA) in Kashmir. Methods: The current study was a retrospective observational study carried out in the Department of Cardiology, Government Medical College, Srinagar, J & K. Data regarding all interventional cardiac procedures performed over three calendar years, before and after the launch of PMJAY SEHAT scheme, was collected and analysed. Results: A comparative analysis of cardiovascular procedures before (2018–2020) and after (2021–2023) the implementation of PMJAY scheme revealed significant trends. The number of angiographies increased substantially from 1,661 in the pre-PMJAY period to 3,858 in the post-PMJAY period (p < 0.0001), while angioplasties also showed a significant rise from 1,308 to 2,103 (p < 0.0001). Pacemaker implantations increased from 490 to 913; however, this difference was not statistically significant (p = 0.215), indicating that the scheme may not have strongly influenced the adoption of pacemaker therapy. In contrast, Cardiac Resynchronization Therapy (CRT-P/CRT-D) and Automated Implantable Cardioverter Defibrillator (AICD) implantations demonstrated an exponential increase from 24 in the pre-PMJAY to 127 in the post-PMJAY period (p < 0.0001), suggesting improved access to advanced cardiac therapies. Similarly, EPS/RFA procedures showed a sharp rise from 80 in the pre-PMJAY period to 289 post-PMJAY (p < 0.0001), reflecting greater utilization of electrophysiological interventions. Conclusion: The findings indicate that PMJAY has played a crucial role in expanding access to cardiovascular treatment in Kashmir, particularly for advanced and hitherto unaffordable cardiac interventions. These results emphasize the importance of financial support programs in reducing healthcare disparities and improving outcomes for patients requiring specialized cardiac therapies. Sustained efforts are needed to further strengthen healthcare infrastructure and optimize utilization of high-cost cardiac procedures in resource-limited settings.
Background: The increasing reliance on artificial intelligence (AI) in healthcare has raised important questions regarding the accuracy and clinical applicability of AI-driven responses, particularly from language models like ChatGPT. Patients frequently turn to online resources for medical advice, but the quality of such information remains variable. This study aimed to evaluate the accuracy, reliability, and clinical relevance of ChatGPT’s responses to commonly asked health-related questions. Materials and Methods: A cross-sectional observational study was conducted between January and March 2025. A panel of 10 licensed health care professionals generated a dataset of 100 frequently asked patient queries covering general medicine, pediatrics, dermatology, mental & dental health. Responses were obtained from ChatGPT (GPT-4) and evaluated by three independent physicians for accuracy, clinical relevance, and completeness using a 5-point Likert scale. Inter-rater reliability was assessed using Cohen’s kappa. Results: Out of 100 responses, 86% were rated as clinically accurate (mean score 4.3±0.5), while 78% were deemed relevant to actual clinical practice. Completeness was rated high in 73% of cases. The inter-rater reliability among the evaluators was substantial (κ = 0.78). However, 9% of the responses were flagged as potentially misleading or lacking important clinical context. Conclusion: ChatGPT demonstrates a high level of accuracy and clinical relevance in addressing common patient queries, suggesting its potential as a supplementary tool in patient education. Nevertheless, caution must be exercised, especially in complex or context-specific conditions, where professional medical consultation remains essential.
An accumulating body of evidence has established that one of the clinical implications of vitamin D deficiency in diabetes mellitus (DM) is the contribution of cardiovascular disease (CVD) among different groups. Objectives: This study aims to investigate the correlation of Vitamin D levels with cardiovascular risk and their association in diabetic patients compared to healthy controls, along with the correlation with significant biomarkers. Materials and Methods: This cross-sectional study was conducted on 240 participants (120 diabetic patients and 120 control group). Standardized approaches were used to evaluate Serum Vitamin D concentrations, lipid profiles, glycaemic parameters, pro-oxidant biomarkers, and inflammatory biomarkers. T-tests and correlation analyses were performed to conduct statistical analyses of significant associations. Results: The diabetic group had significantly lower vitamin D status (13±5 ng/mL) compared to healthy subjects (28.2±8 ng/mL, p<0.001). Vitamin D was found to have strong inverse correlations with low-density lipoprotein (LDL) (r = -0.65, p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (r = -0.58, p < 0.001), and systolic blood pressure (r = -0.52, p < 0.001). Based on sex, it was found that the prevalence of vitamin D deficiency was 65 % among women as compared to 45 % among men (p < 0.05).
Introduction: The adverse prognosis of heart failure (HF) correlates with both N-terminal pro-B-type natriuretic peptide (NT-proBNP) and ferritin. The contribution of an underlying inflammatory process in the pathogenesis of HF is not only evidenced by increased ferritin (acute phase reactant), but also a reduced haemoglobin (Hb) due to cytokine-mediated bone marrow suppression. However, it remains unknown if there is a linear relationship between NT-pro BNP with ferritin and Hb levels. Objective: To determine an association between very elevated levels of NT-proBNP (>10,000pg/ ml) with Hb and ferritin in patients with HF. Methods: A retrospective, cross-sectional study to evaluate levels of ferritin and Hb among patients with very high NT-proBNP levels (>10,000pg/ml) treated at a district hospital serving a population of 500,000 people. Inclusion criteria: in-patient between October to December 2020, diagnosis of HF, NT-proBNP level >10,000 pg/ml, measured haemoglobin and ferritin level within 7 days of NT-proBNP measurement. Results: Forty-five patients met all of the inclusion criteria. Mean age 81 years ± 12 years. There was a positive correlation between NT- proBNP with ferritin and a negative correlation between NT-proBNP and Hb. With NT-proBNP on the x-axis and Hb on the y-axis, the trend line equated y = -0.0003x + 124.88. With NT-proBNP on the x-axis and ferritin on the y-axis, the trend line equated y = 0.0043x + 311.6. Conclusion: With rising levels of NT-proBNP, Hb levels decrease and ferritin levels increase in a linear manner, simultaneously. Larger studies are required to confirm this observation and to investigate the clinical implications of these findings.
ABSTRACTObjectives: A retrospective study to evaluate the outcome of interventional cardiac catheterization in infants weighing <2500 grams.Background: The mortality of small weight infants undergoing heart surgery remains high, so cardiac catheterization has been utilized to improve the outcome.Methods: The study included infants who underwent interventional cardiac catheterization within the first 60 days of life in New Children Cairo University Hospital, Cairo, Egypt from January 2015 to January 2018. The study group included infants < 2500 grams while the comparative group included infants ≥ 2500 grams. Adverse events were classified according to the mechanism and seriousness.Results: The study group (37 patients) had a mean weight of 2.35 ±0.13 Kg, while the comparative group (164 patients) had a mean weight of 3.54 ±0.71 Kg. The procedures included balloon atrial septostomy, pulmonary balloon valvuloplasty, ductus arteriosus stenting and radiofrequency perforation of pulmonary atresia. The study group showed less success rates as compared with the comparative group (83.8% versus 93.9%, p = 0.04), and higher incidence of overall adverse events (48.6% versus 20.1 %, p<0.001) as well as catheterization-related mortality (29.7% versus 4.9%, P<0.001). In the study group, pulmonary balloon valvuloplasty showed the highest incidence of major adverse events while ductus arteriosus stenting had the highest incidence of mortality.Conclusions: Compared to normal weight infants, interventional cardiac catheterization in small weight infants is associated with lower success and higher morbidity and mortality rates. Pulmonary balloon valvuloplasty and ductus arteriosus stenting have the highest morbidity and mortality, respectively.
Objective To examine the association of breast arterial calcification (BAC) with the ankle brachial index (ABI), a sensitive metric of peripheral arterial disease (PAD), among postmenopausal women. Background: BAC is an emerging risk marker of cardiovascular disease (CVD). Methods MINERVA (MultIethNic study of brEast aRterial calcium gradation and cardioVAscular disease) is a cohort of women aged 60 to 79 at baseline (10/24/2012 - 2/13/2015) who were free of symptomatic CVD at baseline. The analytical sample comprised 3,800 women with available ABI, BAC assessment and covariates. We performed cross-sectional logistic regression analysis. Results 203 women (5.3%) had an ABI < 0.90 indicative of PAD, 26 (0.7%) had an ABI > 1.3 and 94% (n=3,571) had an ABI within normal limits. After adjustment for age, race/ethnicity, body mass index, smoking status, diabetes, hypertension, LDL-C, HDL-C, hs-CRP, estimated-GFR, urinary albumin/creatinine ratio, serum calcium, serum vitamin D and serum PTH, BAC presence remained significantly associated with ABI < 0.90 (OR=1.37; 95% CI, 1.01-1.87; p=0.04). After further adjustment for menopausal hormone therapy, parity and history of breast feeding, the association became marginally significant (OR=1.36; 95% CI, 0.99-1.85; p=0.05). No clear pattern of association was observed for increased gradation of BAC and ABI<0.9, and no significant associations were noted between BAC presence vs. absence or BAC gradation with ABI > 1.3. Conclusions Among asymptomatic postmenopausal women, presence of BAC was associated with PAD independently of traditional risk factors. Additional prospective studies are required to establish the value of BAC for prediction of incident PAD in the general population.
Research in the emergency setting involving patients with acute clinical conditions is needed if there are to be advances in diagnosis and treatment. But research in these areas poses ethical and practical challenges. One of these is the general inability to obtain informed consent due to the patient's lack of mental capacity and insufficient time to contact legal representatives. Regulatory frameworks which allow this research to proceed with a consent 'waiver', provided patients lack mental capacity, miss important ethical subtleties. One of these is the varying nature of mental capacity among emergency medicine patients. Not only is their capacity variable and often unclear, but some patients are also likely to be able to engage with the researcher and the context to varying degrees. In this paper we describe the key elements of a novel enrolment process for emergency medicine research that refines the consent waiver and fully engages with the ethical rationale for consent and, in this context, its waiver. The process is verbal but independently documented during the 'emergent' stages of the research. It provides appropriate engagement with the patient, is context-sensitive and better addresses ethical subtleties. In line with regulation, full written consent for on-going participation in the research is obtained once the emergency is passed.
OBJECTIVEThe aim of this study is to estimate whether aortic wall thickness is increased in patients with Aortic dissection (AD) compared to low risk control group and can be used in addition to aortic diameter as a risk marker of AD.BACKGROUNDAD occurs due to pathologies that may increase thickness of the aortic wall. Transesophageal echocardiography (TEE) has the ability to visualize both the thoracic aortic wall and lumen. Aortic diameter has been used to predict aortic dissection and timing of surgery, but it is not always predictive of that risk.METHODSIn 48 patients with AD who underwent TEE were examined retrospectively and compared to 48 control patients with patent foramen ovale (PFO). We measured aortic diameter at different levels, intimal/medial thickness (IMT) and complete wall thickness (CMT). Demographic data and cardiovascular risk factors were reviewed. The data was analyzed using ANOVA and student t test.RESULTS(AD) patients were older [mean age 66 AD vs. 51 PFO], had more hypertension, diabetes, hyperlipidemia and Coronary artery disease. Both IMT and CMT in the descending aorta were increased in AD group [(1.85 vs. 1.43 mm; P=0.03 and 2.93 vs. 2.46 mm; p=0.01). As expected the diameter of ascending aorta was also greater in AD (4.61 vs. 2.92 cm; P=0.004).CONCLUSIONSCMT and IMT in the descending aorta detected by TEE is greater in patients with AD when compared to control and may add prognostic data to that of aortic diameter.
Objectives: The aim of the present study was to evaluate the cost-effectiveness of rivaroxaban versus current standard of care for the acute treatment of deep-vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism (PE) in the Belgian healthcare setting. Background: The mainstay of therapy for venous thromboembolism has been low-molecular-weight heparin (LMWH) for the initial treatment followed by oral vitamin K antagonists (VKAs) for the continued treatment during 3 to 12 months. VKAs are both effective and inexpensive, but require monitoring and carry a risk of bleeding. Rivaroxaban is the first novel oral anticoagulant that received approval for treating VTE, but there are few data on the cost-effectiveness of rivaroxaban versus LMWH/VKA. Methods: A Markov model was designed and populated with: 1) local cost estimates, 2) comparative 2 year clinical data from the EINSTEIN-DVT phase III trial comparing rivaroxaban with LMWH / VKA and 3) data from medical literature. The results are extrapolated to a total time horizon of 40 years. Results: Rivaroxaban was the dominant treatment option for patients requiring three months or six months treatment and cost-effective (€1,905 per QALY) for patients requiring twelve months of therapy. Sensitivity analyses showed these results were robust across a wide range of data input values. Conclusions: The results of the present cost-effectiveness analysis indicate that rivaroxaban provides a dominant or at least a cost-effective treatment alternative to LMWH/VKA for the treatment of DVT and prevention of recurrent DVT and PE in Belgium.
The aim of the study was to assess the impact of cardiopulmonary bypass surgery on corrected QT (QTc) and QT dispersion (QTd) intervals. The possible role of inflammation on these variables was investigated.
OBJECTIVE:Comparing outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT).BACKGROUND:PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCT have compared outcomes of the two modalities in patients with multivessel CAD.METHODS:We did a meta-analysis from six RCT in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively.RESULTS:Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR= 2.31; 95% CI: [1.80 - 2.96]; P=<0.0001), lower incidence of stroke (RR= 0.35; 95% CI: [0.19 - 0.62]; P=0.0003), and no difference in death (RR= 1.02; 95% CI: [0.77 - 1.36]; P= 0.88) or MI (RR= 1.16; 95% CI: [0.72 - 1.88]; P= 0.53). At 5 years, PCI was associated with a higher incidence of death (RR= 1.3; 95% CI: [1.10 - 1.54]; P= 0.0026) and MI (RR= 2.21; 95% CI: [1.75 - 2.79]; P=<0.0001). While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients.CONCLUSION:In patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI.
